[Congressional Record Volume 155, Number 46 (Tuesday, March 17, 2009)]
[House]
[Pages H3508-H3514]
From the Congressional Record Online through the Government Publishing Office [www.gpo.gov]




                           HEALTH CARE REFORM

  The SPEAKER pro tempore. Under the Speaker's announced policy of 
January 6, 2009, the gentleman from New Jersey (Mr. Pallone) is 
recognized for 60 minutes.
  Mr. PALLONE. Mr. Speaker, I came to the floor this evening to talk 
about a topic that's very much on the minds of my constituents and many 
Americans, and that's health care reform. I think that many of us know 
that President Obama has paid a lot of attention to this. It was a 
major focus during the campaign. And since he's become President, he's 
already addressed health care reform in some significant ways, both in 
the SCHIP, or Children's Health Care expansion legislation, that was 
passed in the House and the Senate and signed by the President about a 
month ago, as well as in the economic recovery package, which has 
several initiatives related to health care reform. I would like to talk 
a little bit about those tonight, but I'd also like to talk about where 
we go from here.
  The President had a health care summit about 2 weeks ago where he 
talked about health care reform and outlined what might be done in this 
Congress. He said he wanted to get the health care reform bill passed 
and on his desk this year if at all possible. And he's also in his 
budget outlined some ways of paying for it through cost efficiencies 
and other means. So this is an issue that's very much on the mind of 
the President and certainly on the mind of this Congress, and, also, we 
have begun to move in the committees of jurisdiction. I happen to chair 
the Health Subcommittee of the Committee on Energy and Commerce. We 
have already had 2 weeks of hearings on health care reform, and we are 
going to continue doing this for the next few weeks and then begin the 
process of drafting legislation.
  Now, I wanted to stress that this is an economic issue because some, 
not many, but some have said, well, the economy is in bad shape, 
Congress is so focused on trying to revive the economy, whether it 
involves the banks or it involves unemployment or involves the economic 
recovery package in an effort to try to stimulate the economy. Why are 
we talking about health care reform right now? Can't we delay? And the 
President and those who attended the health summit that President Obama 
held a couple of weeks ago, both Democrats and Republicans alike, as 
well as the business community and the health care providers, the 
doctors, the hospitals, but, interestingly enough, even some of the 
people who have opposed significant health care reform in the past were 
all united in saying that this is the time to do it, that we shouldn't 
wait. And the reason they say that it's important to do it now even 
with the recession is because increasingly the health care system 
gobbles up, if you will, a larger and larger part of our gross national 
product. It goes up maybe 1 or 2 percent every so many years in terms 
of the amount of our gross national product that is dedicated to health 
care. And as those costs escalate, and they escalate exponentially 
sometimes, the health care inflation, if you will, increasingly makes 
the system unsustainable and, as a result, has a direct impact on our 
economy and drags down the economy in many ways. So health care reform 
is an economic issue. It needs to be done now. And a big factor in the 
reform is how can we slow the growth, keep down the inflation, take 
some of the savings that would be generated from cost efficiencies and 
use it to provide health insurance for everyone? Because the goal, 
obviously, is to provide health insurance for every American.
  Now, in the context of this, the other important aspect that I think 
came out of the President's health care summit and that he continues to 
stress is the fact that we want to make these changes in the context of 
the existing system. We're not looking for radical changes in the way 
that we deliver health care or the way that people are covered by 
health insurance. We're not looking towards, for example, the Canadian 
model or the Western European models where they have a single payer 
system or perhaps where the government even runs a significant part of 
the system. What we want to do is build on what we have, and that 
really encompasses three areas, three general areas.
  One is the existing public health programs like Medicare, Medicaid, 
SCHIP for children, and there are many others like the Indian health 
care system or the system for the military. We want to make those 
betterment. We want to make those more efficient. We want to make sure 
that they have adequate coverage and that they don't result in too much 
money having been spent out of pocket by the average American. So 
that's the first part of this reform. What can be done to improve those 
existing government programs like Medicare?
  The second aspect of this is what can we do to improve employer-
sponsored health insurance? Most Americans still get their health 
insurance through their employer. The number has actually decreased 
significantly in the last 10 or 20 years as a percentage of Americans 
who get their health insurance through their employer, but it's still 
pretty big. It's still certainly a majority of the people who do 
receive health insurance through their employer. Well, the second part 
of our health care reform is to make sure that that system is shored 
up, in other words, so that employers continue to provide coverage for 
their employees, perhaps even get more employers to do that by giving 
them some kind of a tax break or a subsidy or looking at other ways of 
encouraging them to cover their employees.

[[Page H3509]]

  And then the third aspect of this reform, if you lack at it in sort 
of a general overview, is to deal with those people that can't get 
insurance either through an existing government program like Medicare 
because they're not old enough or they're not kids or they are not poor 
enough for Medicaid; they can't get insurance through their employer 
because the employer doesn't provide it at all or because it's too 
prohibitive in terms of how much they have to contribute; so they try 
to get health insurance through the individual market, just going out 
on their own and finding an insurance plan individually through an 
insurance policy that might cover them, but when they do that, the cost 
is so overwhelming, they simply can't afford it. So for those 
individuals, what we have talked about, and, again, this is in 
discussion and we'd like to get bipartisan support; so I'm just talking 
about it in general terms, is that we have the government basically 
work with private health insurance companies to either negotiate a 
group policy in terms of lower premiums and having a standard policy 
that provides good coverage and then the government gives those options 
to individuals who haven't been able to get health insurance through 
the individual market.

                              {time}  2115

  So they now become part of a larger group plan that has some 
government regulation to bring costs down and significantly brings cost 
down, because now you are part of a group policy rather than going out 
in the individual marketplace.
  We do that now with Federal employees. Some States, like 
Massachusetts, have actually implemented this type of system, they call 
it a health marketplace because you can basically go to the State and 
buy your insurance through the State government through these private 
insurance companies.
  That's the broad outline of the kind of reform that we are looking 
at, but there are so many other aspects of it, many of which I would 
like to discuss further tonight, but I see that I am joined by the 
gentleman from Arkansas (Mr. Snyder) who also happens to be a 
physician.
  And if I could say, I didn't tell him I was going to say this, but I 
will say it that an important part of this health care reform is how to 
address the concerns of providers, health care professionals. Whether 
they are physicians, whether they are nurses, whether they are home 
health care aids, one of the biggest concerns we have right now is that 
we face a crisis with health care professionals.
  For example, with doctors, we are having a hard time getting doctors 
to go into primary care. A lot of times my constituents will complain 
that even if they have good health insurance they can't find a primary 
care doctor, they even go to an emergency room sometimes because they 
can't find one. We know we have a nursing shortage.
  So an important part of this, as the gentleman knows, is health care 
professionals. I don't know if that's what you want to discuss, but I 
couldn't help it, because I know that you are a physician.
  I yield to the gentleman from Arkansas.
  Mr. SNYDER. Thank you, Mr. Pallone. Here we are in Washington DC, the 
Nation's Capital and there is a good number of people tonight 
celebrating St. Patrick's Day. And for us, for you and I, it has come 
down to wearing green ties on the floor of the House tonight talking 
about health care.
  But I was in my office, and I heard you talking, and I appreciate all 
the work you have done through so many years now talking about this 
issue.
  I just want to share two or three stories, if I might, and they are 
somewhat personal stories. As you know, 3 months ago my wife had three 
babies, three baby boys, Wyatt, Sullivan and Aubrey, in addition to our 
2-year-old boy, Penn Snyder.
  Then shortly after the delivery, about a week later, my wife ended up 
in the coronary care unit and had an extended hospitalization of about 
11 days. So I remember going back home one day, running back from the 
hospital and talking to one of my neighbors. She said, ``How is 
everything going?'' And I said, ``Well, two-thirds of our family of six 
is in the intensive care unit,'' because I had three babies in the 
neonatal care unit and my wife in the coronary care unit. I thought, 
okay, that's quite a burden for a family.
  But my wife has insurance, she is a Methodist minister, she has good 
insurance through where she has worked. You and I are Federal 
employees, and we have insurance. We pay for our insurance like all 
Federal employees do. We have good insurance.
  And one of the things I did not worry about during that period was 
who was going to pay the horrendous cost of the incredibly good care 
that we can get in this country. So all evening my wife has been 
sending me pictures of our four boys out on the lawn wearing green 
outfits with shamrocks on them, I guess just to brag about how nice the 
weather is in Arkansas this evening. But it brought home, here we are 3 
months out and everybody is doing great and she is doing well.

  Last week, I met with a young women that I think if anyone in 
Congress would meet with, we would say she is just a gifted young 
woman, a medical student in her mid-20s, in her final year of medical 
school making decisions about where she is going to do her residency. 
We got to talking about some of the issues of medical students like 
they have got too much debt.
  We are expecting them to pay for all this in medical school on their 
own. They are ending up with tremendous six-figure debt coming out of 
medical school. They don't get paid a lot as residents.
  But in the course of the discussion it came out that while she was a 
medical student she was diagnosed with insulin-dependent diabetes and, 
of course, she is in a medical school. She knows where good resources 
are. She is at the best resource in Arkansas, except the health 
insurance that she has, by being a student, doesn't cover the cost of 
an insulin pump.
  So she doesn't have it, and five shots a day doesn't give her the 
kind of control that we know helps prevent long-term problems. So here 
is this wonderful young woman, gifted young woman. She is our future, 
she is going to be taking care of you and I. And yet we, as a country, 
are not taking good care of her, even though she is in one of the 
medical centers of the world.
  So I contrasted what happened with my family and me, and we do have 
health insurance, with what happens with a person who has health 
insurance, but it's just not the kind of coverage that they need. So I 
applaud you tonight for talking about this topic. I hope that we will 
make the kind of progress that you have been yearning for probably a 
couple of decades.
  In the olden days, I was a family doctor before coming to this job 
here, and I always remind myself, people always come to me and say, oh, 
you are a doctor, you understand all this about health policy. I said, 
no, I used to do sprained ankles, nosebleeds and urinary tract 
infections. Health policy is that kind of mysterious nebulous world 
that many, many people don't understand. We are health care providers, 
we are patients, we are family, we are business people who try to go 
provide for our employees.
  But we have this opportunity right now for all of us, whether we are 
providers or patients or business people or legislators or business 
people, to get up to speed on these topics. Because I think there is a 
real opportunity, with the mood of the country, with the international 
challenges we face from our economic competitors, that don't have the 
same kind of health care plan that we do and with the commitment of 
President Obama and his administration to do something.
  I also think this really needs to be worked through with all 
components of our country. We talk about being across the aisle. Across 
the aisle is fine, but we need the business community and the providers 
and the hospitals and the insurance companies and patients and 
providers and all the advocacy groups and the research advocates to 
come together as best we can.
  This is not going to be a 435-0 vote on whatever we do, but as best 
we can to listen to each other and move ahead. I think you gave an 
excellent outline on the kinds of issues that we need to be talking 
about.
  But I believe that it is a very doable challenge that we have. I 
commend you for talking about this this evening.
  Mr. PALLONE. I appreciate you coming down and talking about this, but

[[Page H3510]]

you made very good points that I just wanted to follow up on briefly.
  First of all, I always stress that this is an economic issue, and 
that's why it's important to do it now. And it does relate to our 
recovery, if you will, from the recession, and coming back with a 
strengthened economy.
  You mentioned that, because you said that, you know, it has to do 
with our ability to compete with other countries. You know, you 
remember at one time, I don't know if it was a year or two ago when 
some of auto companies--they were in better shape then than they are 
now--but all three, Ford, GM and Chrysler came down here a couple of 
years ago and said that we need health care reform, because the bottom 
line is it's hard for us to compete with foreign car manufacturers when 
we have most of the burden, or all of the burden, of health care costs 
on us, whereas that's not true if a car is made in Canada or if it's 
made in France or Italy or some other country where the government, you 
know, takes on the full responsibility--not that we are suggesting that 
here--but takes on the full responsibilities of those costs. I remember 
something like $2,000 of every car that was produced in the country was 
reflected somehow in paying health care costs. So it is an economic 
issue.
  The other thing that you pointed out is that even if you have health 
insurance, even if you have good health insurance, you are a big part 
of this debate. As the cost of health insurance continues to escalate, 
and health care costs in general continue to escalate way above 
inflation for everything else, it just becomes unaffordable ultimately 
for almost everyone. What they end up having is if they have a policy, 
there is a cutback in what's covered, or they have a higher copay, or 
the premium goes up, so that overall they are impacted.
  I could just use a couple of stories, if I could, because I tend to 
be a little wonky sometimes and not tell the stories, but I will give 
you two stories. One is one of my employees who works for me back in 
New Jersey in my congressional office. He is part of the Federal 
employee program just like you and I.
  He, on two occasions, could not find a primary doctor, a primary care 
physician, and ended up going to the emergency room for matters that 
were not of emergency room nature like a strep throat or something like 
that, which could have been handled by a visit to just a general 
practitioner.
  Well, if someone who essentially has, you know, Blue Cross Blue 
Shield, Cadillac plan in this case, can't see a general practitioner, 
who can? I mean, you wonder.
  Then the other example, I remember going a couple of years ago to a 
union organizing effort--well, actually, it wasn't a union organizing 
effort, the employees were members of the union, the service employees, 
I think, at a nursing home in my district. But they didn't have any 
health care coverage. In other words, the employer didn't provide that 
option, or, if he did, it was so prohibitive they couldn't afford it on 
their salary. So that was the irony here of people who spend their day 
and their job taking care of the health care needs of other people, but 
don't get health insurance themselves.
  Now, I wasn't there, you know, to condemn the employer. I mean, I do 
think that he should have provided coverage. But, you know, the problem 
is for a lot of the employers now, it's just becoming so prohibitive. 
So there are so many stories like this, and I appreciate you bringing 
them up.
  Mr. SNYDER. I have seen that myself as a family practice doctor. I 
never owned a clinic, I worked at other people's clinics and met some 
wonderful people. But health care providers are business people too. 
They have got to pay their employees. Some health care programs don't 
reimburse as well as they would like.
  Some clinics are in places that they may end up giving free care or 
have a group of patients that are not able to pay so well, and so it's 
like any business. It can be a strain to find the money for health 
care. It's one of the challenges we have to have.

  You mentioned the economic issue, the one of our ability to compete 
internationally. I think that's an important one.
  I want to also mention the national security issue, and I don't think 
this one has gotten as much attention as it probably deserves. We have 
had a lot of discussions about, you know, mental health coverage for 
our young men and women that come back that we think needed their 
families. The reality is we are expecting the military health care 
plan, or military health care programs and the VA health care programs 
to solve a national problem, which is we do not have a good network of 
mental health care in any of our States, particularly rural areas. But 
it's just difficult to find the kinds of providers you want for that 
kind of care.
  I want to go before they go over. We had an issue, when we first 
started mobilizing our troops to go to Iraq and Afghanistan. When we 
were mobilizing our reserve component forces, about one-third of our 
troops were on some kind of a medical hold.
  Now, a lot of it was for dental, a lot of it could be taken care of 
reasonably quickly. But the reality was, we had a situation. These are 
men and women who have been going on their weekends once a month for 
their training.
  They go every 2 weeks in the summer and yet they are showing up on 
mobilization orders. We are finding out that they were not, under 
military standards, medically fit to be mobilized. I think for a lot of 
us that were on the Armed Services Committee, that was a bit of a wake-
up call too.
  Because one of the issues for dental, although I was in medical and 
not dental school, I actually think my teeth are part of the body and 
should not be divorced from the whole system, because we know it has 
tremendous ramifications on the overall health. Dental health is part 
of this overall picture.
  And here we have a situation where you make a pretty good argument, 
our national security efforts were slowed down and more inefficient 
because of the kind of health care plans that we have.
  Now, having good health insurance doesn't necessarily get everybody 
to the dentist, but I guarantee you, if you don't have good health 
insurance or dental insurance you are much more likely not to get 
preventive care. So that's an issue too.
  Mr. PALLONE. Well, you raised, again, two very good issues that I 
would like to briefly comment on.
  When I was talking before about the first part of this, which is to 
upgrade or make more efficient existing government programs like 
Medicare, SCHIP, Medicaid, you made me think of two aspects of that. 
One of them was with SCHIP, when we passed that bill that the President 
signed just a few weeks ago.
  Not only did it upgrade, if you will, the children's health 
initiative by expanding the coverage to maybe another 4 or 5 million 
kids that were eligible under the SCHIP program, but we just didn't 
have the money with the States to pay for them.
  But it also provided guaranteed dental coverage for the first time. 
In other words, before that bill was passed under the old SCHIP 
program, States had the option of covering dental care, but it wasn't 
required. Now it is.
  And that is very important, because I remember going around to a lot 
of community health centers that just did not have dental coverage. And 
they would tell me that the biggest problem they had was providing 
dental coverage and getting dentists and how it affected kids.
  We had the one instance with a young person in Maryland that actually 
died because his teeth weren't properly treated.

                              {time}  2130

  Mr. SNYDER. I took my little boy to the State Fair in Arkansas this 
year. Me and my littles boys. Anyway, we're walking down the Midway and 
a couple were coming the other way in the crowd there, and he was a 
paraplegic in a wheelchair. And he stopped me. A very polite young man. 
And he obviously had had some significant health issues that he was 
dealing with--had been dealing with.
  But he said, Man, is there anything you can do to help me with this. 
And he had an obvious need for dental work. But here's a man you would 
think would be in the system somehow--our system. But it just pointed 
out once again the inadequacy of the coverage in the country that can 
do the best job of solving his problem if we get him to the right 
person.

[[Page H3511]]

  I want to bring up another issue, and I think it's one that you have 
had an interest in, too, and it's the issue of medical education. I 
think it's one that we will need to pay attention to as we go through 
the very important democratic process of looking at changing our health 
care system.
  We need to be sure that we recognize at our hospitals that are 
involved in medical education that it is more inefficient and more 
expensive to teach while you're doing something. It is much quicker for 
a doctor, an experienced doctor, to come in and see the patient and get 
on to the next patient.
  We have to recognize that there are additional costs for our teaching 
institutions. We make allowances for that through some of our 
government health care programs, probably not as well as we could or 
should, but it's certainly something that we need to watch to be sure 
that our teaching institutions, whether it's for nursing or doctors, 
that we recognize that there is an extra expense and inefficiency for 
them to provide the kind of quality teaching that takes additional time 
to sit down, not with the patient, but with the student.
  Mr. PALLONE. You're absolutely right. I'm not suggesting that under 
the rubric of this reform this year that we are going to be able to 
address all these problems. But it always drives me crazy that more and 
more, and I don't know what the percentage is, but more and more of our 
health care professionals are trained overseas, either Americans that 
go overseas to medical school, or people that we bring here as 
immigrants, either nurses or doctors, because we are not graduating 
enough doctors or nurses here in the United States. I don't think that 
that trend can continue forever.
  I give you an example. In my State of New Jersey, we have a 
University of Medicine in Dentistry that basically has three divisions: 
Newark, New Brunswick, and down in south Jersey in Stratford. I think 
total they graduate--I may be off a little--maybe 700, 800 physicians 
every year in the State of New Jersey. We have what, 8 million people, 
and we are graduating in our university system only 700 or 800 
physicians per year?
  Now, sure, a lot of New Jersey physicians go elsewhere for their 
education. But how can you justify that with a population of 8 million 
people? I just find more and more that we are relying on doctors and 
nurses that are trained overseas, and maybe it's a way for us to cut 
costs because we don't have to pay for their education or training, and 
the other countries do it.
  Somehow it seems to me that that has got to be reversed. And maybe 
it's going to cost more money, but it just doesn't make sense to me.
  Mr. SNYDER. It's particularly a poignant issue for you and me, Mr. 
Pallone, as we get older, because a lot of our doctors are going to be 
retiring and we are expecting these generations coming to take care of 
this big swell of the aging population as the Baby Boomers retire. So 
it's really important.
  We are not going to get to where we want to go though in this process 
of doing health care reform and trying to find ways to save money, 
which we all want to do, if we don't recognize the cost of medical 
education.
  Mr. PALLONE. The other thing that I really want to stress, and I 
haven't tonight, and you did touch upon it also, is new ways of doing 
things. I mean one of the things that President Obama did in this 
economic recovery package is that he actually put in pots of money that 
would be used to try to change the way we do things with health care.
  So there's a pot of money for prevention programs, there's a pot of 
money for wellness programs. There are going to be pilot programs 
through grants for what we call comparative effectiveness, where you 
would actually look at certain operations or certain procedures or the 
use of certain drugs to determine whether they are even effective from 
an economic point of view. It may cost you more, but are you really 
getting anything for your money.
  In addition to that, there's a major initiative--I think it's $20 
billion--for health information technology to upgrade doctors' and 
hospital offices so that records and other things are done 
electronically.
  It's not just a question of covering everyone or reducing costs, but 
it's a question of doing things differently, because if a person can go 
to a general practitioner on a regular basis and get a checkup, then 
it's a preventive measure that prevents them being hospitalized and 
costing more money to the government or to the system later.
  I mean these really haven't been played out much in this economic 
recovery package. Most of the talk has been about infrastructure and 
transportation and all that. There are major changes envisioned in the 
way we look at health care that the President has taken the leadership 
on, and the Congress, too, since we passed this bill.
  Mr. SNYDER. I think this issue of the health information technology 
is really important. I notice that since the bill passed and the bill 
has been increasingly studied by people in the press and policymakers, 
that the health IT part, the health information technology piece of 
that bill, is starting to get a lot more attention.
  There's been articles in the papers in the last couple of days. Wal-
Mart is starting to look at doing some things.
  The challenge--I mean, I'm somebody who most of my career was working 
for doctors who had small practices. And so there have been hospitals 
that have moved in this direction, large practices have moved in the 
direction of having a modern electronic medical record.
  The problem has been that most doctors are in small offices of maybe 
one to five or six people. When the studies have been done about what 
does it take for that kind of an office to move to an electronic 
medical record, the kind that most patients will want, it takes several 
months from the time they start until it's where they want to be.
  It takes several months to get back to that same level of efficiency 
as seeing patients; the installation, learning the new ways of doing 
things, just figuring out how to do things.
  Now everyone recognizes, even the ones who don't have it, that 
ultimately it makes it more efficient, it's safer for their patient, 
safer for them because no doctors want to make mistakes, nurses don't 
want to make mistakes. There's nothing worse than having to have a 
clerk sit there and Xeroxing medical records off because you have got a 
patient that you have had for 40 years that's moving across the 
country. You can do it electronically and it just moves things.
  I think the money that is in this bill is really going to motivate 
both physicians, physicians' offices, the folks that manage their 
practices, but also those kinds of business people out there who say, 
Wait a minute. Here's a chance to move America forward, to invest in 
our health care infrastructure and, by the way, create some new jobs, 
make some money for my business, and do some good things for the 
American people in anticipation of these changes that I hope will come 
in our health care system as part of President Obama's proposals. So I 
think that is very exciting.
  I was talking to one of my Republican doctor friends who voted 
against the bill. I certainly understand his reasons for voting against 
the economic recovery bill. But I said, I want to know, what do you 
think about the health information technology piece? He said, Oh, I 
like that. He might quibble with little details of it.
  But we have liked the bill before, as doctors. The problem has been 
for the last several years is finding the money to pay for it, and the 
opportunity came along through the stimulus package. And I think this 
is a real opportunity to be a good investment in the change that our 
health care system needs. So I find that very exciting.
  I want to say a point about prevention. And I recognize that I am 
probably in the minority on this view. My own view is that we ought to 
not sell preventive measures, which I think are so important, but I 
think we ought to not sell them or oversell them as ways to save 
dramatic amounts of money.
  My own view is that prevention is a quality of life issue. If I can 
work with a patient when they're 25 years old to get them to stop 
smoking, I know, I know their quality of life is going to be better. I 
know there are diseases they are not going to get when they quit 
smoking or if they never start smoking because of good health education 
programs when they're 16, 17, and 18.
  Now, where I have a problem with this prevention-saves-money argument 
is if somebody lives to be 90, I know at

[[Page H3512]]

some point they are going to need health care. But, God bless them, 
that is a good problem to have. I would so much rather deal with the 
infirmities of a 90-year old than the emphysema and COPD and heart 
disease of a 45-year old who smoked for 25 years, since they were 20.
  So I have a little different view on that. I think you can find 
arguments on both sides. But I don't think that we should ever be 
defensive about saying, You know, some preventive things cost money. 
But the quality of life, if you can keep a family from losing a family 
member from cancer, if you can cut down the number of kids that go to 
emergency rooms because their parents smoke, or whatever it is, it's a 
quality of life issue, and that can really turn into additional years 
of life and the pursuit of happiness for that family in this great 
country.
  So I'm pleased that prevention is part of this.
  Mr. PALLONE. I appreciate what you're saying. I think that in fact 
when we had the health care summit, in maybe a little different context 
President Obama actually said, Look, we do need additional money if 
we're going to have health care reform and provide people quality 
health care and cover everyone, because a lot of that is going to have 
to be upfront.
  In other words, if you talk about new ways of doing things, whether 
it's health information technology or preventive care, whatever, a lot 
of times you do need money upfront to pay for some of it. But then in 
the long run you do actually save money.
  So I agree with you that the better quality care is ultimately more 
important. But it can over the long-term save money.
  I use the example with one of my community health centers where I 
went. An incredible part of the building was devoted to keeping the 
medical records. I can't say exactly whether it was a third of the 
building or 25 percent of the building.
  But I looked at where they stored all these handwritten or typed 
records because they didn't have them on a computer, and I said, Gee, 
if we could just get--I don't know how much it will cost so I'll pick a 
number--$100,000 dollars to put all these records into the computer, 
you'd now have all this space available that you're not really 
utilizing right now.
  So maybe upfront it's going to cost you $100,000, but in the long run 
you're saving money.
  I think you can use the primary care doctors. I use the example of my 
staff person who goes to the emergency room because he can't get a 
primary care physician. Primary care physicians say we don't have 
enough of a reimbursement rate. If you gave us a higher reimbursement 
rate under Medicare, there would be more primary care physicians.
  I don't know if that is necessarily true, but assuming it's true, it 
is going to cost you more money upfront. But, in the long run, if the 
person goes to the doctor when they have strep throat rather than going 
to the emergency room, do you save money. But it's oftentimes hard to 
actually put a dollar figure on how prevention saves you money.
  Mr. SNYDER. This will be a true confession here tonight about a 
mistake that I made practicing medicine one time. It was about 15 years 
ago, I had a young boy, I think he was about 7 or 8, kind of a quiet 
boy, brought in by his grandmother. And he was there for a cold or 
something. I dealt with his cold or ear infection.
  Then his grandmother started talking about some behavioral stuff he 
was having. We talked about it for a few minutes, and I didn't have 
much to offer.
  It was like about 2 months later I was reading an article about 
Tourette's syndrome. And I thought, That's what that little boy had.
  Well, the clinic I worked at had a wall about as big as the wall 
behind the Speaker here tonight that was all handwritten medical 
records. One of my nurses aids and I--we did it on Saturday because we 
were slow enough when we worked on Saturday, we could do this--we began 
systematically going through every one of those handwritten charts to 
see if we could find that little boy because I was going to call his 
family and say, Hey, I think I figured what you were talking about with 
this little boy. The reality is in Tourette's syndrome a lot of time 
they are underdiagnosed and, unfortunately for the family, it takes a 
while to sort it out sometimes.
  We never did find that chart even though we systematically went 
through every handwritten chart. Well, if we had had a computer system 
we would have been able to pull up the names of appointments seen in 
the last period of time or probably could have pulled it up by 
approximate birth date.
  There's so many tools that a good health information technology 
system gives you for the benefit of patients.

                              {time}  2145

  Efficiency of doctors, more prompt payment of doctors, less mistakes, 
but ultimately it is for the benefit of patients; and I think that is 
what you were talking about, looking ahead to doing things differently, 
doing things better. It is not just figuring out how to pay for the 
kind of care we are getting now, but it is better care in the future as 
part of this. And I think that is important.
  Mr. PALLONE. I appreciate your input on all this. I know you said you 
haven't practiced for a while, but there is no question that having a 
physician who has had experience in a lot of this makes a difference in 
terms of relating what we have to do.
  Mr. SNYDER. It is interesting, we have a good number of physicians in 
the House now.
  Mr. PALLONE. It wasn't true when we first started, but it is now.
  Mr. SNYDER. Physicians have figured out more and more, number one, 
that this Nation wants us to do something about health care. And I 
always tell my doctor friends, we can either do it with you, or we can 
do it to you. And most doctors have figured out they would like to have 
it done with them.
  The other thing, though, is, and I have clearly seen this change in 
the time I have been in medicine, doctors have figured out that the 
programs that help people are the programs that help doctors. So they 
are here to help make those programs better. Now, we may have 
philosophical differences about how to get there and how to pay for it, 
but we recognize that there is a role for government in trying to make 
sure that whatever that number is, 47 million, 48 million people who 
don't have health insurance over a year's time actually are able to 
participate in this system that we call American health care.
  I want to ask about another topic, Mr. Pallone, medical research. We 
had a pretty good run there for a time under the leadership of Speaker 
Gingrich and President Clinton in terms of increasing the research 
dollars available for NIH. My own view of the last administration over 
the last 8 years has been very poor with regard to research, all kinds 
of research. There are, and I am talking now specifically about medical 
research, medical research funds in a variety of different budgets, 
from the military budget, veterans budget, NIH, agriculture budget, 
Department of Agriculture, they have research. Well, this is another 
place that is part of the kind of quality care we want for all of us. 
We need to be investing in that kind of research, because the reality 
is medical jobs are good jobs.
  In fact, when you look at the numbers, as people have been losing 
jobs, the thing that stands out the most in terms of who is gaining 
right now is health care. It is kind of counter-cyclical. There are 
medical jobs out there that don't get filled that people will look at. 
Now, we need to do I think a better job of helping nursing home aides 
get paid and all. But there is a tremendous opportunity to create the 
kind of technology and new jobs and new treatments that this country 
can be selling all over the world, and we need to be the leaders in a 
lot of these things.
  I think the whole issue of stem cells has gotten a lot of attention. 
Regardless of where you come down philosophically on the issue of stem-
cell research, there is a ton of things out there that would benefit 
from more research dollars, and it has to be part of this picture, too. 
You mentioned the comparative effectiveness. That is probably too fancy 
a name. It kind of got bad-mouthed in some of the media when that bill 
came out. The reality is, why wouldn't we want to see what

[[Page H3513]]

works the best for the least amount of cost? We would do that as a 
family.
  If I go in to my doctor and he said, here is my prescription, it is 
$180. And I say, well, is there anything better? Oh, yeah, there is a 
generic. It is like $14. Why don't I take the generic for $14? I mean, 
why not go for something that would work as well, perhaps even better, 
but be dramatically less expensive? I mean, we all are responsible as a 
country for these health care plans and making sure we pay for things. 
And somehow the idea that we would actually want to pay attention to 
what things cost and what works and what doesn't work, and are we 
prescribing things that we don't really need? I mean, that is just 
common sense, and I think families want that. They don't want us to 
prescribe things that are not effective or there could be something 
cheaper that would work just as well. So I think that is part of this 
picture.
  Maybe I am making the universe bigger than it needs to as we are 
talking about health care and health care coverage, but it is all part 
of this investment in our future. And medical researchers will do 
better with a health information technology system. Those people who 
are responsible for paying the bills, who are processing claims will do 
better if that health IT system is more efficient. All this stuff 
builds on each other. Ultimately, we want to lead to better coverage 
for the best price that we can give.
  Mr. PALLONE. You make such a good opinion. And, again, we are always 
talking about the budget. So much of the discussion here is about the 
spending in the economic recovery package or the spending in the 
budget. The fact of the matter is that the economic recovery package 
had a significant amount of money for medical research at NIH and at 
other institutions, and the President's budget also significantly 
increases funding for medical research. And I remember that, actually--
and I am not trying to be that partisan tonight. But some of the 
Republicans did actually criticize the economic recovery package 
because it had that medical research money in it, because they said, 
well, how is that a stimulus?
  The fact of the matter is, it is a tremendous stimulus; because when 
you give money to medical research, it is always matched either by the 
university or by private sources of funding, pharmaceuticals, whatever. 
And if you look at what it generates, it generates a lot more. For 
every one job that is generated through the public money, there are two 
or three or more that are generated through the private money, and it 
is actually a tremendous stimulus. So it makes sense to include it in 
an economic recovery package.
  The fact of the matter is that in the beginning of President Bush's 
administration, he actually did increase funding significantly for NIH 
and medical research, but then gradually lessened and lessened it to 
the point where it was an actual cut. And I got particularly annoyed. I 
probably shouldn't even mention it, but I am going to, because I heard 
on one of the talk shows that they were picking out pieces of the 
research in the economic recovery package and criticizing it. Like, I 
think there was money for research on venereal disease and somebody was 
saying on one of the talk shows, why are we spending money on that? 
There is an epidemic in some of these venereal diseases and they have 
become resistant to a lot of the drugs and things that have been 
traditionally used. So why not spend money on research?
  You can pick these things apart, but the bottom line is that if you 
have problems and you are trying to address the diseases, you have got 
to spend some money on research. And the few Federal dollars capture 
private and other money and actually do a lot towards not only finding 
a cure but creating jobs.

  Mr. SNYDER. We also have learned in a very difficult way for a lot of 
American families the challenges of what happens to our men and women 
in uniform overseas with the traumatic brain injury and some of the 
kinds of injuries that have occurred. And what happens in every war is, 
sadly, we have opportunities to learn new things and get better at 
treating these. And there are some real opportunities of helping these 
families in terms of looking at traumatic brain injury and how we 
respond to them.
  Looking over the long run, we are just a few years into this thing, 
what impact will this have on their lives 10 years and 20 years and 30 
years and 40 years from now? And what opportunities will there be for 
them 10 and 20 and 30 and 40 years from now depending on what we do in 
terms of investing in research? And we have had these discussions 
before, both in the Armed Services Committee and the Veterans Services 
Committee. There are research projects out there that can be funded if 
we have adequate funding for them. And that is not part of civilian 
health care for them; that is part of our responsibility as a 
government to be sure that we adequately fund medical research. And a 
lot of it is going to be done in our civilian facilities, also, whether 
it is medical schools or veterans hospitals. The research needs to go 
on, and it needs to be well funded.
  Mr. PALLONE. I wanted to mention one last thing, if I could, because 
I don't know how much time we have left.
  But when you were talking about doctors, when we had the health care 
summit with the President a couple weeks ago, there were many things 
that struck me, but one thing that struck me was there were so many 
groups there represented demanding health care reform now that 15 years 
ago, whenever it was that President Clinton and Mrs. Clinton came up 
with their health care initiative, and of course it failed. But many of 
the groups that opposed the initiative then were present at the summit 
saying we have to do something. And I don't know that the doctors were 
in that category, but all the doctor groups were represented at the 
summit and they were all saying we have got to do this, we have got to 
do this now. The trade group from the health insurance companies, which 
opposed and actually ran the ads against the Clinton plan 15 years ago 
were there saying, we are here because we want to participate and we 
need health care reform. The small business representatives, the 
National Federation of Independent Businesses were there and said the 
same thing: We were against the Clinton reform 15 years ago. We are for 
what you are saying now, because we know that something has to be done.
  Mr. SNYDER. If I might intervene for a minute. I think it is 
perfectly consistent for somebody to have been opposed to the plan in 
1993 and be for something now. There is a broad spectrum of ideas out 
there. I am hoping that, and I think President Clinton would 
acknowledge, that we have learned from that experience 15 years ago, 16 
years ago.
  So I think that is a very important point you make, because we don't 
know what the ultimate product is going to be; but, hopefully, it is 
going to be something that will be shaped so you won't have somebody 
out there doing a huge media bite trying to kill a plan when the 
country is trying to come together to make something work. And I am not 
sure if everybody will be happy, but I am hoping that almost everybody 
can live with the ultimate result, because we all come from different 
perspectives.
  Mr. PALLONE. I think the other difference is that we are trying to 
make this bipartisan. We are trying to have it come from the House and 
the Senate. In other words, we are not actually getting something from 
the Obama administration and saying, this is what we want you to do, 
this is what we want you to pay us. We will give you some principles, 
but we want this thrashed out in the House, in the Senate, with 
Democrats and with Republicans, going through the committees and all 
that.
  And I did want to mention, because I am not sure if I did, that we 
are really determined to do this this year. I mean, the timetable 
essentially would be that sometime between now and the August recess 
that we would actually pass bills that would come to the floor of the 
House and come to the floor of the Senate, and then in September, 
October, in the fall we would try to work out the differences between 
the House and the Senate and send something to the President by the end 
of the year. I know it sounds ambitious, but I am optimistic.
  I really think, when I talk to Members, we had a hearing today and 
our ranking member, the Republican, Mr.

[[Page H3514]]

Barton from Texas, said: I want you to know that I want this done, and 
I am going to participate in this and the Republicans are going to 
participate in this. So the atmosphere is very good in terms of trying 
to work out something that can pass.
  Mr. SNYDER. May I close out my contribution here this evening. I want 
to tell you another story. And I appreciate your talking about this 
evening.
  I began by talking about my four little boys who are age 3 months, 
three of them are 3 months and one is 2 years old, and how much we 
benefited not only from the quality of health care we had but also from 
the quality insurance plans that my wife and I had.
  Over the weekend, Senator Blanche Lincoln had an event in Little 
Rock, and Vice President Biden was there and her family was there and 
there were a lot of people there. I was looking for her grandmother-in-
law. Her grandmother-in-law, her husband's grandmother, is Mrs. Ruth 
Lincoln. Mrs. Ruth Lincoln is 111 years old. She is delightful. And I 
thought, well, surely she would be here. Well, she had fallen about a 
month ago and broke a bone I think in her pelvis. And I thought about 
that and felt badly about that, and then I thought later, well, of 
course I assumed she is going to bounce back from that, get healed up, 
and I am going to see her again. On her birthday she always does 
something special like cross the Arkansas River on a bridge. She always 
does a very special thing. And when you talk to her, she talks about 
how she loves growing old. She has loved growing old at age 111. And I 
think in a way that is what we aspire to through this health care 
reform. We want everyone to say, whether they are young with young 
children who benefit from our health care system, or people who go 
through the very frail years, that throughout they can say that I have 
loved growing old. Now, maybe we won't live to be 111, but if we all do 
this right, we will increase the chances of more people being able to 
have those kinds of long, long years.
  I applaud you once again for spending this time this evening.
  Mr. PALLONE. I think I am going to end with that, because I like that 
ending of our hour this evening.
  Mr. Speaker, I yield back the balance of my time.

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