[Congressional Record (Bound Edition), Volume 151 (2005), Part 17]
[House]
[Pages 23116-23123]
[From the U.S. Government Publishing Office, www.gpo.gov]




                        CHILDREN'S HEALTH MONTH

  The SPEAKER pro tempore (Mr. Kuhl of New York). Under the Speaker's 
announced policy of January 4, 2005, the gentleman from Pennsylvania 
(Mr. Murphy) is recognized for 60 minutes as the designee of the 
majority leader.
  Mr. MURPHY. Mr. Speaker, I am joined by my colleagues this evening to 
talk about Children's Health Month. It is very important for all 
families in our Nation, and certainly an issue that concerns all of us 
on both sides of the aisle.
  While the rhetoric of the House often echoes through these walls 
about cuts and people being harmed, it seems to me that is the only 
part of the discussion that we are taking away. Little offers are made 
in terms of what is needed.
  What we do often hear is discussions of who is paying. Should 
individuals pay, insurance companies be taxed more, businesses be given 
tax cuts, perhaps health savings accounts, association health plans, or 
just have the Federal Government take over? But this should not just be 
an issue of who is paying, for although that is important, and how much 
we are paying is important, really much of this comes down to what we 
need to have is an open discussion of what we are paying for.
  According to the National Center of Health Statistics, 83 percent of 
children in this country under 18 years of age have excellent to very 
good health. That is good news.
  Now 17 percent of America's children are in less than favorable 
health, either to mild or severe levels. We have to make sure we do all 
we can to help these children have a better health future and help the 
rest remain healthy. According to the American Academy of Pediatrics, 
6.3 million uninsured children, over two-thirds of all uninsured 
children in America, are currently eligible either for Medicaid or for 
the State health insurance programs, but they are not enrolled. There 
are many opportunities. I know the State of Pennsylvania, where I 
represent the 18th Congressional District, really has very good 
services and insurance for children of a low income level but we need 
to make sure that we expand enrollment and get those kids beyond. For 
those who are uninsured or underinsured but beyond the level of 
Medicaid, there are several things that we should be looking at to make 
sure that they get the health care they need to maintain their health 
to prevent higher expenses for emergency care.
  But what this means is not just more discussions on we are cutting 
money out of Medicaid or other aspects. Look at what has happened to 
the growth of Medicaid. In 1995, and this is for all ages, Medicaid 
spent $150 billion. We are now up to $300 billion. About half of 
Americans are covered by some level of Federal insurance or health 
care. But the system is growing, and the concern is it is growing out 
of control.
  While we are looking at such things as how do we pay for Hurricane 
Katrina's outcome in this devastated gulf region, how do we take care 
of so many needs, is it fair to just continue to say to the American 
people we are going to continue to spend more without finding ways of 
eliminating waste and fraud and abuse?
  Let me give an example. The New York Times wrote recently about an 
amount of some $4.4 billion in Medicaid fraud in that State. One 
dentist billed for over 980 procedures in one day.

[[Page 23117]]

Clearly these were patients that were actually being seen. Another 
company used van rides for supposedly disabled people, billing those 
rides to the government. But these people when followed by a reporter 
clearly were not disabled. They walked around just fine. There is 
example after example after example.
  I believe the American taxpayer wants to make sure that this waste, 
this fraud, this abuse is removed from the health care system. But it 
is not just a matter of that. When it comes to our children, we also 
have to make sure the system works with these programs in ways that 
optimize the health and outcome.
  One of the things that I want to talk about today, along with the 
gentleman from Georgia (Mr. Gingrey), is transforming our health care 
system. We oftentimes use a tongue-in-cheek quote around here that says 
one of the definitions of insanity is doing the same thing over and 
over again and expecting different results. Indeed, in the health care 
system where so much money is used inappropriately and wastefully, we 
ought to have some changes.
  From the Center of Health Transformation, they say we have this 
current health care system and we are trying to come up with some 
reforms within the network. We try things like so much money is going 
to pay for diagnoses. We ask for some procedures to be done inpatient 
and outpatient, all within that system. What happens is if this system 
does not change, it will lead to some decay. The system cannot continue 
to go the way it is. Anyone who owns a small business or a household 
cannot continue to operate the way our health care system operates. 
When we go into hospitals, inpatient/outpatient, you will see the 
latest equipment, the greatest skilled personnel, MRIs, PT scans, CT 
scans, but very often we also see that data is kept on patients on 
pieces of paper. We have 21st century health technology kept on 16th 
century monitors. What happens, people slip through the cracks. The 
wrong prescriptions are ordered. Tests that are done have to be 
repeated because someone cannot get them.
  I was talking to one of our colleagues today and he was telling me 
how a sonogram was done of his wife who is pregnant, but he cannot get 
it from here back home to his wife because he has to carry it manually. 
It cannot be e-mailed. We take e-mails for granted, but doctors have to 
wait for papers to transfer locations.
  What happens? Can we come up with some real changes to really help 
our children? Yes, if we switch to an intelligent health system that 
uses electronic prescribing, electronic medical records, real patient 
care management for our children rather than having a system that gets 
bogged down and collapses of its own expense and weight, we can come up 
with success for our children and no longer be mired in failure.
  Let me describe a little bit about what we mean by managing the whole 
patient. A lot of what people think happens when they have an 
individual or chronic disease is something common, like diabetes or 
asthma in a child, the doctor will examine and make sure that the child 
has the right medications, watches their diet and the environment 
around them, and hope all goes well. As long as the parents are 
monitoring that carefully and there is communication between doctor, 
nurse, patient and child, you can have a pretty good system. What 
happens if the information does not get to the parents, the patient 
education is not quite there? Maybe they skip a prescription, maybe 
they did not pick it up on time, maybe they do not fully understand all 
the elements of diet and medications for complicated diseases. What 
does that mean? You can end up with chronic diseases, repeat tests, 
many hospitalizations, emergency care may be required, increasing 
medications, going from doctor to doctor who may not know the other 
medications the child is on, leading to further risks, and all of this 
costs unnecessary money, unnecessary time in hospitals, increases the 
risk for harm, and what happens, we end up paying for it.
  About 10 percent of the cases that show up in an emergency room are 
someone who has no ability to pay, but it is estimated that 60 percent 
or more, 60 percent or more of patients who show up in emergency 
departments are nonemergencies. If in such cases the care was given 
ahead of time, whether it is through a community health center, a 
clinic, direct patient care with a physician, if we monitored and kept 
a careful eye on those children with chronic conditions, we could save 
massive amounts of money.
  This is not cutting care, it is improving care. Emergency care can 
cost five to eight times more than outpatient care, and we can actually 
save billions of dollars in the system. This is where we can find 
savings, and in so doing we save lives as well as money. But this means 
we use a chronic care model and not the inefficient going to a doctor, 
another disease, go to another doctor.
  What this involves is not just the health system, it really involves 
the community, the resources. What takes place, the support systems, 
the families, the individuals helping to make sure they are watching 
their children, they are educated and they know what to do. It is 
making sure we have a delivery system involved with making sure doctors 
are notified if someone does not pick up their prescriptions. A lot of 
this can be done with electronic prescribing notification. It is making 
sure that clinical information systems are there so that if X-rays are 
done, procedures and tests are done, that information is communicated 
back to the doctor.
  One study I looked at said something like 14 percent of the charts 
reviewed the physician found that they were missing some important 
data. Perhaps the physician referred the patient on to have some 
testing done, and it was never done. In the majority of these cases, 
the doctor said it would affect what diagnosis they had and future 
tests called for.
  This is not a matter of just saying we are going to cut care, this is 
improving care. But this also means that clinical information systems 
must be there. They are a critical component of health care, of having 
the physician and nurse and family work together. What does that do? It 
is a matter of having productive interaction between everybody 
involved. You have an informed, active patient and you have a prepared, 
proactive practice team.
  No longer the passive system, the doctor says here is your diagnosis, 
here is your prescription, good luck, call me if there is a problem. If 
that prescription is not filled, there is a call from the doctor. It is 
a system of interaction between the patient and doctor to make sure 
they are going back and forth.
  Mr. Speaker, I am not talking about things that take place only in 
families that have access to computers and finances to do this. A lot 
of this is done in areas of low income levels, of high risk populations 
where we really find it is much more affordable. What we need to be 
looking at here as Congress is when we are reviewing such things as the 
Medicaid system, it is not just saying we are going to lop off $8 
billion or $10 billion and see what happens. It is a matter of doing 
more effective work.
  Much like a household that says our spending is going out of control, 
they do not just say let us not spend any more. Every small business 
and family does this. They look at what they are spending, but you have 
to change some of your habits and make habits more effective.
  The system that seems to be adapting the slowest is our health care 
system, perhaps because we just keep doing the same thing over and over 
again and expecting different results.
  What the Federal Government is going to do and what we are doing here 
in the Republican Conference is asking those questions and demanding 
some answers of changing some of that system.
  What I would like to do is call upon the gentleman from Georgia (Mr. 
Gingrey), who as an obstetrician has worked with many families, 
particularly in the area of prenatal care. One of the critical areas in 
cutting costs and being more effective in health care is dealing with 
prenatal care in an effective and positive way.

[[Page 23118]]

  Mr. Speaker, I yield to the gentleman from Georgia (Mr. Gingrey) to 
talk about these aspects of prenatal care, and he can tell us about 
some of the elements of saving money by doing more effective patient 
care management.
  Mr. GINGREY. Mr. Speaker, I thank the gentleman from Pennsylvania 
(Mr. Murphy) for leading this hour during this week of Children's 
Health Care Initiative and calling attention to the health of our 
children. The gentleman from Pennsylvania (Mr. Murphy) has worked 
extensively in the field of psychology, particularly child psychology. 
He has actually written a book and has another coming out soon on the 
subject. I think as we get further into the hour, we probably will 
discuss a little about bit about how important a child's not only 
physical health but their mental health is.

                              {time}  1730

  But I do appreciate the opportunity that the gentleman has given me, 
Mr. Speaker, to share some of this time with him.
  My background in a prior life, my professional experience was for 30 
years in the practice of medicine, and the specialty that I enjoyed 
practicing was obstetrics and gynecology; and we have that opportunity 
in that field of medicine to see a child at the very beginnings of life 
and know how critically important a good start is. We talk about some 
of the things that this Republican majority has done, some of the very 
good programs since President Bush has been in office, certainly not 
the least of which is No Child Left Behind regarding our K-12 education 
program. But it is so important from the health care perspective that 
no child is left behind from the moment of conception.
  So I do want to talk a little bit about the importance of prenatal 
care and actually call my colleagues' attention to this one poster that 
I have here regarding prenatal care, entitled ``Proper Prenatal Care 
Leads to Healthy Children.'' No question about it. Some of the bullet 
points, these may be a little bit difficult to see, Mr. Speaker, but 
hopefully we can focus the camera in on the bullet points.
  First of all, 1 million, 1 million, American women deliver babies 
annually without receiving prenatal care. Secondly, in the United 
States, more than 250,000 low birth weight infants are born each year. 
More than 250,000. Now, for my colleagues' understanding, a low birth 
weight infant is one that weighs less than 2,500 grams. That is about 
5\1/2\ pounds. Those children are not all premature. In some instances 
they are unhealthy children who are near term, but low birth weight. 
But most of them, most of these 250,000 low birth weight infants are 
actually born premature as well.
  And the third bullet point, low birth weight infants are more likely 
to suffer from disabilities, things like heart defects and respiratory 
illnesses. They are four times more likely to prematurely die than 
infants with a normal birth weight.
  I have had many situations, Mr. Speaker, as an obstetrician having 
delivered over 5,000 children, where women come into the emergency room 
having had no prenatal care. And they are clearly the ones who are more 
likely to deliver these low birth weight babies and deliver them 
prematurely. That is why I think it is so important, and I know the 
gentleman from Pennsylvania (Mr. Murphy) would agree with me, that when 
we emphasize the issue, the immigration issue, of securing our borders 
and want to make sure that every immigrant that comes into this country 
comes here legally and has an opportunity to get prenatal care, as, of 
course, many of those who come in an illegal manner are afraid or do 
not now how or where to get prenatal care and will just show up in the 
emergency room having delivered an unhealthy premature low birth weight 
infant, the cost of taking care of a child in that situation in the 
very expensive setting of an intensive care nursery, a 2-month stay, 
and that would not be uncommon for a very small infant, could approach 
easily $750,000 to $1 million worth of health care. And that, Mr. 
Speaker, is really just the beginning.
  That is just the beginning of the cost, because if there is a 
disability that is long lasting or maybe even lasting a lifetime, and 
that is often the case, whether it is a heart defect or a 
musculoskeletal deformity or a mental defect as a result of lack of 
oxygen, sometimes even blindness, the cost is just astronomical. So it 
is so important, it is so important, that we do things in this Congress 
at the Federal level to encourage that women get prenatal care and that 
children are born healthy and that, indeed, no infant, not just no 
child left behind, but no infant is left behind.
  So I just wanted to go over with my colleagues some of the things in 
regard to prenatal care that are so important that I always stress to 
my patients: of course, encouraging immunizations and vitamin 
supplements, monitoring of diet, increased physical activity, clearly 
to avoid smoking and alcohol use during pregnancy and drug use. 
Certainly any drug use that is nonprescription or not under the 
jurisdiction and guidance of a physician is to be discouraged. 
Environmental factors are hugely important. As I say, a healthy diet, a 
regular weight check, physical activity, all of these things are so 
important. And then to come see the physician on a regular basis during 
the pregnancy. This is how we avoid, Mr. Speaker, these 1 million 
American women delivering babies annually either without receiving 
prenatal care or ending up with premature deliveries.
  I want to, if the gentleman would allow me, to expand on this a bit. 
It is not just being born healthy and well; but the first 5 years of 
life, what happens to the child after that is tremendously important as 
well. I have a grandson, little Grey Collins. He will be a year old 
soon. And it is so much fun to see him, and I often have that 
opportunity to see him, watching the little Baby Einstein tapes, that 
he is hugged many times a day and loved by his parents and grandparents 
and his aunts and uncles and how important it is to provide that love 
and affection to a child and let them know that they are loved, and we 
will get into that. I am sure the gentleman from Pennsylvania (Mr. 
Murphy) will talk about that later in the hour as he discusses things 
like childhood obesity and childhood mental health.
  But I wanted to speak a little bit about a program that we just 
reauthorized in the last couple of weeks here in this 109th Congress, 
and what I am talking about is the Head Start program. Sometimes we get 
criticized, we, the Republican majority, that we do not care enough 
about social programs and we do not care enough about the poor and 
underprivileged and people that do not maybe have the same opportunity 
that the upper middle class society has.
  But let me tell the Members we do care. We do care. And this 
reauthorization is proof of the pudding.
  Just a little historical perspective on that. Head Start and its 
cousin, Early Head Start or comprehensive child development programs, 
serving children from birth to age 5, as I stated, as well as pregnant 
women and their families, the critical component of the Head Start 
program is that it is child focused with the overall goal to increase 
school readiness of young children in low-income families, Mr. Speaker. 
The Head Start program has a long tradition of delivering comprehensive 
and high-quality services designed to foster healthy development in 
children that need our help the most.
  The program provides a range of individualized services in areas of 
education, early childhood development, but not stopping there. It also 
offers medical, dental, and mental health services to these children 
and to their families. It even goes a step further by providing 
nutritional counseling and encouraging parental involvement in their 
child's development. It is a rich program. I have got a lot of 
statistics, and as we continue the hour, I will relate some of those 
specifics, particularly in regard to the reauthorization and how much 
we are doing in that program.

[[Page 23119]]

  But I just wanted to point out, as I know the gentleman from 
Pennsylvania (Mr. Murphy) agrees, how important it is that we do 
everything we can to make sure that our children get a good start in 
life. And as I have stated at the outset, the prenatal care aspect is 
hugely important. Programs like the Early Head Start and Head Start 
program so that the children, all children, when they get to that 5-
year-old kindergarten class or get to the first grade, that they have 
an equal opportunity with their peers and they are not starting school 
with one hand tied behind their back. So it is hugely important that 
they are healthy, that they are happy, that they are loved and they 
have an opportunity, as we all want, in life.
  At this point I will continue to be here with the gentleman from 
Pennsylvania (Mr. Murphy) during this hour.
  Mr. MURPHY. Mr. Speaker, reclaiming my time, I thank the gentleman 
for his learned information for our colleagues to be aware of not only 
Head Start but about prenatal care.
  One program I want to mention, the National Nurse-Family Partnership, 
is a great example of success. It is a public-private nonprofit center. 
I believe it is centered in Colorado, with over 700 nurses delivering 
in-home prenatal care and early infant care to more than 13,000 low-
income families throughout the Nation. Interestingly enough, they were 
able to demonstrate they could return $4 savings for every $1 invested 
in these services by the time the children reach age 15 by reducing 
expenditures for such things as special education, emergency room 
visits. Again, when we use a more comprehensive patient care model, we 
look at the whole family and not just the individual disease, we can 
save money and provide care.
  Secondly, I also applaud my colleague for bringing up those aspects 
about Head Start and Early Head Start, so critically important for 
families who are struggling to make ends meet to have this system that 
really puts the parent at the center of the child's care, making sure 
they are involved in all the decisions, making sure they have the 
information they need to have, making sure that they are, in essence, 
put into the role of parent and not government in the role of parent; 
and that makes all the difference in the world.
  Let me shift into another area here, however, that is also critically 
important and something we dealt with today. At any point if my 
colleague has comments he wants to make, I certainly would encourage 
him to do so. But this is the area of childhood obesity. Today, we 
passed a bill out of the House that said that we cannot just be blaming 
restaurants and fast-food companies and food manufacturers when someone 
has obesity problems. Indeed, it is something we all have to work on 
and have responsibility for because whether they are healthy snacks 
that a person eats too much of or unhealthy snacks, whatever that is, 
we have to make sure that we watch our diet and have proper exercise.
  Unfortunately, what has happened in this Nation, I believe it may 
only be the State of Illinois that still requires gym class in school, 
and as such, children spend much more sedentary time at home, playing 
video games or in front of the television, less active, and eating more 
during that time. This is a major contributor to childhood obesity. And 
what has happened in the last 10 years, and look here, the proportion 
of obese children has tripled since 1970. It has doubled in the last 10 
years, tripled among teenagers actually during this time period, and 
increased incidences of disease associated with that, including such 
things as now we see adult onset diabetes showing up in our children. 
We also see heart problems showing up. We see the risks that take place 
with blood pressures that are showing up in children who really did not 
have these problems before.
  This is an estimated annual cost of obesity-related diseases in the 
United States: $100 billion. $100 billion annual cost of obesity-
related diseases. This is not something that is cured by simply having 
government come in and tell people what they can and cannot eat. 
Something has broken down in our families and our communities where we 
are no longer telling kids they have had enough to eat or they are not 
going to eat any more of that or they need to get out and play.
  The annual hospital costs for obesity-related disorders in children 
ages 6 to 17 years of age increased from $35 million to $127 million 
between 1979 and 2000. It is a lack of physical exercise; 38.6 percent 
of United States adults report they have no leisure-time physical 
activity at all. The annual estimated cost for diseases associated with 
this physical activity in 2000 was $76 million, but we know that daily 
participation in physical ed classes by high school students has 
dropped from 42 percent in 1991 to 29 percent in 1999 and continues to 
decline.

                              {time}  1745

  Even though we have data that continues to tell us physical exercise 
is critical and important, not just for a child's physical health, but 
really, as we are looking at ways of managing this, we cannot continue 
to just pump money into the Medicaid system and into our insurance 
systems to cover the costs of the outcome at the end of the line.
  We need to go upstream and work on some basic prevention, and that 
means, quite frankly, mothers and fathers across America have to work 
on these issues of teaching their children to be responsible for their 
own bodies, making sure that we, as Members of Congress, are talking 
about these issues, but making sure as we monitor how money is spent we 
are much better off looking at ways that funding could be given to 
communities, programs, to schools, to hospitals to help make sure we 
are working on prevention of obesity rather than paying the high costs 
at the end of the line for so much of the increases in health care 
because obesity has continued to climb.
  Now, with obesity often comes behavioral disorders as a matter of 
fact. Many a child I saw in my clinical practice as a psychologist 
oftentimes came in a child who was well overweight, teased by their 
peers, struggled with this on top of their other physical problems. 
They oftentimes got in this downward spiral, less activity, more 
socially isolated. Perhaps they were teased by other kids, the butt of 
jokes, a sad condition, and many of these children also suffered 
problems with mental health.
  What happens in the area of mental health is sometimes in this 
Chamber and our Nation, we look down upon it from a couple of different 
angles. We see perhaps mental health problems are some sign of 
softness, that perhaps people should be a little tougher, take it on 
the chin, not be so sensitive. Sometimes I am not sure we have advanced 
from the days of the Salem witch trials, and blame those who suffer 
from mental illness and say somehow you should have done more.
  Sometimes we ridicule those who are on medication. Jokes still abound 
on television calling people crazy, loony, out of control, retarded, in 
derogatory terms, for something that we continue to see in this Nation 
as a sign of weakness instead of a real disease.
  Again, if we are going to deal with things in the health care area, 
to truly reduce costs and deal with patients, we have to understand in 
the area of children's mental health psychological disorders are real. 
They are not made up. They are not indications where someone is weaker 
and ineffective.
  There is a very strong and consistent scientific basis to say that 
the myth of psychological disorders and psychiatric disorders has to be 
debunked. Kids do have real problems. Adolescents have more problems. 
Adults have even more problems, and all these grow when we do not deal 
with these problems at an early level.
  There are biological and environmental causes. It is interesting, you 
can have some children face tremendous difficulties in their life and 
they do not seem to show problems in mental outcomes, but that does not 
mean that those who do have problems are simply weak. Just like some of 
us may be exposed to the flu, some of us may eat different, and be 
around those who

[[Page 23120]]

smoke and never develop any symptoms at all, where others are 
susceptible to them as part of their own biological genetic makeup.
  Again, it does not mean they are weak or ineffective. It means a 
combination of the biological and environmental factors that caused 
this. You cannot simply say if we take care of these environmental 
causes it will never occur. Sometimes people say, well, maybe it is 
poverty that causes some of these difficulties with mental illness, and 
that is not the case at all. Depression, bipolar disorders, attention 
disorders, anxiety disorders occur at all lines of children. Boys 
sometimes have more than others, but there is this link between 
biological and environmental causes. Boys have more problems, for 
example, with attention disorders. Girls may have different symptoms 
with depression, but in all cases we also see there is a commonality 
between parents and grandparents having some of these diagnoses that I 
mentioned for anxiety, bipolar disorder, attention disorder, depression 
and their children. Not always children, but certainly some where you 
have significant environmental stresses and reactions which interact.
  We may see, for example, as the outcome of the hurricanes in the gulf 
coast that there will be some children who live through tremendous 
trauma, and they may have some post-traumatic stress reactions, but it 
may never reach the level of post-traumatic stress disorder. It becomes 
a longer term debilitating factor, exhibited, for example, as such 
things as depression, trouble concentrating, nightmares, et cetera. It 
may never reach that level because they may in their own biological 
factors have resilience, but their family may be there to support.
  The other things here is to understand that psychological disorders 
do respond to treatment. This may be pharmaceutical; that is, 
medication, and it certainly is also matters of counseling and therapy. 
This is not just a matter of talking to someone, giving common-sense 
ideas. This is a matter of very strategic, scientifically based things 
such as cognitive behavioral therapy to work with patients.
  We know, for example, that children with depression respond fairly 
well, pretty well, to some of the talk therapy or counseling to help 
them understand strategies to deal with problems in their life, 
recognize the symptoms and do their own intervention themselves to 
change those symptoms.
  But we also know when people move from moderate to more severe levels 
of depression, medication, it is pretty darn helpful and sometimes 
almost necessary for them to have that. It does not help when we have 
movie stars out there saying there is no such thing as mental illness, 
an irresponsible statement. It does not make things go away just 
because you wish it to be so. I do not want situations put upon our 
country where we see that, again, people from Hollywood are saying, 
well, there is no such thing as mental illness, and therefore, we do 
not treat it. That is wrong. We do know that they can respond to 
treatment, and it is important we continue to fund in areas of Medicaid 
and everywhere else, Medicare, psychological, psychiatric treatment 
because it is helpful.
  We also need to, however, carefully evaluate the treatment, the 
planning and follow-up assessment of these. I will give you a couple of 
examples.
  Last year, there was a lot of discussion about some anti-depressant 
medication, and when some children took it, there was a higher risk for 
suicidal thinking, suicidal ideations we call it. What did not come up 
in those discussions are a couple of important factors. One, 75 percent 
of psychiatric medications are prescribed by nonpsychiatrists. They may 
be highly qualified physicians. In many cases, they may be general 
practitioners, pediatricians, family doctors, obstetricians. Seventy-
five percent, however, and they may or may not be doing the other 
follow-up that is necessary.
  What anti-depressant medications do is they can change a person's 
mood. They can help change the chemical, biological reaction that a 
person's central nervous system and brain of how they process stresses 
that can lead to the debilitation of depression, but it does not change 
the way a person thinks. That is why it is so important that we make 
sure we are funding programs that also provide the psychological 
therapy for children to help them understand what these thoughts are, 
to help them change the way they are thinking about the world so as 
they start to feel better they do not have more suicidal risks.
  Interestingly enough, one of the things we oftentimes taught medical 
students in medical schools is once patients start getting better with 
symptoms of depression, the risk for suicide may increase because the 
support systems back off and they say Johnny's feeling better, we do 
not need to have him in the hospital or do not need to be around him as 
much. Perhaps people are no longer monitoring the person 24 hours a 
day. They start to go back to school, face more stresses.
  As they are getting their energy up, as they are back in the world 
and thinking if we do not change the way they think with depressive 
thought patterns, if we do not interrupt that and change it, you can 
actually increase the risk for suicide. That being the case, we have to 
make sure that as we are looking for more effective ways of spending 
money, the taxpayer dollars in Medicaid and Medicare and Head Start 
that we are working comprehensive care with the patient, with mental 
illness as well, such problems as I said before about bipolar; that is, 
manic depressive illness, attention deficit disorder, anxiety 
disorders, all of these with a strong genetic component and elements 
where we can make huge changes in people's lives.
  It is something that we need to make sure we are no longer just 
criticizing about overprescribing or perhaps saying that too many kids 
are getting stimulant medication with attention disorder; we should or 
should not do this.
  Here is the crux of this. It really is a matter of having accurate 
diagnosis and treatment and making sure that we are not overmedicating 
or undermedicating our children. Somehow in this Chamber we politicize 
this to somehow think we are doing something wrong in both areas of the 
conservative far right, the liberal far left, somehow accuse maybe 
there is some conspiracies involved in this, and there is not. It is a 
matter of making sure the physicians have the training to deal with 
this. They are interacting a comprehensive care model, a patient care 
model, disease management model, together with people of various 
professions and working closely with the families.
  We see this in the area of children's health when you start to look 
at so many aspects here that you really can make some huge differences.
  I would like to point to a couple of things here and then call upon 
the gentleman from Georgia (Mr. Gingrey), my colleague, on a couple of 
questions. But one of the things to keep in mind about depression, 
which is one of the most common mental illnesses affecting more than 19 
million Americans each year, that it can cause longer lasting forms. 
You can lose pleasure in life, complicate other medical conditions, can 
lead to suicide, but it is also associated with many other medical 
issues.
  For example, cancer has a higher incidence of depression, stroke. 
Diabetes, people with diabetes have a 25 percent chance of having 
depression. That is higher than the rest of the population. Depression 
also affects as many as 70 percent of patients with chronic diabetic 
complications. People with heart disease, 40 to 65 percent of them will 
have depression, and what is interesting is untreated depression in 
these patients can lead to complications, such as the health care costs 
can double.
  Now, I ask the gentleman from Georgia (Mr. Gingrey) on this, he 
certainly treated many a patient who had medical complications as well 
as some of the psychological ones, and I would like to ask him, in 
looking at some of these more comprehensive chronic care models, of how 
we need to be moving forward in a modern system of health

[[Page 23121]]

care and not be just looking at individual disease, but how looking at 
more advanced forms of bringing technology and changing the system, how 
he sees that affecting the patient in a cost-effective way.
  Mr. GINGREY. Mr. Speaker, as the gentleman pointed out, and he is so 
right, we need to move into the 21st century in regard to our health 
care system and modeling. Just trying to come up with better drugs and 
the latest surgery techniques to treat complicated illness is not 
enough. We really need to focus on preventive care.
  You are talking about in the last few minutes, of course, your 
specialty, in talking about mental illness, and as it relates also to 
childhood obesity, and I could not help but think as I was listening to 
your discussion, and as you know, this week we just passed H.R. 554. 
H.R. 554 is the Personal Responsibility in Food Consumption Act of 
2005. This is a bill my colleagues are aware of the fact it would not 
allow someone to sue a fast food manufacturer because they have gorged 
themselves with a multiple number of Big Macs or any other kind of fast 
food, or sometimes what we refer to as junk food. It is not the fault 
of the food industry.
  I used a little analogy when I was talking about this on the floor 
yesterday in discussing the rule of my belt, which is a size 36. That 
is, I hate to admit, the size of my waist, but if I wanted really out 
of blind pride to suggest that I had a 24-inch waist and I cinched that 
belt down a couple of notches, in doing so, I put pressure, compression 
on something referred to as the lateral femoral cutaneous nerve, it 
would result in a condition of numbness and lack of feeling on the 
anterior thigh. Then should I go out and sue the belt company because 
they are at fault because I misused a product?
  This is what this bill, of course, is all about, a common-sense type 
bill.
  Parenthetically, Mr. Speaker, I also want to mention the gentleman 
from Florida (Mr. Keller), the author of the bill, our good friend and 
colleague, is actually in the hospital now and recovering hopefully 
from a fairly minor condition, but we want to pay tribute to him. I 
know he is proud that we passed this bill this week.
  The comment that I wanted to make is this issue of personal 
responsibility, and parents should have that personal responsibility 
obviously in the way they conduct themselves in regard to how they eat 
and a healthy diet and exercise, but even more importantly is the 
responsibility that they have to give a good example and instruction to 
their children.
  I think it is probably the worst form of child abuse to let these 
youngsters that at a very early age overeat and become obese. You have 
talked about the issue of poor mental image, self-image, and of course, 
I also see you talked about Hollywood and, of course, this issue of 
there is no such thing as mental illness. I think probably they might 
predominate in some of those diseases, which we categorize as mental 
illness.
  But quite honestly, when a child goes to school and there is this 
emphasis on thinness and you see these youngsters wearing these Britney 
Spears' jeans and that sort of thing, a child even a little bit 
overweight and certainly one that is significantly obese, of course 
they are going to have a poor image of themselves. They are going to 
withdraw, and they are going to become shy. It is very likely they are 
going to be picked on. How in the world can they grow and develop with 
a healthy self-image? No wonder they end up needing to be counseled and 
treated by the gentleman from Pennsylvania (Mr. Murphy) and other 
mental health care specialists.
  Yes, unfortunately, some even go on to harm themselves and possibly 
even commit suicide. So I guess the most important thing that I would 
want to say as a physician Member is that we need to prevent this.

                              {time}  1800

  We need to make sure that parents get the message that they have an 
obligation, not just to take care of themselves, but first and foremost 
to take care of these precious children that they bring into the world. 
It is their responsibility to make sure that they are from the very 
beginning, when they start eating at the table, to make sure that they 
are healthy and stay healthy so you do not have to have them ending up 
in your office treating them for not only mental illness but also the 
many complications of obesity.
  You mentioned them. You mentioned diabetes, high blood pressure, so 
many things. And talk about the cost to this health care system of 
ours. We always talk about waste, fraud, and abuse in the Medicare and 
the Medicaid programs and wanting to eliminate that, and we are very 
diligent and will continue to be so. But this is almost a no-brainer. 
It is like we heard former Speaker Newt Gingrich say to a group of us 
earlier today, and the gentleman from Pennsylvania was a part of that 
as we had him come to speak to Members of the House. We are not talking 
about low-hanging fruit here in regard to saving money and saving 
lives. We are talking about fruit that is lying on the ground sitting 
there rotting waiting for us to pick it up. So clearly that is what my 
message would be in regard to that.
  Mr. MURPHY. I thank the gentleman. I asked about another issue, too, 
which is one that is so critically important for children. My colleague 
from Georgia had mentioned before, during pregnancy, smoking being one 
of the risk factors. I believe that the sad statistic is that the 
Pittsburgh region has some of the highest maternal smoking rates during 
pregnancy in the Nation. My understanding is a lot of complications can 
come when you have a mother who smokes during pregnancy. Certainly an 
important part of prenatal care for our children is understanding the 
importance of helping a mother to stop smoking during that time.
  I wonder if the gentleman can comment on some of the complications 
that might come for that mother and that baby not only during labor and 
delivery but the long-term effects for that child when the mother 
smokes during pregnancy.
  Mr. GINGREY. Without question probably the most common condition that 
we see in smoking moms is something called toxemia of pregnancy. 
Toxemia, by the very word, it is a poison. We do not know exactly what 
that poison is, but something occurs in those moms that develop 
toxemia. It is not always because of smoking, but frequently it is. And 
also so often that condition will lead also to pre-term labor and 
delivery and one of these low birth weight infants.
  In the extreme, toxemia of pregnancy before birth results in a very, 
very high blood pressure. It can cause a stroke, a deep coma, one from 
which sometimes the mother never recovers and the child is lost. So we 
are talking about one of the worst complications of pregnancy other 
than just out and out exsanguination from bleeding, which is also a 
possibility in any pregnancy.
  But smoking, we see that condition more often. And then, of course, 
childhood asthma, which I am sure the gentleman has seen plenty of 
cases of that, youngsters that come in because there is that secondary 
smoke situation. Not only do they have to suffer with it during the 9 
months of pregnancy of their mom; but once they are born, that smoking 
continues in the household. So it is a huge complication, no question 
about that.
  Mr. MURPHY. Also, it is related to, my understanding is yet so many 
other aspects come from this that you may find in such children also 
eating disorders and diabetes and cancer risks even if that child never 
themselves smoked cigarettes. But the risks are huge. I believe a 
direct and indirect medical cost of smoking in this Nation is about 
$138 billion per year.
  Of course, another reason why I believe it is so important not only 
for the government but really for individuals and businesses to focus 
so much on helping to change that is the State of California, for 
example, estimates that their statewide tobacco prevention program 
during the 1990s resulted in overall cost savings of $8.4 billion in 
health care. That is pretty remarkable.
  Again, unfortunately, the way the Congress scores things with the 
Congressional Budget Office, when we talk

[[Page 23122]]

about starting programs that would actually save money, my colleagues 
are aware of this, we never can get an accurate measure of what it 
actually saved because of the way the CBO, the Congressional Budget 
Office, scores things. It is not how much you save, but how much you 
spend. So if we would do similar things that would lead to a smoking 
cessation during pregnancy, and it might cost X number of dollars, the 
CBO would score that but never tell us how much money it would save 
over time. That is something that frustrates all of us because the 
things we are talking here tonight really require some expenditures to 
get these savings.
  Businesses are picking up on this. A recent review of health 
promotion and disease and management programs in businesses that 
provided health education to their employees, including exercise, 
health-risk screening, weight control, nutrition information, stress 
management, disease screening, and smoking cessation, found a 
significant return in investment, saved about $1.50 to about $5 for 
every dollar spent in the program.
  For example, Motorola, their wellness program saved the company about 
$4 for every dollar invested. Northeast Utilities' program in its first 
24 months reduced some of the claims by about $1.4 billion. Caterpillar 
Company, they had a program that saved about $700 million. Johnson and 
Johnson's health and wellness program saved about a couple hundred 
dollars per employee per year.
  What is interesting here is how much we can save and what we have to 
look at here. And I call upon my colleagues, we need to make some 
fundamental changes in how CBO scores these things. We have got to stop 
just looking at how much it costs up front and look at how much it 
saves in the long run. Again, I look at such things as if we are able 
to have more people go to federally approved health centers, community 
health centers in their community instead of showing up in the 
emergency departments, yes, it may cost money; the President called for 
a couple billion dollars to put into those community health centers. 
But if it is one-fifth of the cost of going there rather than the cost 
of going to the emergency departments, that is a massive cost savings.
  Certainly I call upon my colleague, too, it is one of those things 
you have seen as well, how do we get these prevention issues begin to 
be scored. It is of fundamental importance to health care.
  Mr. GINGREY. The gentleman is so right, and I appreciate the 
opportunity to weigh in on this issue.
  This issue of scoring, as the gentleman is talking about, it reminds 
me of course of the debate during the Medicare Modernization and 
Prescription Drug Act that we passed in December of 2003. Of course, 
that part D will go into effect and the modernization piece is already 
in effect for Medicare, but part D, the prescription drug part, will 
start January 1. But all we heard and continue to hear, particularly 
from the other side and for those nay-sayers who keep wanting to talk 
negative about really a very good program that is going to be a Godsend 
for our neediest seniors, I talked about this on the floor, my 
colleagues I know heard me last night. But the talk, the emphasis is on 
the cost of part D, and the cost estimate is based on the number of 
seniors that participate ultimately.
  I do not think anybody really knows, Mr. Speaker, what that number 
will be; but at one point it looked like the CBO said, well, it is 
going to be $400 billion additional Medicare cost over a 5-year period 
of time. Then those numbers were revised, and then we were hearing as 
much maybe as $750 billion. That is the scoring that the gentleman from 
Pennsylvania is talking about, and my colleagues understand what he 
means. You get no credit for the fact that many people who sign up and, 
yes, there will be an additional Medicare cost for them on this part D 
program, but the fact that they are able to take those medications, 
they can finally afford to take that statin to lower their cholesterol 
and that medication, that insulin to lower their blood sugar or 
whatever antihypertensive to lower their blood pressure, guess what, we 
get less spending on part A, the hospital part, when you end up in the 
emergency room with a stroke because you could not take your medicine, 
or you end up on the operating table for your coronary bypass or maybe 
even worse an amputation or a kidney transplant, and then you have this 
huge cost to the physician under part B.
  The truth of the matter is, and what the gentleman was emphasizing, 
is that you get no credit for saving those costs, not to mention the 
fact that it is so much more compassionate to spend money on prevention 
rather than treatment, particularly when the treatment sometimes is not 
very successful and a person could ultimately be in a nursing home for 
years and disabled for the rest of their lives.
  I will take it a step further before turning it back over to my 
colleague. It is the same thing, this scoring issue, in regard to the 
tax cuts that this Republican leadership has effected over these past 3 
years. The scorers, the CBO, the number crunchers say, well, these tax 
cuts, the elimination of the marriage tax penalty, increasing the child 
tax credit from $600 an infant to $1,000 a child, giving small business 
men and women an opportunity to more rapidly depreciate investment in 
bricks and mortar and creating new jobs, all of these things, 
elimination of the death tax, no taxation without respiration I firmly 
believe in, the scorers said that was going to cost us $1.3 trillion.
  My colleague remembers that. And a lot of people said, oh, we cannot 
afford that. What are we doing cutting taxes? Well, after about a year 
and a half, when we looked at our revenue stream, what was the result? 
We had about 225 billion more dollars, which on the scoring side we get 
no credit for.
  So the gentleman is so right. So many of these things that we are 
talking about tonight in this hour, these innovations, these community 
health centers that the President has funded, recommended, and feels so 
strongly about, on the scoring side you get no credit for; but we do 
save money, as the gentleman points out. And just think, also, it is 
the compassionate, conservative thing to do for the American people.
  Mr. MURPHY. I am reminded of the story of the fellow who was on his 
hands and knees late at night under a streetlight in the city, probably 
had too much to drink, and a police officer sees him and says: Excuse 
me, sir, what are you doing? The gentleman says: I am looking for my 
car keys. And the police officer says to him: Well, where did you lose 
them? He said: I lost them down at the end of that dark ally down 
there. And the policeman says: Well, why are you not looking for your 
keys at the end of that dark ally over there? And the gentleman says: 
Because there is more light over here.
  Sometimes I think the way we look at these medical issues, instead of 
looking at the cost savings involved with prevention, we simply are 
able to look at how much it costs us up front because it is easier to 
find that data. It is tougher to pay attention to prevention.
  My colleague brought up some great points. Prenatal care, Early Head 
Start, Head Start, what that contributes to in helping save problems. 
We talked about community health centers and spending money. I like the 
President's plan of a community health center in every county in 
America where there is poverty and an uninsured, can help reduce 
emergency visits by four-fifths, the cost of the emergency visits. It 
is an incredible amount of savings, but not one that we can get those 
scores for. And it is one of those things where, unfortunately, the 
political rhetoric comes through in this Chamber, and I do not know of 
anybody who has ever been cured by a floor speech, but it certainly is 
one where there is just so much talk that continues on, spending too 
much here, spending too much there. We need to pay attention to 
spending too much.
  The problem is not what we are spending, but what we are spending it 
on. And if we are continuing to spend

[[Page 23123]]

on wasteful or fraudulent or abusive or simply health care issues that 
are not taking care of the disparity of outcomes between, for example, 
low socioeconomic families, families that are struggling to make ends 
meet and feel they do not have the money to pay for their doctor 
visits, and those that may be in poverty, we need to work on those 
disparities of outcomes and make sure that we take care of those 
children early on; and that is why the issue of community health 
centers for our kids is so critically important. But, again, some will 
say we are spending too much, causing the budget to go up, and we 
cannot get the proper numbers.
  Now, some of the public that may be listening is wondering why we are 
even talking about the CBO. But that is, unfortunately, the way this 
Chamber operates now and that people oftentimes look at those numbers. 
We have seen tremendous inaccuracies in those numbers. My colleague 
from Georgia spoke about those inaccuracies when it came to looking at 
things such as the death tax and them being off over $1 trillion in 
their estimates. But also it is one of those things in health care, 
too.
  Think about this: if you take a medication that costs you $50, but it 
may prevent you from having a heart attack and further 
hospitalizations, surgery, disability, workers comp, losing your job, 
having the family require other care, that is a massive amount of cost 
savings. But, instead, we may focus on only that aspect of the cost of 
that medication, instead of all the other costs that are saved there. 
When we look at what we are doing with children's health, it is so 
critically important that we look at the big picture here as well.
  Now, I am going to see if my colleague has any final comments to make 
in this area of health care. Barring that, I just want to mention a 
couple of final comments here.

                              {time}  1815

  We are certainly the stewards of the people's money, and although we 
are not here to take the place of the family, we are here to do 
sometimes what Abe Lincoln said. President Lincoln said, ``Governments 
should do that which the people cannot do for themselves.''
  Now, in the areas of such things as food and consumption, people and 
parents ought to be watching what they eat. Well, what we also ought to 
be doing ourselves is working along with physicians and schoolteachers 
and people in the community to make sure our kids are healthy and safe 
and exercise and eat right.
  But we also have to make sure we are working at comprehensive care, 
real patient care models, that involves nutrition and exercise and 
prevention and mental health, and integrated care of all of those 
things together. If we are truly going to do what is right and decent 
and honorable for the next generation, it is a matter of doing what is 
right in health care.
  It is a matter of pooling our resources together and looking at the 
answers, to be science-based and not emotion-based on this. The science 
tells us we have things we can do, but we are not yet doing. The 
science tells us when it comes to managing the disease it is not 
appropriate to just look at that individual disease, but to see how it 
operates in the context of the child and their family.
  This is true compassion. This is where we will save lives. This is 
where we will save money. This is where if we do things like looking at 
electronic medical records, and make sure that every hospital around 
the Nation has this, and providers and pharmacists have these, you can 
find out these things and work on them together.
  That is what takes place in States like Nebraska and other hospitals 
around the Nation. We have here an opportunity to make a huge 
difference, to save lives by the hundreds of thousands, and to save 
money by the hundreds of billions of dollars. We have that opportunity 
before us.
  The question is, will we have the courage to work together in a 
bipartisan manner to do it? My hope is that our colleagues drop the 
gloves on this, put down the swords, stop looking for opportunities to 
send out sound bytes and to have people make phone calls and use it as 
political fodder, but instead to be able to look our constituents in 
the eye and say when we were all here, when we were all granted the 
authority to do something about America, we took an opportunity to save 
lives and save money, and we ought to start with our children.
  I thank my colleagues.

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