[Congressional Record (Bound Edition), Volume 155 (2009), Part 11]
[House]
[Pages 14873-14881]
[From the U.S. Government Publishing Office, www.gpo.gov]




                           HEALTHCARE REFORM

  The SPEAKER pro tempore (Mr. Minnick). Under the Speaker's announced 
policy of January 6, 2009, the gentleman from Illinois (Mr. Kirk) is 
recognized for 60 minutes as the designee of the minority leader.
  Mr. KIRK. Mr. Speaker, tonight, what we would like to talk about is a 
new and positive medical reform agenda as Congress prepares to debate 
health care in the United States.
  I want to focus this discussion on what we should be for--a 
bipartisan and centrist agenda for the United States--and compare our 
country to plans in other countries to make sure that we take the best 
of all medical care around the world but don't replicate some of the 
problems that we see both here and abroad.
  When we look at a comprehensive reform agenda that would receive 
widespread support both in the House of Representatives and the Senate, 
we basically unify around eight major themes.
  First, we want to make sure that we guarantee that medical decisions 
are kept in the hands of patients and their doctors and not a new 
government bureaucracy.
  Second, we want to lower the cost of insurance to make sure that the 
competitive advantage that the United States could enjoy would be 
realized, and that also individual costs for all American families are 
lowered.
  We want to increase the number of Americans who have health insurance 
to make sure that more and more families have the peace of mind that 
they need to protect their family incomes, their health, and most 
importantly, their lives.
  We want to allow Americans to keep the insurance they like because we 
know that over 80 percent of Americans--and especially voters--report 
that they are either satisfied or extremely satisfied with the health 
insurance plan they have.
  And we want to make sure that we replicate the doctor's principle, 
that first we should do no harm. And in the Congress, on health care 
policy, we should follow that advice.
  Fifth, we would like to improve quality and accountability and make 
sure that especially the cost of defensive medicine is reduced and that 
we know exactly what we are doing with regard to health care outcomes 
to make sure that we are maximizing the treatment and cures provided 
when a patient presents in a health care facility.
  We want to increase personal responsibility, especially for many of 
the decisions Americans are making because we know that if they lose 
weight, quit smoking, and stop drinking, their health care will improve 
dramatically.
  And, finally, we want to lower demand for more Federal borrowing at a 
time when the United States is already reporting that it will borrow 
$1.8 trillion this year. It is difficult to argue that we should turn 
every family's health care over to the Federal Government, an 
institution which is already, as the President says, ``out of money.''
  When we look at health care across the world, we see that the 
percentage of patients who wait more than 2 months to see a specialist 
is not a dramatic issue in the United States, but this is front-page 
news in both Canada and the United Kingdom. According to the 
Commonwealth Fund International Health Policy Survey of Sicker Adults, 
they report that about 10 percent of Americans wait more than 2 months 
to see a specialist, but one-third of Britons do, and approaching half 
of Canadians wait a long time for health care.
  We know that health care delayed is health care denied. And imagine--
especially if the specialist that you need is an oncologist, someone 
who treats cancer--what a 42-week wait would be as compared to what we 
see in the United States.
  Secondly, we know from asking Americans, What is the most important 
thing you would like to see in health care?, they say lowering the cost 
of their health insurance. Many in this body also say the number one 
priority is to expand health care coverage so that Americans who do not 
have health insurance can get it. I would say those two goals are very 
important, but the most important goal of health care is to determine 
whether you live or die, to make sure that, especially if you are 
facing health care challenges of the most severe degree, you have the 
greatest chance for you or a member of your family to survive. This is 
most clear in the case of cancer.
  When you or I or a member of our family gets that terrible diagnosis 
from a doctor that you will be fighting cancer, the question is often 
asked, How much time do I have? Will I be able to survive? When we look 
at The Lancet, Britain's number one medical journal, they did a ground-
breaking study of cancer survival rates across

[[Page 14874]]

Europe, Canada, and the United States and found that you are more 
likely to survive in the United States than you are in especially 
European countries.
  They looked at a number of different cancers. For example, prostate 
cancer: a 78 percent survival rate in Europe--which is fairly good--but 
a 99 percent survival rate if found in the United States. Bladder 
cancer: only 66 percent of Europeans survive bladder cancer, 81 percent 
of Americans. Breast cancer: 79 percent of Europeans will survive 
breast cancer, but 90 percent of Americans. And uterine cancer: 78 
percent of Europeans will survive, but 82 percent of Americans.
  Why is it that Americans are doing so much better against cancer than 
Europeans? Part of it is because in Canada and Europe advanced oncology 
medicines to fight cancer are restricted; and especially imagery to 
find cancer, either through x rays, MRIs or CAT scans, are much more 
available in the United States to find cancer, especially at its 
earlier stage, which means that Americans, bottom line, have a greater 
chance of surviving cancer than Europeans.
  When we look at 5-year survival rates, overall the picture is also 
stark. Women fighting cancer have a 63 percent chance of surviving if 
they are treated in the United States. That survival rate drops to just 
56 percent in Europe. For men, the difference is even starker. Sixty-
six percent of American men will survive a cancer diagnosis, only 47 
percent of European men.
  Bottom line, once again we see, across both men and women, you are 
much more likely to survive cancer in the United States than in 
European countries. And much of the reason why is because in countries 
in which the government controls more of the health care sector, they 
restrict access to oncology medicine and to imagery. That means that 
cancer is found later and is fought with less aggressive drugs, meaning 
that Europeans will die at a higher rate than Americans.
  When we look at high-tech medical procedures in Britain, Canada, and 
the United States, many people would say that health care costs are 
derived by too much access to high-tech medical care. But what we see 
here is that survival rates are higher in the United States, meaning 
high-tech is good. And the chance of your family member surviving 
improves when you have access to oncology medicine and MRIs.
  We see the differences between Britain, Canada, and the United States 
most clearly here where Britain, who has had the longest record of 
socialized government-controlled medicine, has very low rates of 
providing dialysis care as opposed to the United States. In coronary 
bypass, we see even Canadian rates are much lower. And especially in 
coronary angioplasty, the United States far outdistances countries with 
socialized medicine, leading to higher survival rates and better 
outcomes for Americans over patients who face socialized medicine.
  When we look at quality outcomes, this is another study showing the 
amount of time that you have to wait to see a specialist doctor. In 
this Commonwealth study, they rated the percentage of people that had 
to wait more than 4 weeks to see a specialist doctor. This is not a 
critical issue in the United States, but once again, front page news in 
the U.K. where we see the rate of patients that have to wait and, 
therefore, are denied care is three times the rate of the U.S. rate in 
Canada and in the United Kingdom as opposed to the U.S. And only 
Germany has a level somewhat equaling the U.S. record of getting you to 
see the specialist you need when you need to see it without a wait.
  This is another chart which shows patients having very long waits. We 
see that in the United States, only 8 percent of Americans have to wait 
more than 4 months to see a key specialist, but 41 percent of people in 
Britain. Imagine getting a diagnosis of cancer, knowing that it is in 
your body, and being told that you had to wait more than 4 months 
before you could even see the specialist that you need to survive. This 
is why we are quite worried about the restrictions that would be caused 
and denial of care in a socialized system.
  Remember also that since the U.S. Government is $1.8 trillion in debt 
just this year, if you give control of your health care to the 
government and the government is already out of money, how will it try 
to save money to rectify the deficit? If it's in control of your health 
care, it may do what the Canadians and Britons do, which is control 
your access to care.
  I am very happy to be joined by my co-Chair of The Tuesday Group, 
Congressman Dent from Pennsylvania, who has been a leader on health 
care and has engaged in a number of these international comparisons.
  Mr. DENT. Thank you, Congressman Kirk, for your leadership on health 
care. As you know, we have been working diligently to come up with some 
alternative ideas. And the chart that you have just identified in terms 
of cancer survivability rates as well as health care costs, I think 
really drives home the point that Americans all across this country 
understand: that we have a health care crisis, we particularly have a 
crisis in cost. And they understand, too, that depending on how we 
engage in health care reform could impact the care they receive.
  Americans are concerned about medical breakthroughs, innovation, and 
quality. They're also concerned about the ability to get the care they 
need when they need it because they understand that if care is delayed, 
care is denied.
  And you pointed out some interesting cancer survivability statistics 
from Canada. Interestingly enough, an anecdote: there is a member of 
Parliament in Canada, I believe she was a member of the Liberal Party. 
She is a great proponent of the Canadian health care system. And what 
happened is that she contracted breast cancer, and for whatever reason, 
she decided she needed her care in the United States. It created quite 
a controversy in Canada because it really spoke to the issue in Canada, 
which was that the Canadian system was good enough for all the 
Canadians, but not for this particular member of Parliament. And it 
spoke to the issue of two tiers of system, one for those who are in 
Canada, and those who, when they can't get the care that they need when 
they need it, they simply go south--because much of the Canadian 
population lives within 50 miles of the American border. So the second 
tier of Canadian health care can be provided across the border, and 
people pay top dollar.
  So I think that's something that we have to talk about quite a bit as 
we engage in this discussion: that we understand that care delayed is 
care denied, that people understand that the costs are rising, and that 
we have to come up with solutions.
  I am going to be, at some point tonight, talking about medical 
liability reform, why we need that. And that is a major cost driver. 
Defensive medicine costs have gone up significantly because of the tort 
system in the United States. We understand that there is just too much 
money being spent in the courtroom and not in the operating room. I 
think we all understand that.
  We are also joined tonight by our friend and colleague from western 
Pennsylvania, Tim Murphy, Dr. Murphy, who has a background in 
psychology, and also has a great deal of interest on this issue.
  At this time, I would be happy to yield to my friend and colleague 
from western Pennsylvania.
  Mr. TIM MURPHY of Pennsylvania. I thank my friend from Pennsylvania 
and also thank Congressman Kirk of Illinois for putting together this 
important session tonight to talk about health care.
  One of the concerns that comes up repeatedly when you talk about 
health care is the cost. And one of the things that happens, as 
Washington deals with it, is two approaches: one, they say health care 
is expensive, let's have the government pay for it, which means you 
raise taxes. And the other one they say, health care is expensive, 
let's deal with insurance issues, perhaps some tax credits, which means 
it's still taxes that pay for it. And I understand in both cases we are 
trying to lower health care cost, but neither one really gets to the 
root of that, and that is, dealing with some of the issues that

[[Page 14875]]

have to do with improving the quality of health care to make it more 
affordable and accessible. So I would like to focus a little bit on 
some comments tonight that specifically address this issue of how we 
lower health care costs.
  As part of the plan that Congressman Kirk and Congressman Dent have 
led here for our group in coming up with some cost savings in health 
care, one of them has to do with trying to make sure we are providing 
health care to those who are not able to afford it. We know that 
currently the government provides assistance for those who have a low 
income through Medicaid, for the elderly through Medicare, for veterans 
through the VA; but for those just above the level of Medicaid income, 
that's the group that we are really deeply concerned about because we 
want to make sure they get the care they need.

                              {time}  1845

  One thing that's also important then is to make sure they have a 
health care home. Those who have a doctor or a specialist they can go 
to when they have an illness are much more likely to have that illness 
treated in a timely manner to provide a cure for them. Care delayed, 
care denied. When we look at how Medicaid and Medicare operate, that it 
really sometimes takes an act of Congress to get something done, that's 
care delayed. Let me give you a couple of examples about how there are 
problems with that. Let's say you have a stroke and an ambulance takes 
you to a suburban hospital. Sometimes those hospitals do not have a 
neurologist. Many times they don't have a neurologist on staff 24/7 or 
a radiologist. So what happens? Wouldn't it be great--imagine a world 
whereby a neurologist, through telemedicine, for example, could connect 
up with the patient, looking at them on a video camera, the patient 
seeing the doctor. That doctor could be half a country away or could be 
20 miles away, whatever it may be, doing the exam with the assistance 
of a nurse on site. Look at the signs, look at the way the patient 
responds, and be able to diagnose and offer, does that patient get one 
type of treatment, which is if there are blocked arteries in the brain 
leading to the stroke, or another type of treatment which might be 
hemorrhagic, that is, a burst artery. Each one critically different 
life-saving treatments. It could mean the difference between the 
patient who lives and dies. Also it could make a difference between the 
patient who has years and years of physical therapy, occupational 
therapy, and speech therapy or one who has a shorter recovery time. 
Because when you have a stroke, time is brain. That would make sense if 
we imagined that, but Medicare doesn't cover that. Instead, it's going 
to take an act in Congress--I know our friend and colleague Lois Capps 
from California has been pushing a bill for a while to allow Medicare 
to do that. This is not a new idea, but we have to take an act of 
Congress to do this. Or how about this--if you are going to get 
something called home infusion therapy to provide an IV line, to 
provide some medical treatments to you, you could do that at home, in 
many cases, with insurance companies, but not necessarily with Medicare 
and Medicaid because they want you to go to hospital where you have to 
go all the way to the hospital, and your risk for problems could 
increase. It's also going to take an act of Congress to make it so that 
hospitals actually have to state what their infection and complication 
rates are. I always find it amazing, you can go online and you can find 
out, if you are shopping for a new car, everything about that car. You 
want to shop for clothes, you can go all over the place, checking out 
the quality reports, consumer reports, all those things on that. If you 
want to look up the records on a hospital, am I more likely to get 
sicker or better when I am there, you can't find out that information. 
As my friends know, for a number of years I put forth a bill to provide 
transparency in this area, whereby you could look up and find out the 
infection rate of a hospital. This is critically important because 
nosocomial infections, that is infections you pick up in a hospital or 
clinic, kill 100,000 people each year, cost $50 billion, and there are 
2 million cases. Sadly, Senator Byrd, one of our colleagues in 
Congress, is right now suffering a staph infection; and many of our 
colleagues have had a family member who has faced the same problem. It 
would be nice to know, and the advantage of having that information out 
there is that you can look it up, and you could find out. Hospitals 
that have paid attention to this have actually reduced some of their 
infection rates to near zero. That's what we want to see, but it's 
going to take an act of Congress to change that.
  Mr. KIRK. I think one of the key lessons that we want is, we want 
Americans to have health insurance as good as a Congressman, but we 
don't want them to have to call their Congressman to get good health 
care. One of the things that we've also seen is that the United States 
really stands out in a couple of areas that drive health care costs up. 
We have very little to no Federal lawsuit reform in the United States 
for health care, meaning that defensive medicine is the practice of the 
day in our country as opposed to other countries because doctors are so 
likely to be sued. Another is that, yes, Americans generally have a 
higher degree of obesity as compared to other countries. And so the 
Congress and the President, on a bipartisan basis I think, will have a 
lot of common ground in working and encouraging a reduction in weight 
by Americans because this will lower health care costs. One of our key 
experts on how lawsuits drive health care costs up is our colleague 
from Pennsylvania as well, Congressman Dent.
  Mr. DENT. I thank the gentleman for yielding. In Pennsylvania, of 
course, we have been in a crisis state for some time with respect to 
medical liability. In fact, my colleague Tim Murphy remembers the great 
debates we had in Pennsylvania about the need for joint and several 
liability reform, to make sure that the award would be basically 
proportional to the degree of fault. We felt that that was something 
that was absolutely essential. Caps on noneconomic damages, another 
area we were greatly in need of reform in Pennsylvania. Also the notion 
of a periodic payment as opposed to one big lump-sum award. One could 
pay those payments out over a period of time. Something that, again, 
was absolutely essential. In the city of Philadelphia, in particular, 
we had a very real crisis. In fact, at the time a group called Jury 
Verdict Research had done a number of studies about the jury awards and 
settlements coming out of the city of Philadelphia. The average jury 
award at that time was somewhere around $1 million. The rest of the 
State, on average, was a bit less than $500,000. In fact, it got so bad 
one year that there were more awards and payouts out of the city of 
Philadelphia than in the entire State of California; and the city of 
Philadelphia has a population of about 1.5 million people. So what we 
had to do was find ways to get cases out of the city of Philadelphia, 
out of those courts. So Congressman Murphy and I actually passed 
legislation that would have essentially required the cases be heard in 
the county where the alleged malpractice incident occurred, and we 
supported it in Harrisburg. So that made complete and total sense. 
Consequently, we tried to pass it legislatively, but we ended up having 
the Supreme Court establish a rule to essentially provide that kind of 
a remedy. What happened is, we saw the number of cases heard in 
Philadelphia drop dramatically as a result of that. So that was just 
another example of the problems.
  Also, we have many people in this country who must go to an emergency 
room for care. They go to the emergency room, and oftentimes emergency 
room physicians and staff are the subject of lawsuits. But those same 
physicians must provide care under Federal law, something called 
EMTALA; and essentially what that means is that they must provide care. 
So I think what we should do is provide medical liability relief to 
those emergency room physicians by treating them as Federal employees, 
not that they're going to be on the Federal payroll. But

[[Page 14876]]

for tort purposes, in the Federal Tort Claims Act, they would be 
relieved from those types of lawsuits. Because we've had situations 
across this country where trauma rooms have been forced to close down. 
It's dramatic. We also had a situation where we met an obstetrician 
recently from one of the hospitals in the city of Philadelphia who 
actually said, The only reason why we deliver babies is to train our 
students. We lose money. There are many doctors who choose not to 
deliver babies these days because of liability. And in Philadelphia I 
know one hospital, I think it was Methodist Hospital, stopped 
delivering babies. One of the teaching institutions only delivers just 
so that they can train their residents. They lose money, and it's very 
costly to them. But they do it as a service and as a way of training 
physicians. But that's a very sad state of affairs when we can't 
deliver babies because of the high costs.
  Mr. KIRK. I think the gentleman's point is well taken, especially in 
comparing two States and the average premium for health care in these 
two States. In New Jersey, the average premium totals over $6,000 per 
person, a State that has very little lawsuit reform; and a number of 
the other reforms that we are talking about in our reform bill that we 
will be outlining next Tuesday from the GOP centrists are not there in 
New Jersey. In California, a number of the successful reforms that 
we've put forward are there; and the average cost of our premium is 
just $1,885, meaning that if you back the kind of reforms that will be 
in the outline bill that we put forward next Tuesday, you can drop the 
cost of health care by thousands of dollars per patient.
  Mr. TIM MURPHY of Pennsylvania. As an important part of this, we're 
trying to drive the point that the losses themselves do not guarantee 
quality. But it's quality that is very important. I believe you have a 
chart up there about some tests and procedures. I wonder if you could 
explain and comment on them a little bit.
  Mr. KIRK. When we're looking at preventive care, which is so 
essential, in many countries with government-controlled systems, 
because these systems are generally out of money, as governments 
generally are, they have restricted access to preventive care. So 
particularly in a Pap smear and a mammogram, two essential procedures 
in finding cancer in women early, we see that 89 percent of American 
women will have had a Pap smear within the last 3 years, but only 77 
percent of Britons. In a mammogram as well, American women are 86 
percent, whereas women in the United Kingdom are 77 percent. All of 
these major industrialized powers, allies of the United States, have 
much lower access to care, even though they have government systems.
  Mr. TIM MURPHY of Pennsylvania. That brings up an important point of 
how in the U.S. system we handle such things as dealing with breast 
cancer and cervical cancer. One of the sad stories in this country is, 
more often than is necessarily believed, the U.S. handles lumps, et 
cetera, by providing mastectomies to women. Other countries may not do 
that. In part, it may be that the tests come much lower, are much more 
difficult to get in other countries; but it also brings up the other 
point. We need to make sure that physicians are empowered to provide 
that ongoing primary care so they can monitor the patients, get the 
tests they need. Unfortunately we have a system that pays for quantity, 
not quality; that pays for defensive medicine, not really working on 
prevention.
  Let me read you an important quote. This comes from the New Yorker 
magazine, an article entitled The Cost Conundrum by Atul Gawande. It's 
about Texas towns. It says that between 2001 and 2005, critically ill 
Medicare patients received almost 50 percent more specialist visits in 
McAllen, Texas, than in El Paso and were two-thirds more likely to see 
10 or more specialists in a 6-month period. Why? It was a different 
approach to care and, that is, providing more care, providing more 
surgical procedures, et cetera, doing more tests that were not 
necessarily warranted. You have another area, like where the Mayo 
Clinic is up in Rochester, Minnesota, where that dominates the scene. 
They have fantastically high levels of all this technological 
capability and quality; but its Medicare spending is in the lowest 15 
percent in the country, $6,000 per enrollee in 2006, which is $8,000 
less than the figure from McAllen, Texas. I bring that up to say that 
in the U.S., it is a part of what you are describing that patients need 
access to these tests in a timely manner, number one; but number two, 
we also need to make sure the physicians and nurses and all medical 
specialists are getting the information they need to make sure the 
quality is what we're driving here. When you are dealing with just 
issues of insurance or just issues of defensive medicine, you are not 
necessarily driving quality. You are driving more tests.
  Mr. KIRK. One of the other things that we've been concerned about is 
the increasing price of medical malpractice insurance in the United 
States. Especially if you look between 2000 and 2002 for obstetricians 
and gynecologists, for physicians, for internists in general, you've 
got an explosion in the cost of buying insurance. We do not have 30 
percent more malpractice in America in just 2 years, but what we may 
have is a 30 percent greater chance of being sued in America, the most 
litigious society on earth. All of this drives health care costs up, as 
physicians have to cover the cost of malpractice insurance and, of 
course, over-prescribe tests and other procedures.
  Mr. DENT. I would like to get in a few statistics about this. This is 
a very interesting and pertinent subject, this whole discussion of the 
cost of health care and why it's rising. Defensive medicine costs the 
U.S. as much as $126 billion per year. That was out of a 2003 HHS 
study. One-third of the orthopedists, obstetricians, trauma surgeons, 
emergency room doctors and plastic surgeons can expect to be sued in 
any given year. The data for 2006 shows 71 percent of the medical 
liability cases are dropped or dismissed. Only 1 percent of the cases 
result in a verdict.
  Mr. KIRK. So 71 percent are dropped, but a payment is still made 
because it's a settlement, and that's going to drive up insurance rates 
anyway.
  Mr. DENT. And the physicians and hospitals have to hire attorneys to 
defend themselves. So there's a lot of time, effort and money expended 
just to prepare and fight this battle, only to have it dropped. So 
there is still a cost incurred even though the case is dropped.
  Mr. TIM MURPHY of Pennsylvania. Another issue with regard to this 
bill we've introduced has to do with allowing doctors to volunteer 
their services. And here is something that only the United States would 
mess up in our government. Community health centers, which provide 
great health care at home for people with lots of different services 
from primary medical care, dental, mental health, pediatric care, et 
cetera. But they are strapped for money. In many cases they have a 15 
to 20 percent shortage of family physicians, OB/GYNs, et cetera. The 
doctors are covered under the Federal Tort Claims Act. The Federal 
Government handles their malpractice at a lower cost for them. But if a 
doctor wants to volunteer, they're not covered. Basically if a doctor 
says, I would like to give my time to work a couple days a month, offer 
my time on a volunteer basis, the clinic has to turn them away because 
they cannot afford the full price of their malpractice insurance. It is 
the opposite in a free clinic, where if a doctor is paid, they have to 
cover their own insurance. But if they volunteer, they are covered 
under the Federal Tort Claims Act.
  We have a bill we've been trying to get in for a number of years to 
allow doctors to volunteer. The advantages people have at health care 
home, it is a much lower cost. It even reduces the cost for Medicaid 
patients to go there by some 30 percent, and it focuses on getting the 
doctor near the patient and the patient near the doctor and eliminating 
any incentive of defensive medicine, any incentive to do lots and lots 
of tests just to make up for the losses.
  Mr. DENT. Before we get on to our next topic, I just want to mention 
one

[[Page 14877]]

thing. What's the point of this whole discussion? I was talking about 
the rising costs. But in Philadelphia, premiums rose 221 percent for 
OB/GYNs in the city of Philadelphia. That is between 2000 and 2008. 
Premiums rose 149 percent for general surgeons in New Jersey. Premiums 
rose 348 percent for internists in Connecticut over that 2000-2008 
period.
  Mr. KIRK. But does it mean though that doctors in Connecticut were 
300 percent worse 2 years later?
  Mr. DENT. Absolutely not.

                              {time}  1900

  The point is, this drives up costs, not just in terms of the 
liability payments that the doctors and the hospitals must incur, and 
many physicians are now working in hospital-based practices in part 
because they can't afford liability insurance, so the hospital must 
pick up that bill and they are struggling to make these payments.
  The point is, it raises costs not just for the doctors and the 
hospitals, but the tests that are going to be prescribed and 
administered and treatments perhaps proposed just to protect 
themselves. This will drive costs up. They are protecting themselves 
against lawsuits.
  What is the other issue? Access to care is a consequence, that there 
will be less access, that doctors won't deliver babies in the city of 
Philadelphia. That means people don't have access to an OB. That is 
important. I think that is the point. It drives up costs and it limits 
access, and Americans want access to health care and need the care when 
they must get it.
  Mr. KIRK. The bill that we are going to be putting forward by the 
centrists on Tuesday has a number of liability reform provisions 
authored by Congressman Dent, and community health center and volunteer 
liability provisions authored by Congressman Murphy.
  One of the things we talk about is access to care. A critical issue 
coming up is the uninsured. Now, the Census Bureau indicates that there 
are about 45.7 million, about 46 million people in the country who are 
lacking insurance. Of those, about 9.5 million are non-citizens, and 
the question we have to ask is, should we provide taxpayer-funded care 
to those people who are not legally present in the United States?
  About 12 million of the currently uninsured are already eligible for 
public programs. Because of lifestyle or because of their choice, they 
haven't even signed up for the health care that the government already 
will provide them. About 7.3 million have higher incomes than most 
Americans. They make over $84,000 a year. And about 9 million are only 
temporarily uninsured.
  As you can see here from an older chart showing 49 million uninsured, 
a large number of the uninsured were uninsured temporarily, only 5 
months, and another 25 percent were uninsured for only 6 months, 
leaving about 53 percent of this cohort uninsured for a long time, a 
group we all agree should be addressed.
  When you take 45.7 million people uninsured, remove the noncitizens, 
remove the people who haven't signed up for the government programs 
they have already been eligible for, remove people who have higher 
incomes than most Americans and should buy it anyway, and remove the 
temporarily uninsured, you get down to a number of only 7.8 million. 
But this might not be a big enough number for a government takeover.
  Mr. DENT. If the gentleman will yield, one of the interesting 
demographics with respect to the uninsured population, I think we 
really need to focus on this like a laser beam. Over half, I believe, 
55 percent of the people lacking coverage in America are under the age 
of 35. Many of them are insurable. Those college-age kids up to age 35, 
they tend to be more insurable than much of the rest of the population.
  So I believe we do have some suggestions and proposals as a way to 
cover that population, get them into an affordable catastrophic 
coverage that they will need in the event that something dramatic 
happens in their life where they need that kind of coverage. I would 
like to talk about that a little later. But that is another statistic I 
don't think we talk enough about.
  Also, there are a large number of people uninsured who are currently 
eligible for programs, whether they be Medicaid or the Children's 
Health Insurance Program.
  Mr. TIM MURPHY of Pennsylvania. If the gentleman will yield. As you 
know, many of those younger folks you are talking about consider 
themselves to be the invulnerables. They don't need insurance, they are 
never going to get sick. The problem becomes one that when they don't 
do that and they do get sick and they do end up in the emergency room, 
we pay for it. It is important that we remove any barriers and provide 
every encouragement and incentive for them to purchase that insurance 
that many times the employer does offer.
  Mr. KIRK. I want to just point out, and I do want to go on to 
expanding health care insurance, we find for many small businesses they 
lack health insurance for their employees, and we ought to allow small 
businesses to join together. For example, the Libertyville Chamber of 
Commerce Association Health Plan is right now prohibited under Federal 
law. We should allow small businesses to band together to create large 
insurance pools on their own, because we know half of all Americans 
work for small businesses, and many don't have a plan through their 
employer, and that will be included in our legislation.
  Mr. DENT. And that is a very important point. You know, there are so 
many people out there who need coverage, and there are so many things 
we can do to help. You just mentioned the idea of allowing employers to 
reach across State lines and realize greater discounts. That is 
critical.
  But the other issue, too, to help the uninsured, we know that 
employers receive favorable tax treatment. They get a tax exclusion 
that is very beneficial to helping them provide health care coverage to 
their employees. That is a good thing. We want to protect that. There 
are about 165 million Americans that have health care through their 
employers in many respects, and what we should do is give the 
individual who lacks insurance, if his employer cannot provide it to 
them or if they are self-employed or on their own, give them the 
opportunity to buy health insurance and give the same kind of favorable 
tax treatment to the individual that we currently give to the business. 
That would do a lot to help cover particularly that younger population 
that is relatively healthy and insurable.
  Mr. TIM MURPHY of Pennsylvania. In addition to that, it has to do 
with how they purchase it. The Federal Government recognizes that if we 
allow people of low income to pool together they can negotiate better 
prices. The VA does this all the time. They combine the purchasing 
power of the VA to purchase for veterans across the Nation. Yet we 
don't let individuals do that.
  We don't let a small business that only has half a dozen employees or 
20 or 50 employees to join other businesses of the same type, and that 
wall placed by insurance companies and by the government leads to 
higher costs. We ought to allow businesses to do the same thing the 
Federal Government does and use that as a mechanism to drive down costs 
substantially.
  Mr. KIRK. One of the things that you have put forward, Congressman 
Murphy, is the need for public health clinics, et cetera. I think that 
puts forward a critical point right now missing in the debate.
  We know that of the uninsured, by this estimate 44.7 million, of the 
uninsured, currently 14.7 million are already eligible for public 
coverage.
  Mr. DENT. That would be Medicaid and SCHIP.
  Mr. KIRK. That is right, Medicaid, SCHIP and other State programs. 
But as we found in the State of Massachusetts, when a mandate that 
everyone has to buy health insurance is put forward, what they have 
generally found is that a technical and legal solution is not adequate.
  They thought that by putting a health insurance signup machine at the 
entrance of every emergency room in the State they would register and 
collect the required number of people who

[[Page 14878]]

hadn't yet signed up for the public assistance that they were eligible 
for.
  What they found is, for a small percentage of the most difficult 
patients, either because of alcohol, drug abuse or law enforcement 
problems, these patients were not registering under similar names, not 
registering under similar addresses, and were failing to report for 
appointments and other preventive care, meaning for that very small 
percentage of Americans, we need to provide an open public clinic.
  It is the much-more appropriate health delivery system than an 
insurance system, because for this small group of Americans we have 
different names, different addresses and different lifestyles, and yet 
we still want to provide care. But having a 100 percent insurance 
mandate didn't do it. You needed to do it through a public health 
clinic.
  Mr. TIM MURPHY of Pennsylvania. And as you described, it brings the 
thought too that in addition to people having this hodgepodge of how 
disjointed a difficult system that does not allow individuals or 
employers to purchase insurance is, we oftentimes look upon other 
solutions and think, well, they are not purchasing it for other 
reasons, and we artificially keep those things high, and we keep a 
system that also incentivizes lots of tests, we incentivize a system 
that is really dysfunctional.
  In that I bring to my colleagues' attention an article published by 
the New England Health Care Institute that said out of this $2.4 
trillion health care system, this Nation wastes about $700 billion a 
year, and all these inefficiencies have to do with care delivery, even 
beyond that of what we are talking about here, with the tax, the 
incentives, the insurance and barriers we set up too.
  Mr. KIRK. One of the things that we want to make sure is sometimes in 
this debate when you hear about the uninsured, you may have the 
impression that the Federal Government doesn't spend any money already 
providing health care to low-income and needy Americans.
  As this chart, already somewhat outdated from 2004 shows, it is a 
total of almost $35 billion in assistance given to cover the uninsured. 
But one of the problems has been that some of the patients directly 
eligible for these government programs don't sign up.
  Mr. DENT. The gentleman, Mr. Kirk from Illinois, pointed out an 
interesting point. He mentioned the Massachusetts health care 
experiment. What they did in Massachusetts, they had a universal 
mandate for coverage, but they did not do anything to deal with the 
cost issue.
  So what happened in Massachusetts is while the numbers of those who 
were being provided coverage through the various programs in 
Massachusetts through the mandates, those costs rose, but the ability 
of the taxpayers to meet those rising costs, of course, was limited. So 
what does the government do? It restricts care, it denies treatment, it 
denies service, it rations care. That is sort of a microcosm in 
Massachusetts of what happens in perhaps some other Western European 
countries or perhaps even Canada.
  I am not here to either praise or condemn those systems in Western 
Europe and the United Kingdom or in Canada or anywhere else. They are 
different systems. And people need to understand that what happens in 
those systems when the costs continue to rise for health care and there 
aren't the tax dollars to meet those costs, they deny care. I think we 
all know that people are concerned about cures and not treatments. They 
want to be treated like human beings and not numbers.
  Unfortunately, that can happen in those systems where you have a 
single-payer system. You take a number, wait for your dialysis, wait 
for your hip replacement, if you can wait that long. If you are a 
Canadian, if you have the money, you come across the border and get the 
care you need when you need it. We need to have this very sober 
discussion.
  Mr. KIRK. By the way, the gentleman points out Canada, a country that 
has basically a two-tier health care system, the Canadian health care 
system, and then when you are denied care, which is especially 
prevalent in any care needing advanced imagery or new oncology 
medicines to fight cancer, the relief valve is they come to the United 
States. Some Canadian doctors call it ``Fargo-ing a patient,'' meaning 
when a patient is denied care or care is going to be tremendously 
delayed under the Canadian system, they will then refer that patient to 
Fargo, North Dakota, where they will immediately get care under the 
U.S. system.
  The concern I have though is if we have the government take over 
health care, where will we be able to drive? Where will we be able to 
go? That is why in our legislation that we will be outlining on 
Tuesday, it includes the Medical Rights Act, and the Medical Rights Act 
says this: We guarantee the right of patients to carry out the 
decisions of their doctors without delay or denial of care by the 
government.
  The legislation protects the right of each American to receive 
medical services as deemed appropriate by their doctor.
  Mr. TIM MURPHY of Pennsylvania. Let me add to that. That is a great 
base to be moving from that what they do there does need to be these 
basic rights outlined, because we have a system that stands with huge 
barriers between doctor and patient and much of that barrier is the 
government.
  The government through Medicare and Medicaid, for example, handles 
cost controls by delaying care, by denying care and by denying or 
diminishing payment. So physicians and hospitals that are paid, for 
example, 30 or 40 percent less for Medicare services, or saying you are 
not allowed to do these other tests, we are not going to pay for it, 
end up promoting a situation that is more based on quantity than 
quality, and that actually increases many costs and increases the 
chances for fraud and abuse. In Pennsylvania, there was news in the 
paper of just millions of dollars again of abuse in this system.
  What is so important is if you have the patient and the doctor in 
charge of their care, you incentivize quality, you make sure the doctor 
has timely information through electronic medical records, et cetera. 
Those are important things which we are not doing yet as part of this.
  But then you look at other clinics, you look at a Mayo Clinic, you 
look at the Geisinger Plan, you look at the University of Pittsburgh 
Medical Center, ones that have really focused on, We are going to 
change the quality and delivery of care and focus on outcome--you 
actually see those costs go down. That is part of the focus we need to 
have.
  With that, I yield back to my colleague.
  Mr. KIRK. Let me just follow up. I want to talk about some of the 
solutions we are going to put forward, because what is lost sometimes 
in this debate is we agree with the President that we should lower 
costs. We agree with the President that we should expand health care. 
But we think we have a better way.
  Many times in partisan debate people can say that we have no 
alternative. So we have spent about 90 percent of our time coming up 
with that alternative. We want to make sure that we guarantee the 
rights of each patient in the doctor-patient relationship so that you 
or a loved one in your family is allowed to carry out the decisions 
made by you and your doctor and not be interfered with by a government 
bureaucracy.
  Also though we are focusing in our legislation coming up on lowering 
the cost of insurance through alliances, through equalizing the tax 
benefit for individuals so they get the same benefit that employers get 
when they buy health insurance, and obviously what we have talked about 
here, lawsuit reform.
  Mr. DENT. That was the point I made a few moments earlier about 
equalizing the tax treatment. That is a point we are stating; that the 
165 million Americans--I think that is about 60 percent of our 
population--has insurance through their employers, but those 
individuals who cannot afford insurance, and there are a lot of them 
out there, unfortunately, cannot afford their insurance, but they get 
no favorable tax treatment themselves. Their employer

[[Page 14879]]

receives it, as they should, that treatment, but the employee, the 
worker or the self-employed individual should get that same favorable 
treatment.
  That is a way to really help particularly the younger population, 
some of whom have some capacity to purchase insurance. They may be 
relatively healthy, but they choose not to purchase it. Some use the 
term ``the invincibles.'' Obviously they are not. But they need 
insurance, and we can help that population afford a reasonable, 
comprehensive plan.

                              {time}  1915

  And that's one of the major parts of the reform that you and I have 
worked on. And I think we can do this in a bipartisan manner. I think 
there are plenty of people in this room, on both sides of the aisle, 
that would be willing to vote for this type of commonsense reform 
that's going to help people get access to care and coverage.
  Mr. KIRK. And here's what we've been working on. We want to equalize 
the benefit so that if you buy your own insurance, you get the same tax 
benefit that an employer gets when it buys for employees.
  But here's what I'm concerned about. There are ideas building in 
strength now, in the Congress and downtown, that talk about cutting the 
tax benefit that employers get for providing health insurance to their 
employees.
  One study by the Llewellyn Group says that if that tax break that 
employers get for providing care to their employees is cut, 100 million 
Americans will lose their health insurance. And so a health reform 
bill, ironically, will cut the number of Americans who have their own 
insurance from 170 million to 70 million.
  Our bill, our positive alternative, goes in exactly the opposite 
direction. We're enhancing employer-provided coverage and making sure 
that it's more available.
  But I yield to the gentleman.
  Mr. DENT. That's an astounding statistic from the Llewellyn Group. 
When you talk about 100 million Americans potentially losing their 
health care, where will they go to get it? That's really the issue. So 
that employer exclusion, that favorable tax treatment is absolutely 
essential to making sure that many Americans are able to maintain their 
coverage. And that's the first thing we have to protect in this whole 
discussion. We have to protect that first.
  And some of the proposals that are floating around this capital, as 
you correctly pointed out, would either eliminate that exclusion or 
severely limit it as a way to finance whatever kind of program they're 
advancing. And this is big money.
  So I just wanted to share that with the American people, make sure 
they understand that that seems to be the primary funding mechanism 
that many are looking at to finance whatever kind of health care system 
would be proposed, whether it's a government option or some other 
proposal, single-payer. That's something to be concerned about.
  Mr. KIRK. That's what we worry about. They're talking about maybe a 
$1 trillion cost of a government plan. And so the most obvious response 
with such a cost is a huge income tax increase, but we know most 
Americans oppose that.
  Some, including Ezekiel Emanuel, one of the heads of the President's 
advisory committee, has talked about a national sales tax on top of the 
other tax, but I think there's significant opposition to that. So 
they've talked about cutting back on the tax benefit that employers get 
when they provide health care to their employees, but by this estimate, 
it could cost over 100 million Americans their health insurance.
  I yield to the gentleman.
  Mr. TIM MURPHY of Pennsylvania. As that goes, when we look at the 
government running a plan that costs $1 trillion, that's several 
hundred billion more than the Pentagon. And I'm not sure that people 
would say the Pentagon, for all the pride we have of all our soldiers, 
our sailors, our airmen and marines, I doubt that people would say 
that's the model of economic efficiency.
  Would they say that Social Security run by the Federal Government is 
the best investment system? Would they--I mean, pick a system that the 
Federal Government runs, and it's hardly seen as the best. We know we 
have a lot of dedicated employees there, but oftentimes they are 
saddled and handcuffed by regulations.
  We have a system that is still, after all these years, Medicaid, that 
has been around since the 1960s, so fraught with inefficiency that it 
invites waste, fraud and abuse. It has not been revamped.
  An article that appeared in the New England Journal of Medicine a 
couple of weeks ago by Victor R. Fuchs was saying we've got to fix this 
system first; otherwise--and I go back to this article from the New 
Yorker. It says this: Providing health care is like building a house. 
The task requires experts, expensive equipment and materials, and a 
huge amount of coordination. Imagine that, instead of paying a 
contractor to pull a team together and keep them on track, you paid an 
electrician for every outlet he recommends, a plumber for every faucet 
and a carpenter for every cabinet. Would you be surprised if you got a 
house with 1,000 outlets, faucets and cabinets at three times the cost 
you expected, and the whole thing fell apart a couple of years later?
  That's where we are with our health care system. It must be focused 
on quality and on outcome. And I worry that if we have a government-run 
system and this bureaucracy created, it's going to be a matter between 
you and your doctor and this Congress. To get anything done, it's going 
to take an act of Congress or bureaucracy. That's going to be such a 
huge cost on top that all the people will say, well, it's going to be 
less involved with regard to administrative cost. I don't see how that 
is possible, given the track record we have.
  Mr. KIRK. If the gentleman will yield, we also not only see other 
examples of the government poorly running the bureaucracies that it 
already has taken over, but recently the government took over the 
largest bond dealer, Bear Stearns. The government has taken over the 
largest insurance company, the American International Group, and the 
government has taken over the largest car manufacturer, GM. And I don't 
think that any us of would argue that the government is running it 
better in their current states.
  Mr. DENT. And if the gentleman would yield, to follow up on that 
point you were just making about government ownership and autos and 
financial services and elsewhere, let's talk a moment about health 
care. And there's an idea being floated about called a government 
option, which needs to be, I think, fully understood and vetted before 
the public. But that government option many fear may become the only 
option for insurance because a government option coverage perhaps would 
be able to offer it at a much lower cost than any kind of a private 
sector insurance product. And the fear is that you would have a 
backdoor government takeover of our health system through this 
government option, a very real concern.
  And again, I just don't think that we should lose sight of the fact 
that if we--this turns into a backdoor, single-payer system or a 
government takeover of health care, what will soon follow will be 
rationed care, that is, waiting lines, delays, denials of care.
  Mr. KIRK. I want to emphasize the point the gentleman raises. Not 
only, if we create a government health care program, will it compete 
and may be the lowest cost option because it has a taxpayer subsidy, 
but that taxpayer subsidy may be paid for by ending some of the tax 
break that employers have in providing health care to their employees.
  Mr. DENT. 165 million Americans.
  Mr. KIRK. Right. And so, employers seeing that they don't get a tax 
break anymore for giving health care to their employees will simply 
cancel your health insurance program, and then the government will be 
your only option.
  Mr. TIM MURPHY of Pennsylvania. As this goes, I mean, I believe the 
government does have a role in terms of

[[Page 14880]]

providing regulations, standards of clinical excellence, and pushing 
companies toward this constantly. Provide the oversight that says, if 
you're going to be spending the taxpayers' money on Medicaid, Medicare 
and the VA, we want to see quality measures.
  So, if the Federal Government's going to put up money for electronic 
medical records, to say we need to see you driving constantly towards 
interoperability, towards intelligence systems, towards integrated 
systems, towards ones that are highly interactive with the physician. 
If the Federal Government can play a role in pushing people towards 
higher quality, I worry if the Federal Government is the prime owner of 
this, will the Federal Government, itself, push things towards that, 
and that's were I have trouble reckoning that.
  Mr. KIRK. I am going to keep this on the positive side because what 
we're doing is we're putting together a positive alternative. And one 
of the other reforms that we will be outlining is to dramatically 
expand the number of Americans who can have a health savings account, 
very much like an IRA, so that they can save, especially in their 
younger, more healthy years, in a tax deferred account that they will 
use to make up for their deductible expenses and their health 
insurance.
  Over time, as with our IRAs, an account balance will build up. And 
then, if each of us reaches the age of Medicare, at 65, with a balance 
in that account, that account either can become part of our retirement 
plan or eventually a part of our estate to our children.
  This is a much more flexible way of providing health care and, more 
importantly, it's owned by you, not by a government bureaucracy.
  I yield to the gentleman.
  Mr. DENT. Well said. And I think we should focus on solutions. We've 
talked a lot about the challenges and the problems and the costs, but 
it does come down to solutions. And I think to sum up what we've been 
talking about tonight in terms of our solutions, you, Congressman Kirk, 
have been a great leader on the Medical Rights Act. And to make sure 
that that sacred relationship between doctor and patient is not 
violated, we have to protect that principle, and that notion must be 
protected up front.
  As we lower the cost of insurance, we've talked about some ideas 
about making sure that businesses can reach across State lines, they 
can reach across State lines, realize greater discounts so they can 
provide more affordable coverage to their employees. That's a cost 
issue.
  Medical liability reform, and we've given some specific examples of 
things we can do on medical liability reform to help lower the cost of 
care. Absolutely critical.
  We want the States to be innovative. We want them to be innovative. 
And many States, I believe 34 States, have high risk pools, some of 
which work reasonably well, and others are not very effective. And so 
how can we help States innovate, to provide ways to make sure people 
receive coverage, particularly that uninsured population I think we're 
all generally concerned about. That's that population that is 
chronically uninsured, and maybe it's about 10 million people. I don't 
have the statistics in front of me, but somewhere around 10 million 
people are chronically uninsured. They're not that under-35 population, 
but people who really need help and may have a preexisting condition 
that prevents them from getting picked up. Or a person, right now, 
let's face it, a lot of people are more--what they're afraid of more 
than losing their jobs is losing their health care coverage. And I 
think we have to make sure that we take care of that population, 
uninsured who have a preexisting condition. We need to help them, 
particularly if they're high risk. And that's where we can use the 
States, I think, to be very, very innovative.
  And the other thing that we have to talk about too, and we don't talk 
enough about it, but I think people want to see medical breakthroughs 
in the United States. They want quality and they want innovation, and 
they don't want an average system.
  And I've always been struck. I visited the country of Ecuador once 
with my family a few years ago, and I was struck. The tour guide was 
telling me about their national system, and then we drove by the 
hospitals. They're right next to each other, the public hospital and 
the private hospital, and you could tell which was which visually. The 
private hospital looked like a hotel, a very inviting place. The public 
hospital, unfortunately, looked like a building that was somewhat 
dilapidated. And that's what just frightened me, two tiers of care. 
Now, this is a Latin American country. Some might call it a third world 
country. But nevertheless, that's what I saw, and I would never want to 
see that happen in America.
  Mr. KIRK. If the gentleman would yield. What you heard tonight is 
focusing on positive outcomes, making sure we reform health care, less 
defensive medicine, deploy health information technology, health 
individual savings accounts.
  We have spent far less time criticizing the President and far more 
time outlining a new positive agenda. But to close tonight, I'd like to 
turn to Dr. Murphy, who's been more in the health care system than all 
of us, to finish us out.
  Mr. TIM MURPHY of Pennsylvania. When I look at this, I want Americans 
and all of us to imagine a system that's based upon cures and based 
upon outcome, a system where doctors are in charge of your health care, 
not insurance companies, not the government. And I know that both sides 
of the aisle are deeply concerned about this. It is not that one side 
or the other wants insurance companies or the government to win. We all 
want patients to win, Democrats and Republicans alike. But we must have 
a system that's focused upon this, not that creates incentives because 
we're paying people so low to do more and more tests, not to promote 
more and more medical procedures, but to really focus on this outcome. 
We can do this through these things we're doing, the patient and doctor 
in charge. Don't create more barriers. Make sure we have all the 
efficiency there for quality. We can do those things. Imagine what can 
happen. Imagine the possibilities. And let's just not throw it out and 
say it's too difficult; let the government run it.
  With that, I yield back to my colleague, Congressman Dent.
  Mr. DENT. Just in conclusion, I just think we want to say a few 
things. I think in our health care system we certainly want our system 
to be focused on prevention, not maintenance. We want cures, not 
treatments. The system should be about doctors, not lawyers. We want 
patients to be treated like they want to be treated, like human beings. 
They want to be treated like people and not some number, something 
abstract. They want to be treated like a human being.
  And so, because at the end of the day, we all want our loved ones to 
be cared for. You don't want them to have to wait. You don't want to 
see your mother, like mine, who's 80 years old be told that she's 
contributed her whole life, relatively healthy, we don't want to tell 
her, I'm sorry, we're going to discard you now that you've reached a 
certain age. That's what we are concerned about.
  So we're going to try to work, I think, in a bipartisan manner, try 
to work in a way that embraces a lot of ideas that we can all share. 
And short of a government takeover of our system, I think we can do 
that. We have the capacity to do it. The American people expect it of 
us, and I look forward to working with all my colleagues to come to 
that kind of result.
  Mr. KIRK. I thank the gentleman, and we will be outlining a positive 
set of reforms that we think can attract tremendous bipartisan support 
this Tuesday, from the centrists.
  Mr. PETRI. Mr. Speaker, today, President Obama is in my home state of 
Wisconsin conducting a town hall meeting to promote his health care 
agenda.
  I know that the residents of my home state will tell him that they 
are struggling to keep up with the rising cost of their health care 
premiums, while others are simply unable to afford health care 
coverage.

[[Page 14881]]

  Many people in my state have lost their jobs and fear that they won't 
be able to afford their children's medication or that an unforeseen 
illness will bankrupt them.
  Some individuals who have insurance are simply staying in a job they 
don't like because their next job may not offer health care insurance.
  Others who are happy with their insurance worry that any drastic 
reform will force them into a system that will limit their choice of 
doctor or access to medical treatment.
  I agree with the President that it is time to fix the health care 
system in the United States so that all Americans, all my constituents, 
have access to quality affordable health care coverage.
  However, I strongly believe that any reform that we consider in the 
House must be based on a few important principles.
  First, it must give everyone access to quality and affordable health 
care.
  All individuals should have the freedom to choose the health plan 
that best meets their needs.
  Second, any reform should ensure a patient centered system.
  Patients in consultation with their doctors should be in control of 
their health care decisions and not government bureaucrats or insurance 
agents.
  If your child or parent is sick, you should have access to timely 
tests and treatments and not subject to waiting lists or treatment 
decisions dependent on anyone other than you and your doctor.
  Third, our health care system must emphasize prevention and wellness.
  Chronic diseases account for 75 percent of our nation's medical 
costs. By implementing programs focused on preventing such things as 
smoking and obesity-related diseases, we will not only save lives, but 
reduce health care costs.
  And lastly, any reform needs to focus on getting rid of the waste, 
fraud and abuse that plagues our current system. Approximately $60 
billion is lost due to fraud in the Medicare program alone. We can't 
afford to multiply that number through a government takeover of our 
entire health care system.
  Our health care system needs to prioritize efficiency, transparency, 
and results.
  I look forward to working with Members of both parties to ensure that 
these principles guide any legislation we will consider in the future.

                          ____________________