Michael Burgess

Mr. BURGESS

Mr. BURGESS. Mr. Speaker, I rise today to recognize Denton County, Texas. I grew up in Denton, a town where a mere 160 years ago there were more cattle than people. In fact, when my parents moved to the area in 1951, the town of Denton was a city of 20,000. Today it is well over 100,000 and the county is well over 400,000. Denton is not the biggest county in America, but as long as I can remember, it is the kind of place where you knew the mayor, the local shop owners, the bank tellers, or the manager of the local grocery store. The fabric of the community was in the businesses that helped build the community and sustain life there. The same is true today. Some of these Denton County businesses and the Chambers of Commerce that represent them are here in Washington today. I am pleased to welcome my friends and some of the local officials to the Nation's capital. I also want to thank them for helping make Denton County a place of entrepreneurship and economic opportunity, a friendly place where people are glad to see you, and I, for one, am very glad to call home. I would like to submit the names of the Denton County delegation for the Record: Mandy Calvin, Jonathan Calvin, Gene Carey, Donald Combs, Cindi Howard, Mary Jacoby, Claude King, Matt McCormick, Stan Morton, Jody Smith, Katy Taggart, and Lori Walker.

Mr. BURGESS

Mr. BURGESS. Madam Speaker, I rise today to congratulate Robert and Carolyn Crawford for receiving the Mothers Against Drunk Driving (MADD) Hero Award. The Lewisville couple received the award on Saturday April 19th, 2008, for their commitment to educating others about the dangers of drunken driving while volunteering for MADD. The Crawfords' mission began back in 1993 when their daughter, son- in-law, granddaughter and another unborn grandchild were killed in a car wreck by a drunken driver. From that moment the couple has made it a priority to inform others of the dangers involved with drunk driving. Since 2007, Robert Crawford has traveled all across the country participating in the MADD speaker's tour. He has spoken to over 10,000 people, and in these first few months of 2008, Robert has talked to almost 400 convicted drunk drivers at Victim Impact Panel meetings at the Denton County courthouse. Robert has also attended court trials to provide moral support to victims' families affected by drunk driving. MADD was founded in 1980 and has more than 2 million members and supporters nationwide. Like Robert and Carolyn, the organization's goal is to stop drunken driving. The Crawfords' avid participation in MADD can be attributed to their passionate aspiration of trying to ensure that no other families endure the pain and devastation they suffered as a result of a drunken driver's poor decision. Madam Speaker, I proudly rise today to honor two worthy citizens who strive every day to make this world a better place. Robert and Carolyn Crawford are truly deserving of the honor MADD has bestowed upon them. I am proud to represent them in the 26th District of Texas and greatly appreciative for their ongoing service to their local community and the Nation. Their passion and devotion to such a worthy cause is admirable.

Mr. BURGESS

Mr. BURGESS. Madam Speaker, I rise today to congratulate the Texas Woman's University Pioneers gymnastics team on winning first place at the 2008 USA Gymnastics Women's Collegiate National Championship in Shreveport, Louisiana. Through a show of dedication, passion and solidarity, the Pioneers secured the USAG National Title on Friday, April 18, 2008. The Texas Woman's University Pioneers rallied dramatically to come from behind and win the National Title. Their score of 194.700 was not only sufficient to clinch first place, but was also the team's highest score of the season. Additionally, many members of the team met or exceeded their personal best scores in the individual events. The Pioneers seized their first USAG National Title in 1993, with additional wins in 1994, 1995, 1996, 1998, 2000, 2003, and 2006. Their success at the 2008 USA Gymnastics Women's Collegiate National Championship gives them a total of nine National Titles in the last 16 years. Many titles and awards have been awarded to the team as a result of their hard work and dedication, as well as the support and guidance of head coach Frank Kudlac, Assistant Coaches Lisa Klein and Tim Rivera, Graduate Assistant Gretchen Goerlitz, and Trainer Kris Ring. TWU team members Courtney Arno-Templet, Jennifer Kingsbury, Nicole Poling, Michelle Graves, Alexa Brennan, Keri Miller, Leslie Pladson, Amie Boles, Amy Hulbert, Brista Michael, Kelsey Nixon, Brittany Parker, Tonya Pipkorn, Abbi Thomas, Mollie Blessing, Kristie Costa, Caroline Hilpisch, Jennifer Liberato, Lauren Sizemore, and Amanda Walker have carried on the Pioneer's legacy of excellence, and are outstanding representatives of their school and the community. Madam Speaker, I rise today to heartily applaud the efforts and success of the Texas Woman's University gymnastics team. Their legacy of hard work and excellence shall continue to inspire others to go after their dreams. I am extremely honored to represent these fine young individuals in the 26th District of Texas, and I am confident that they will continue to achieve greatness in future endeavors.

Mr. BURGESS

Mr. BURGESS. Madam Speaker, I rise today to congratulate Dr. Jerry W. Roy on receiving the Annual Silver Eagle Award. The award will be presented to Dr. Roy by the Longhorn Council, Boy Scouts of America, on April 29, 2008. The Annual Silver Eagle Award is presented to individuals who exhibit excellence in their selected field and have embodied the Boy Scout Oath and Law in their personal and professional lives. Each year the honoree is someone who has shown dedication to improving their community, an important aspect of the morals and values of scouting. Dr. Roy has served as the Superintendent of Schools for Lewisville Independent School District since June 2001. Prior to joining Lewisville ISD, Jerry served Goose Creek CISD in an array of positions ranging from teacher and coach to Superintendent over the course of 28 years. Dr. Roy received his bachelor's and his master's degrees from Eastern New Mexico University and his doctorate from Baylor University. Among his many achievements, Jerry was named a Select Distinguished Alumnus by Baylor University in 1996 and is a recipient of the Texas Superintendent of the Year Award by the Texas Association of School Administrators. Madam Speaker, today it is my honor to recognize the achievements of Dr. Jerry W. Roy. He has demonstrated a level of commitment and accomplishment that is truly extraordinary, and deserves our sincere appreciation and respect. It is a privilege to represent Dr. Roy in the 26th District of Texas. I look forward to observing the positive impact he will continue to have on our children's educations, both now and in the future.

Mr. BURGESS

Mr. BURGESS. Madam Speaker, you know, it is said that nothing in the world is certain except death and taxes. And I'll tell you, being a physician in my former life, that sometimes even death is a little less complicated than our tax system. The complexity of the tax code is a consequence of countless deductions and exemptions that are aimed not at collecting revenue, but steering a social agenda. And the result is a Federal law that is fraught with opportunities for avoiding taxes and full of loopholes to be exploited, all at the expense of fellow Americans. My criticizing the tax code is as American as apple pie and baseball, and for good reason, because every year Americans spend billions of hours and billions of dollars, and that's not counting the billions of hours that we spend complaining about the tax code. Time is money, and time should be spent growing the economy and creating jobs. There is a strong prescription for real change in our tax code. We caught a glimpse of it when Ronald Reagan cut the tax code in half back in 1986. As a result of that reform, the economy grew, revenues increased, and jobs were created. The prescription is pretty simple: Flatten the tax, broaden the base, and shift the burden away from families and small businesses. And we do have a practical and effective blueprint, it's called the flat tax. Back in 1981, Robert Hall and Alvin Rabushka proposed a radically simple structure that would transform the Internal Revenue Service and our economy by creating a single tax rate for all Americans. Today, several States have implemented a single rate tax structure for their State income tax, and from Utah to Massachusetts citizens are realizing the benefit. In Colorado, a single rate tax generated so much income that it was reduced 10 years after its implementation. In Indiana, the economy boomed after a single rate went into effect in 2003, and since that time the corporate income tax receipts have grown by 250 percent. Now, several people in Congress are working on the problem. I have a bill, H.R. 1040, which is a voluntary flat tax. A companion bill was introduced by the senior Senator from Tennessee just this past week. We have bills from David Dreier, the gentleman from California, Paul Ryan from Wisconsin, all trying to accomplish the same goal, and it is so simple. You have a single rate, you have a single piece of paper. You put in your name, just a little bit of identification data, write in your income, there's a line for personal exemptions, calculate your deductions from personal exemptions and calculate your taxable income, multiply it by a flat rate, subtract the taxes already withheld, and you're done. And what did that take? Not even 30 seconds. No more expensive tax attorney bills, no more hours of stressful research, no more headaches. It is much less costly, saving the taxpayers more than $100 billion per year. And it would increase tax compliance. The result: Increase in personal savings, and there is a stimulus package that would have an immediate effect on our American economy. Recent polling by a group called American Solutions shows that over 80 percent of Americans favor an optional one-page tax return form with a single rate. Now, we hear a lot of talk about change this year. You practically cannot turn on the television without some political commercial talking about change. Well, let's consider how change could improve the most complicated of institutions, the Internal Revenue Service. And more importantly, consider how that change could deliver prosperity and return time, the precious commodity of time, to the American taxpayer. Now, that's a stimulus package worthy of everyone's vote.

Mr. BURGESS

Mr. BURGESS. Madam Speaker, I rise today to congratulate Mr. Gregory Matthew Proske, for attaining the impressive rank of Eagle Scout. Gregory has been involved in the Boy Scouts of America for the past 11 years. Joining as a Tiger Cub, he has shown dedication to the organization, successfully moving up the Boy Scout ranks over time. Gregory is a proud member of Troop 434 in the Trailblazer District in North Tarrant County, Texas. Gregory went through a rigorous process to receive this honor. A scout must fulfill seven main requirements before achieving Eagle status. He was required to be active in his troop for a period of at least six months after he had achieved the rank of Life Scout and to demonstrate that he lives by the principles of the Scout Oath and Law in his daily life. He earned the expected 21 merit badges needed to qualify and served in a position of leadership in the scouts for at least 6 months. Gregory took part in a Scoutmaster conference, successfully completed an Eagle Scout board of review, and provided the Fort Worth community with a service project. Gregory reworked two planting beds at St. John the Apostle Catholic School in Fort Worth, Texas for his project. A student at Nolan High School, Gregory plans to attend Texas A&M University, where he intends to become a member of the Corps of Cadets. Additionally, Proske aims to serve in the Air Force as a fighter pilot. Madam Speaker, becoming an Eagle Scout is only the most recent in a string of impressive achievements, and I am confident Gregory will continue to excel in his future endeavors. I commend Gregory for his penchant for service, his commitment to the community, and this most remarkable accomplishment. He is a role model, both to young people and the entire North Texas area, and I am proud to represent him in the United States Congress.

Mr. BURGESS

Mr. BURGESS. Madam Speaker, I come to the floor tonight to do what I often do, spend a little time talking about health care. The hour spent in this way, I think, delivers for the Speaker and other Members of the House perhaps perspectives on health care that you wouldn't hear in any other location. I've heard the hour that I spend down here talking about health care referred to as the ``House call.'' So perhaps that's a good way to look at it. Madam Speaker, we have got a big job ahead of us here in this Congress and the next Congress. We are going to be talking about health care from all sorts of different perspectives. And really where we ought to be focusing our efforts, where we really ought to be channeling our efforts is delivering better care at a lower cost. And you know what? The good news is there are some examples out there in the real world. There are some examples in the real world that this House can embrace and expand upon and maybe accomplish this thing that we all want to accomplish, which is delivering more care to more people in our country at a better price. But we don't need to do it at the sacrifice of freedom because freedom is the foundation of life here in America. Without our liberty, we aren't America. So unlimited options, the unlimited opportunity that people have in this country, that's what makes this country great. I always feel a little inadequate when I go into Starbucks because all I can do is order a cup of coffee. But other people go into Starbucks and are able to order from a wide variety of menu options. Who would have believed, when I was growing up, that there can be 57 different ways to spend your money in a coffee shop all to purchase a cup of coffee? Madam Speaker, innovation goes hand in hand with the ability to make choices. The combinations that are available for all of us to choose from have, in fact, engendered that market, and the young folks of today wouldn't have it any other way. And I think that is exactly as it should be. The same kind of options, the same kind of inventive technology and the same kind of innovation should be what makes health care great, as well. And, Madam Speaker, when it comes to innovation in health care, the United States is the world's leader in health care. Now in October of 2006, in the New York Times, no less, and please don't tell anyone back in my district that I read the New York Times, but in October of 2006 in the New York Times a piece by Tyler Cowen talked about just that issue. He talked about how 17 of the last 25 Nobel prizes in medicine have been awarded to American scientists. He talked about four of the six most significant breakthroughs in the last 25 years having been developed in the United States of America, things like the CAT scan, things like neuro treatments for hypertension, statins to lower cholesterol, coronary artery bypass surgery, all the product of the inventive American mind. And, as we all know, American scientists are not done with advances in medicine. And we are now counting on the next generation of doctors and scientists, a whole new generation, to produce whole new generations of breakthroughs, things like single gene therapy, advancements in protein science, and the incredible revolution in the way information is transmitted and handled. All of that is on the threshold. All of that is just over the horizon and going to have a significant impact on the delivery of health care in this country. And these breakthroughs occurred because there was an environment that encouraged innovation, an environment that embraced innovation, and yes, an environment that sometimes tolerated a little bit of chaos because that, after all, drove some of that creative energy. And this environment is better known as a competitive environment and one based on individual choice. Innovation and choice are the hallmarks of our health care system. But it doesn't mean that we can't make a good thing better. Now, Madam Speaker, as someone who has spent 25 years in the practice of medicine, I do believe I have a unique perspective on some of the issues that face our Nation's physician workforce, and certainly some of the issues that face those of us in the House of Representatives here up on Capitol Hill. But I do have the unique perspective having lived in both worlds. I have had the pleasure, the opportunity and the high honor of sitting in an examination room and talking with a patient, being in the operating room or the emergency room or the delivery room with a patient. I have filed claims. I have filed claims with private insurance companies, Medicare and Medicaid, and dealt with the almost impossible bureaucratic nightmare that those claims have become, and also discovered that with the advent of electronic submissions for claims, some clever individuals delivered about 1,300 different codes for denying those claims. I figured out how to build my business, sometimes in an environment that was quite hostile to small business. I figured out how to pay my employees, how to keep the lights on, how to provide health insurance for my employees. Sometimes I have the burden of being the only one in my committee, the Committee on Energy and Commerce, the Health Subcommittee, the only one who has had experience with the practice of medicine, the only one who has ever picked up a pen, written a prescription, looked a patient in the eye, counseled them for risks and benefits and costs, a significant burden to carry as we go through bills like the FDA Reauthorization bill that we went through this summer. I have also had the benefit of some very good advisors along the way, some of my professors in Medical School, Jack Pritchard, who was the head of my residency program at Parkland Hospital, and my own mother, who told me, ``don't you ever let your office put me on hold on that telephone again. And further,'' she went on to say, ``don't let me ever hear that you refused to take a Medicare patient.'' And she never did have to hear that. But what does this experience give me? Practical knowledge is absolutely critical when you delve into trying to craft the best public policy. And this practical experience is invaluable, especially in an environment that is as rapidly changing as our health care system and the focus of so many across the country. Now, there is widespread recognition that there is some change in the air. You can scarcely turn on the television at night and not hear the word ``change'' mentioned over and over again. In fact, I told an audience of doctors the other day that I haven't heard the word ``change'' so many times since I was an intern in the newborn nursery at Parkland Hospital. There is a widespread recognition that change is coming in health care. There are a lot of different ideas on how to accomplish it. Presidential candidates have their ideas. A lot of Members of Congress have their ideas. And somehow we are all going to have to come together with these ideas to try to get the best policy going forward. Now one of the things that has become absolutely apparent to me as I have spent a good deal of time studying this issue is that health care, not disease, but health care, the administration of health care, begins and ends with those who actually deliver the care. That means those that actually deliver the care, the doctors, the nurses, the technicians, really are the ones who should be on the front-lines leading that transformation in health care. A lot of health care professionals don't realize the critical role that they can play and, in fact, they must play in shaping the health care debate. If the professionals who work in health care, if the doctors and nurses are not active and engaged, they are going to be forced to play by the rules that someone in this House will set for them, someone in this House who may not have a clue as to what goes on in the day-to-day practice or administration of medicine. So every chance I have, I meet with doctors, nurses, physical therapists, technicians, either here in Washington or my district back in Texas, listen to them about what their concerns are, try to understand the problems that they are having, problems that may have changed in the few short years since I left the clinics, and try to talk to them about how to not just complain about the problems of today, but how to craft the solutions of tomorrow and how to effectively communicate that to those who are policy makers, whether it be in a Federal agency or here in a legislative body. I am firmly convinced that if our health care professionals don't lead, we are going to have to accept the prescription given to us by those in the Federal agencies and those that may be sitting in the legislature this year, next year or the year after. Now there is no sane person who would try to conduct their own operation. Most doctors, if they have controlling sense, wouldn't try to prepare their own income tax form. Doctors and nurses, health care professionals, need to be the ones to lead this change. And I will tell you something that just makes me stop dead in my tracks is when I hear people talk about a single payer government run system. It scares me to death. Now you stop and think, where is the largest single payer government health care system in the world? And it is here in the United States. It is our Medicare and Medicaid program. This body, the United States House of Representatives, currently controls about 50 cents out of every dollar that is spent in health care in this country, and that is an enormous amount that is spent on health care, 15, 16, 17 percent of our gross domestic product, upwards of $2 trillion a year, 50 percent of that originates on the floor of this House of Representatives. So government already controls 50 percent of the market. When people talk about expanding that role, I have to stop and ask myself, well, are we doing a good job with what we are already controlling? And I don't think there is anyone who would stand up and say, yes, you are doing such a good job, we want to turn more of it over to you. But government can play a role by encouraging coverage and helping create programs that people actually want and empowering them to choose between options. And really, we just have to go back a year or 2 or 3 to look at the experience with the part D part of the Medicare program signed into law late in 2003. The prescription benefit became available in January 2006, and now we are coming into the beginning of our third year of experience with that program. And sure, there were some bugs early on. But if you look at some of the numbers now, and probably 90 percent of eligible seniors now have some type of health care coverage, which is an incredible change from when I took office in 2003. Eighty percent are happy with the program. Well, those are numbers that I will just tell you controlling practitioner would love to have. When we crafted that program, the smart people over at the Center for Medicaid and Medicare Services put their sharpest pencils to the program and said, okay, here it is. We can devise a program that will provide coverage for seniors for $37 a month in premiums. Well, now the average plan costs $24 a month. So what happened on the way to that $37 a month premium? Well, I will tell you what happened. The plans were opened up for competition and bidding. And guess what? The private sector found they could do things a little cheaper, faster and safer than those in the Federal agency. And I say more power to them. They have crafted different plans. Not everyone needs the same prescription drug plan. There is the ability to buy a prescription drug plan and change it once a year if your coverage needs change. It is a phenomenal tool to put at the hands of our seniors who are covered under Medicare. Again, who is going to argue with something that delivers more health care, lower cost and better quality? It is just too simple to argue with. That is the type of program on which we need to be focused. But you hear so many people talking about, well, people won't do the right thing if you leave them to their own devices. You have to put a mandate on it. You have to put an individual mandate, or we have to put a State mandate, or we will have to put an employer mandate where we require people to take up this coverage; as opposed to creating programs that people actually want, pricing them in a reasonable range, making them available, and helping people understand the wisdom of taking up that coverage. There are a variety of studies that have been done on mandates. Most recently there was one in Health Affairs in November of 2007 looking at the experience and the history with mandates. I think the title of the article was ``Consider It Done'' because it was the opinion of the article that mandates would just simply have to be the next step. But in this country, we have 50 percent of people with no health insurance and a voluntary program. Well, you say, we could do better with mandates, couldn't we? Well, for mandates to work, you have to have, of course, a widespread dissemination of knowledge that the mandate is required. You have to have widespread dissemination of the knowledge of the penalty for not taking up the good, service or product that has been mandated, and you have got to have a pretty strict enforcement mechanism, and people have to be aware that that enforcement is going to be swift, sure, and it is going to be painful when it happens. Well, where in real life in America today is there such a system? Hey, we are coming up on April 15. How about the Internal Revenue Service, for example? With the Internal Revenue Service, there is broad understanding throughout the population that you have to pay your taxes. There is a broad understanding of what will happen to you if you don't pay your taxes. Now there may be nuances, fine nuances to the Federal law, whether it is prison term or a fine, but people do understand there are a plethora of unpleasant circumstances for those who don't pay their taxes. And what is the take-up rate, if you will, on this generous offer from the Internal Revenue Service? Well, it is about 85 percent. You have about 15 percent of people who don't comply, even with those relatively draconian and well-known practices within the IRS if you don't comply. So it does beg the question, if we simply go up there and say, you have to buy an individual insurance policy or there are going to be consequences to that behavior which will cost you, how do we know we are going to get up-take greater than the 85 percent up-take that we have today? And indeed, some of the experience early on with some of the States who have experimented with this have found that some people look at the cost of the insurance, and since it is now required, guess what? The cost went up because it is no longer a free market where you have a willing seller and a willing buyer. You have a buyer who is being coerced to buy that product, so the price goes up. And so some people look at that and say, that is pretty costly, I will just pay the fine, thank you very much. So then we are in a very difficult situation. We have someone paying a fine for not carrying health insurance. And if they get sick on top of it, then they are still a burden on the hospital, doctor, the State, whoever has to pick up the cost for that hospitalization. So I would just urge my colleagues to be circumspect, to be careful when we talk about mandates and also look to the experience we had with Medicare part D where then a program was created that didn't exist before, and it was created in such a way as to put something out there that people actually wanted, put something out there that people actually saw as adding value to their health care coverage, put something up there that would be useful to people. Not simply putting a requirement out there, a penalty if you don't comply, and then people are constantly gauging, well, would it be better just to pay the penalty and not comply and not have the more expensive health insurance, which I, after all, don't need, because I will never get sick. So the part D program provides us a model that we could use when we are trying to see about developing those types of programs. And in a few minutes, let me cover with you some of the other models, some of the experience that has recently been gathered from the private sector, because I think that is useful to instruct, that is useful to inform this debate as well. But the experience of part D in Medicare showed us that sometimes the best thing that government can do for health care is just simply get out of the way and let people, providers, third-party payers, work this out between themselves. If we create the right conditions, the right environment, the right set of circumstances and let the private sector develop the innovation, sometimes the cost savings can be substantial, the quality can be increased. And, after all, isn't that what we want, more care, better quality, lower cost? Who can be against those three things? Now, Madam Speaker, I can remember a time when I was growing up that you could only have one kind of telephone. It was black, it was tethered to the wall and had a rotary dial. Over 10 or 15 or 20 years time we saw some technical innovation. It was still black, it was still tethered to the wall, but it had push buttons instead of a rotary dial. Then came deregulation. Then came many phone companies that were able to compete on the open market, compete for the individual phone user's business. And the story tells itself, because nowadays you have cell phones on every belt buckle and hip pocket. You have text messages. You have a whole generation of young people who know how to text better than they know how to communicate with the king's English. So change has come to this industry, not because the government said it would be a good idea for everyone to have a cell phone on their belt buckle or a cell phone in their hip pocket. It came about because industry, the private sector, was allowed to innovate, it was allowed to experiment, it was allowed to sometimes fail, and produce these products that people actually wanted and that deliver value, real value, to people's lives. Many, many years ago I got a pilot's license. A lot of people learned to fly in a Piper Cub. The Piper Cub is truly a marvel of engineering science. But would anyone argue that the 737, the 787 that is new this year, would anyone argue that that is not a better way to move large numbers of people from one end of the country to another, rather than having each of us fly our own individual Piper Cub? You know, you can't help but when you have this kind of discussion recognize that the invention of the Internet really changed a lot of things. Of course, now we have the Internet, we have e-mail, we have Web sites, we have YouTube, all of which were absolutely unimaginable as short as 20 years ago. Here is the secret. Here is the secret to that success. The private sector, with its ability to tolerate innovation, with its ability to tolerate risk and reward, its ability to tolerate a little bit of experimentation, and, again, a little bit of chaos, can deliver that kind of value. I have personally experienced this in my years practicing medicine, and I have learned more about it since I have come here and worked legislatively. Last fall, last November, I believe, there was a big health care symposium put on downtown by the periodical Health Affairs, and the morning panel was going to be four smart people. But one of them was a CEO of a large insurance company, an insurance company, quite honestly, that I had some trouble with when I was a practicing physician. So I thought, well, I want to go hear what Dr. McClellan has to say. I want to hear what Dr. Sarhuni from the National Institutes of Health has to say. But I will probably go for coffee when this CEO gets up to talk. But the CEO gave the most important part of the talk that morning. This particular individual talked about running his large insurance company. He talked about his 45,000 employees, 15 percent of whom were devoted to the development of information technology. If that 15 percent had been a stand-alone software company, they would have been one of the largest in the United States of America. Well, that is a pretty powerful notion. I stopped and did a little quick mental calculation of my own and I thought about my five or six physician practice back in Louisville, Texas. We were faced with the specter of Y2K and I had to upgrade my ancient and ailing computer system, and although at the time I thought it cost an incredible amount to do that, just doing a quick back-of-the-envelope calculation, I spent about .015 percent of my annual budget on information technology. So was it any wonder that that particular insurance company could run rings around a small practice when it came to the managing, the flow of information, the speed with which they could process information? I was very intrigued by the fact that this individual said we have learned a lot about the progress of disease and the course of disease, not by studying clinical data, but by simply analyzing the financial data available to us within our information technology system. For example, if we see A and B, we are very likely going to see C, and of those patients who have C, some are going to go on to D, and D costs a lot of money. So we are far better off intervening at A or B and not having to buy as many Ds as we might otherwise have to buy. He gave the example, and, of course, my practice was not in taking care of heart disease, but he gave the example of a middle-aged individual suffering a myocardial infarction or heart attack. He said we know from studying our data that this individual is very likely to suffer about a bout of significant depression somewhere along the line in their recovery, and in fact that bout of depression may be so significant that it precludes that individual complying with their exercise program, their cardiorehabilitative program, and very likely puts them at risk for a second cardiac event, or perhaps even consigning them to congestive heart failure in the future, which is terribly expensive to treat within and out of the hospital and lots of expensive medications. So he found that by intervening early on with an aggressive assessment for depression, an aggressive treatment for depression, that they were in fact able to get better compliance in their rehabilitation, and ultimately lowered their cost at the out end because of this very aggressive management program that they had developed. Again, that is all done with financial data. They were just beginning to be able to incorporate clinical data. They have got some problems with that because of some of the constraints, regulatory constraints that we here in Congress have put on them. But, nevertheless, it told a great story about the types of things that can be done in managing information in this brave new world, where so much information is available and so much can be assembled and analyzed at a very rapid rate. We are coming up on a period of rapid learning unlike anything ever seen before in any branch of science, and certainly medicine is not going to be any stranger to that. When I was in training in the 1970s, when I was in practice in the 1980s and 1990s and early 2000s, it was very difficult to encounter a patient late in pregnancy with an elevated blood pressure. You never knew whether this was going to go on to a much more serious condition or whether in fact this was simply a transient problem that would be self-limited and of no consequence, and you had to treat them all as if they were the most serious consequences, sometimes even requiring hospitalization for a period of observation until things got squared away. There are tests that are just around the corner that will analyze for a couple of things in the bloodstream that have a very high predictive value as to whether or not someone will develop a condition called preeclampsia over the next 14 days. What a tremendously powerful tool to put in the hands of clinicians. And how many dollars is that going to save? It may well be an expensive test when it first comes out, but how many dollars is it going to save for unnecessary hospitalizations? Sometimes we would have to take someone off from work, not knowing whether they had a more serious disease or whether this was going to be a benign self-limited event. But you just couldn't take a chance. You just couldn't take that risk of not counseling that patient to behave as if this was going to be the more serious of the two conditions. How great it will be for the next generation of doctors who practice my specialty of obstetrics to be able to have that test at their disposal so they can adequately counsel their patients, recommend to their patients the correct treatment course for them, and, in the process, not overtreat a large group of patients, and, very importantly, not undertreat a much smaller but potentially much more lethal condition in a smaller group of patients. Yesterday up here on the Hill I was very fortunate to be able to host a panel with several speakers that included the former Speaker of our House, Newt Gingrich, who came up on the Hill to talk about change in health care reform and transformation in health care. Everyone knows that former Speaker Gingrich is a real leader when it comes to health care transformation. In fact, he has made that now his life's work here in Washington. We are certainly grateful for, first off, for his service in the House, but we are very grateful that he has devoted his enthusiasm, his considerable energy, his considerable ability to generate new ideas and to recognize great ideas when they are presented to him. We are very fortunate to have his expertise in Washington. So it was really a great experience to have him involved in this panel yesterday. Several companies came in. The whole premise of the seminar, the whole premise of the series, was, just as I started out this talk, better health, lower cost, examples from the real world. These were four individuals that came in and talked to us about real world experience and how they have been able to deliver their product, health care, in a more timely fashion, better quality, lower cost. Let me share with you some of what I learned. It was a very action- packed hour-and-a-half that we had yesterday. But let me share with you just a little bit of what I have learned with talking to some of those innovative medical leaders. One of the central themes that kept repeating itself over and over again was the issue of personal responsibility. It is important to have someone invested in the concept that it is a good idea to take care of their own health and to be personally invested in their own health care, and a lot of the discussion came around to a concept that is popularly called consumer-driven health care. We have talked about that a lot up here on the Hill. The fact is that because of our third-payer system, so many people are actually anesthetized to the true cost of their health care. All they want to know is can they see the doctor when they need to, how big is the copay, and if I need an expensive test, well, is it covered by insurance? If is not, I don't want it. If it is, I will take two. Now, my own staff tells me that when they receive an explanation of benefits, that little form, that little EOB form that you get from your insurance company after you have a medical event or an intersection with the health care system, whether it be doctor or hospital, most people take that explanation of benefits, it says on it ``this is not a bill,'' so what happens to it? It goes straight into the trash. They never look at it. They never try to assess what is or is not on it. So they are consuming the health care service, but not really are conscious as to the cost. As a consequence, there is little or no incentive for anyone to take any proactive stance on the health care that is delivered to them, the health care that is offered to them. There is very little incentive for someone to actually take an active role in that. There is an old saying from P.J. O'Rourke, if you think health care is expensive now, just wait until it is free, and that is the concept. If it doesn't cost anything, then, again, yes, nothing but the best will do, and let's be sure we have plenty of it, and don't be too long about getting it to me. In a consumer-driven health care system, people would be more conscious of their health care cost, more conscientious, and more likely to make wiser decisions about lifestyle choices, about things that they might do to alter a lifestyle choice, to be able to maintain their health. There was a study take that was talked about yesterday that found that in one hospital group, the patients who were in a consumer- directed health care plan were twice as likely as patients in traditional plans to ask about the cost, and three times as likely to choose a less expensive treatment option. And this is just not for young healthy patients. Patients with chronic conditions, chronic disease states, were 20 percent more likely to follow the treatment regimen recommended to them, to follow that regimen much more carefully. Now, there is no shortage of critics of consumer-directed health care up here on the Hill. People will argue that it will cause patients, consumers, perhaps those less wealthy, perhaps those less educated, to avoid needed and appropriate health care because of the cost burden and the inability to make informed appropriate choices. One of the companies yesterday that discussed this at the panel has data that they say directly contradicts that criticism. And I don't doubt that that is correct, because back in the late 1990s a comparison was done with a country that had a large component of what were then called medical savings accounts or consumer-directed health care, in contrast to the United States, which at that time had no high deductible consumer-directed health care options, no MSA options, and that was in a lead-up to the beginning of the MSA era in 1996 or 1997. Experience with that country that had about a 50/50 mix of consumer directed plans and what might be called standard indemnity plans found that there was no dialing back on needed services. There was no pulling back on services that were critical for the maintenance of a person's health, but more optional types of treatments perhaps, were the ones that had a lower uptake. Now, a Midwestern health care company introduced consumer-driven health care plans to its 8,600 employees. They also left their traditional PPO plan in place. In the first year, 79 percent of their employees chose one of the four consumer-directed health care options. These health plans had several important features. Preventive care is free. Now, what a concept. That means that the annual visit to the doctor, required screening exams, don't cost money. They are provided for you free of charge. Employees also receive financial incentives to change behaviors like smoking or those who need to lose weight. They also receive financial incentives to manage chronic conditions like asthma and diabetes more carefully and become active participants in the management of their disease. The results so far have shown that they had 7 percent of health care dollars spent on prevention compared to a national average that was about a third of that. Nearly 40 percent of employees take an annual personal health risk assessment and earn $100 for their trouble. But a 40 percent uptake on an annual health risk assessment is a significant number. Five hundred employees have quit smoking, their employees have lost a total of 13,000 pounds through their weight management programs with appropriate monitoring, 13,000 pounds. Talk about your biggest loser or your biggest winner, clearly, that's a program that is paying off. Now, the average claim increase of 5\1/2\ or 5.1 percent the last 2 years is compared to a national trend of over 8 percent, so there has been a 3 percent savings on the average claim. The company has, again, collected an impressive amount of data, and we could learn from their example, from their experience. There are some other companies we can learn from as well. There was another very large health insurance company that was on the panel. Then, again, it was a health insurance company with which I used to have some differences, but they described their incentive-based benefit design. They provide or have available to their employees one of the high deductible plans. A high deductible plan with a large deductible is going to cost less than a plan with a lower deductible. They offer a plan with a high deductible. But without an increase in premium, the individuals, the families can lower that deductible to $1,000 by changing things like weight, smoking, serial cholesterol measurements complying with annual screening exams. A $5,000 deductible at a lower policy rate then becomes a $1,000 deductible at the same rate. It's a significant cost savings for that patient or that family, that employee, where they get the benefits of a very high deductible plan but the deductible comes to them in a much more manageable size. We also heard about some of the very positive results driven by consumer-driven health plan options. Now, the speaker who talked about that actually took me back a little bit, because I do remember back 1976 and 1977 the MSAs first became available. They were called the Archer Medical Savings Account after Bill Archer, chairman of the Ways and Means Committee from this body who had worked so hard on that over the years. Phil Gramm, then a Senator from Texas over on the other side of the rotunda, had worked on that on the Senate side. As part of a large bill that was passed to increase insurance portability, they got a demonstration project, a pilot project that was going to allow 750,000 so-called high deductible policies or medical savings accounts to be sold. I heard about that, and I thought I don't know if I can sign up quickly enough to be in that first 750,000. But the reality was I needn't have worried. There were so many restrictions placed on that insurance that the uptake was, in fact, probably only one-tenth of what were available. There weren't many insurance companies that offered it. The premiums had to be paid for with after-tax dollars. Many of the things that we now think of as being associated with a health savings account just weren't available back in those early years. But, still, although the amount that you could put away in a medical IRA or a medical savings account wasn't nearly as large as what you could do today, still, it was a significant amount of money. I purchased one of those myself back in 1976 or 1977, keeping it until I started service here in the House of Representatives, where at that time it wasn't available. But that chunk of dollars has sat there, and with the time value of money, earning interest, compound interest, the miracle of compound interest, year over year now is a sizeable sum of money that is available to my wife and I for health care needs. Whether it be pre- Medicare or post-Medicare age, that money is still going to be available to us as additional cash that can be spent on health problems. The doctor that talked to us about the nuances of the newer health savings account talked about how in his experience 88 percent, that's nearly nine out of ten account holders, carried a balance from 2006 to 2007. The actual percentage of people who either did not contribute or used up all the money that they had contributed to their medical IRA or their health savings account was only about one in 10, and the average balance for people across all income levels was $597 at the end of that carryover from year to year. Now, you have to ask yourself how many Americans, how many families are encouraged to live a healthier life, conserve their health care dollars, like these individuals have done. These guys are making personal decisions about prevention, they are making personal decisions about life-style changes, they are managing chronic conditions, actively engaged in the management of those chronic conditions. As a consequence of those behaviors, they are holding down costs. Now, most other populations with regular private indemnity insurance are not. The key is bringing about the necessary change to effect that transition from an individual who is really indifferent as to the cost of the expenditure on health care to one that is actively managing the cost of their health care. But there are other tools we can put in the hands of people. We hear people talk about transparency. I have, in fact, introduced legislation dealing with transparency. We have got some good things going on back home in my home State of Texas as far as some of the web-based transparency information and data that's out there as far as hospitals are concerned. The Centers for Medicare & Medicaid Services has, in fact, published their own data up on the web. So as more and more information is gathered, patients, individuals, can have access to greater and greater amounts of information detailing what is available to them as far as what if the difference between one hospital and another is substantial as far as the cost of rendering a particular service, regardless of what it is. But the ability to go on the Internet and be able to compare the cost of those two services, that's a tremendous tool to put into someone's hands. If you can further refine that to allow an individual to put in information about their particular health insurance or their health plan, or if they are a self-pay, to make that information available, to then go on and compare between the institutions, where would their best benefit be derived? Where can they most adequately get the type of care that they want and, of course, there does have to be quality data published alongside that. It can't just simply be the cheapest care at the cheapest cost. You want the best care at the most reasonable cost, or, as Dr. McClellan, former administrator of Centers for Medicare & Medicaid Services always talks about the four Rs, the right care for the right patient at the right time and the right price. These are going to be critical aspects of any health care policy that we craft in this House. We simply have to keep those basic tenets in mind. One of the speakers yesterday talked about in education the fundamentals of the three Rs, reading, writing and arithmetic. He went on to say in health care the fundamentals should be risk, responsibilities and reward, because, indeed, the risks are those that must be balanced against the possible benefit. The patient needs to be an active participant in that. They can no longer simply be passive passengers on the journey through the health care system. They actually have to play a role in taking responsibility for their own care. The rewards, the reward aspect, the incentive aspect is often given. Well, while we are real good about being punitive in this body, we are pretty stingy when it comes to rewards or incentives. I could give you several examples of that. One that comes to mind is the bill that was introduced late December as far as trying to encourage physicians for e-prescribing. The reward was a 1-percent increase in Medicare fees for a physician who participated in e-prescribing. The penalty 4 or 5 years later was a 10- percent reduction if they don't. On a $100 procedure, and I will tell you there are not many office procedures under Medicare that pay $100, but let's use that number because it makes the math easy. In a $100 procedure administered in a physician's office if they utilize an e-prescribing module to administer that patient's care, they are going to get $1 extra for that $100 procedure or interaction, visit, whatever it was. That's okay, $1 is $1, and it's better than nothing. But if you don't participate in 4 years time, 5 years time, that's going to be a 10-percent reduction. That same $100 procedure or test or interaction now will pay $90. We are so focused on the punitive in this body, and we never focus on the front end of the problem, which is assigning the appropriate dollar amount or the appropriate incentive. Now, go back to my earlier example of that large insurance company, and again an insurance company in the past which I have had great difficulty with, but what innovative thinking they have. They are offering a patient the ability to reduce from $5,000 to $1,000 their risk, their cost, on a deductible with no increase in premiums if they will do four simple things, lose a little weight, stop smoking, exercise regularly. If you have asthma or diabetes you participate in a disease management program, and your deductible falls from a $5,000 deductible down to $1,000, and, oh, by the way, that premium that was less because you had a $5,000 deductible, it doesn't go up. It doesn't go up when that policy changed. That's the kind of innovative thinking I am talking about when I say we must balance the risk and rewards, because we haven't been good about doing that. Everyone likes to quote the Rand study when they talk about information technology and programs like e-prescribing. The Rand study says that if we go to electronic prescribing in our health care system in this country, we are going to save $77 billion in 15 years, a tremendous amount of money. Now, most of that savings is, in fact, out toward the end of that 15- year time. They don't really talk very much about who is going to pay for the cost of the implementation, putting the software, the hardware, the training, the upkeep of the software, the maintenance of the software, the time spent on the learning curve for all of these small offices across the country that have to make that investment. That's just going to be a given, but it will be worth while because we get a $77 billion savings at the end. What is missed so often in this study is the last paragraph. At the end of a very large study, it talks about the incentives to make this happen, to get us to this happy place where we are saving $77 billion with e-prescribing. The incentives have to be early. The late innovators are going to be rewarded, so you have to have the incentives arrive early, and they have to have a time limit otherwise people will wait and see if the technology doesn't improve because, after all, they know they will have to pay for the hardware, software, the training, the upkeep and maintenance of the software. Finally, the third thing is the incentives must be substantial. And again, on both sides of the aisle, we forget that very important point. So while we hear the Rand study quoted over and over again, please remember the incentives are early, they are time limited, and they are substantial. That was the economic modeling that got them to the happy place where they were saving $77 billion in the 15th year of that study. If we concentrate on the fundamentals, getting back to the fundamentals, focusing on the risk, talking to our patients about responsibility, that is not so hard to do; but we should obviously compensate the health care professional for their time, for counseling about that responsibility, so that we don't forget the reward for the provider, to be sure; for the patient, to be sure; for the taxpayer, the American taxpayer if it is on that 50 percent of every health care dollar that is spent in the largest single-payer, government-run health care system in the world, which is Medicare and Medicaid today. So the right prescription for health professionals has to be focused on these three areas when it comes to providing the real direction for health care reform. I know I am not alone when I say that I am going to use these principles as my guiding star as I continue to work on health care policy. I hope I can convince my colleagues both in committee and here in the House of Representatives to focus on those same issues as well.

Mr. BURGESS

Mr. BURGESS. Madam Speaker, I rise today to recognize Joel Estrada of Lewisville, Texas for his efforts to protect the environment. Joel has been granted a rebate by the Texas Emissions Reduction Program (TERP) to replace an older-model dump truck. Joel's involvement in this program illustrates that the world can be made better through the efforts of a single person. Estrada's TERP rebate will allow him to upgrade his current dump truck to a new, more environment-friendly vehicle. Joel's participation moves TERP one unit closer to reaching its goal of replacing 4,500 older diesel engines with newer, less polluting models. Over the course of the next 7 years, the new dump truck will stop 5.8504 tons of nitrogen oxides from polluting the planet. The Texas Emissions Reduction Program presents businesses with the opportunity to save money and protect the environment by trading in their business vehicles for cost-efficient diesel engines that conserve fuel more effectively. Over all, North Texas businesses have accumulated more than $3.3 million in savings and cut down pollution by nearly 353 tons to date. The rebates and grants offered by TERP set a positive example of the benefits of replacing and modifying older diesel engines for the Nation. Madam Speaker, it is with great pride that I rise today to congratulate Joel Estrada of the 26th District of Texas. He is a phenomenal example to other small businesses, and I heartily commend him for doing his part to help reduce pollution in North Texas one engine at a time.

Mr. BURGESS

Mr. BURGESS. Madam Speaker, I rise today to commend A and M Excavating, Inc. of Lewisville, Texas, for its involvement in the Texas Emissions Reduction Program (TERP). By participating in TERP, A and M Excavating was given the opportunity to replace four of its trucks. A and M Excavating was awarded four rebates to upgrade its aging dump trucks to a modern, more efficient fleet. This constructive move by A and M will give it a competitive edge among competitors while preventing 26.7542 tons of nitrogen oxides from polluting our North Texas skies over the next 7 years. The Texas Emissions Reduction Program presents businesses with the opportunity to ``go green'' by trading in their vehicles for cleaner, more economical diesel engines. TERP provides rebates and grants to help replace aging diesel engines that consume more fuel and generate more pollution than newer models. All together, North Texas businesses have accumulated more than $3.3 million in savings and cut down pollution by nearly 353 tons to date. The rebates and grants offered by TERP set a positive example of the benefits of replacing and modifying older diesel engines for the Nation. Madam Speaker, I am privileged to represent such an environment-savvy and cost-conscious company in Texas' 26th Congressional District. I am certain that A and M Excavating's involvement in the Texas Emissions Reduction Program will encourage other area businesses to apply for the program in the future.

Mr. BURGESS

Mr. BURGESS. Madam Speaker, I rise today to congratulate Pro Tow Wrecker Service, of Lewisville, TX, for participating in the Texas Emissions Reduction Program (TERP). Through its involvement in TERP, Pro Tow Wrecker Service recently received a rebate to upgrade one of its company trucks. The rebate was awarded to Pro Tow Wrecker Service to replace an old haul truck with a new, more efficient model. By improving its fleet, not only is Pro Tow Wrecker Service becoming more competitive, it is also preventing a total of 10.6308 tons of nitrogen oxides from polluting the air over the course of seven years. The Texas Emissions Reduction Program is offering an affordable means for businesses to replace older diesel equipment that they would not otherwise be able to upgrade. TERP provides rebates and grants to help replace aging diesel engines that consume more fuel and generate more pollution than newer models. So far, North Texas businesses have saved over $3.3 million and reduced nearly 353 tons of pollution. TERP serves as a national model for replacing and retrofitting older diesel engines. Madam Speaker, it is an honor to represent such an economically and environmentally-conscious company in the 26th district of Texas. I am confident that the positive example set by Pro Tow Wrecker Service will encourage more businesses to participate in TERP in the future.

Mr. BURGESS

Mr. BURGESS. Mr. Speaker, I move that the House do now adjourn.

Mr. BURGESS

Mr. BURGESS. Mr. Speaker, it has been a long week. We have had a pretty tough legislative day today. It is springtime in Washington. Springtime brings lots of different groups to town; we saw farmers this week, we saw the firefighters, first responders this week, FEMA personnel this week. We also saw some of my friends at the American Medical Association this week, many of my friends from the Texas Medical Association. They came to Capitol Hill to discuss things that are important to them in health care. And, as I frequently do at the end of the day, I thought I would come down here and talk a little bit about health care. I like to call these little visits house calls. Now, prior to coming to Congress I was a practicing physician. I am still licensed; I am not insured. But in honor of my fellow physicians who are here in town this week, I brought a picture of a famous doctor. No, he is not a medical doctor; he is a physicist. This is Dr. Albert Einstein. But I thought we would have Dr. Einstein accompany me on this house call this afternoon. It is going to be a little talk about the role of healers, the role of physicians, the roles that perhaps they should play in health care reform in America. Now, Dr. Einstein did a lot of famous things. He did some things that were infamous as well. He is well known for a number of quotes, and one of my favorite quotes from Dr. Albert Einstein is, ``Insanity is doing the same thing over and over again, and expecting a different result this time.'' Of course, Dr. Einstein was right. And I wanted him to be with us today because that quote is a terrific theme for a little talk about how doctors and policymakers can together work on the things that should dictate health care reform in this country. So if you would, let's have a candid conversation about health care, health care at the Federal level, health care at the provider level. Now, this is an election year in this country, a Presidential election year. It happens every 4 years. There is a lot of big discussions, there is a lot of big debates, and health care will be one of those big debates. There is a broad national recognition that reform is needed in health care. There is not a lot of consensus on how to achieve that. Now, every one of the Presidential candidates, those who are still active in the race, those who were active in the race and have since dropped out, everyone has or had their own ideas. It won't surprise anyone here to know that Members of Congress also have their own ideas. Policymakers are focused on change. That is good. That is appropriate. And as we learned this week from visits from doctors of the American Medical Association, physicians are focused on change as well. And they must be because, after all, in this country health care begins and ends with doctors. Without our doctors, there is no health care. That means our doctor friends, the ones who are in town this week, have to be ones who take an active role in the process of transforming health care in this country. We need them to take a leading role in creating the road map on reasonable reform, to go from where we are now to where we ought to be. We depend upon our physician leaders because they are leaders and are proactive. They are not reactive. Think about it for a minute. When you are only in a reactive mode, what you end up with are basically band- aid solutions. You think about the term death by a thousand cuts, we can call this death by a thousand scalpels because we were talking to doctors all week. You know, refusing to do something about liability laws in this country, putting the interest of trial lawyers ahead of patients, that is a cut. Let me give you an example. My home State of Texas, September 2003, we enacted sweeping liability reform as it affected the health care industry. We got fair medical justice legislation out of our State legislature. It required a constitutional amendment to go into effect, but it did pass under a vote of the people. As a consequence, now some 4 or 5 years later, Texas is seeing the benefits from passing commonsense legislation that limited the amount of payouts for noneconomic damages in medical liability cases. Because this Texas law has made such a difference in Texas, and let me give you an example, in 2002, the year I first ran for Congress in Texas, the number of medical liability insurers in Texas had dwindled from 17 down to two. You don't get much in the way of competitive bidding when you only have two insurance companies that are willing to write your business. But all the rest had left. The climate in Texas was so hostile that no one wanted to write insurance in Texas. As a consequence, you had good doctors who were simply unable to get insurance and stopped practicing. I met a young woman during one of the stops I made during my campaign in 2002 who was a radiologist, an interventional radiologist, highly trained, highly specialized, trained by the State of Texas, State-supported schools, so the taxpayers of Texas had paid for a portion of her education. And now 4, 5 years out in practice, she lost her liability insurance and was not able to get another carrier to pick her up. It was too risky. She couldn't practice without it, and she became a full-time mom, no longer practicing interventional radiology at a time I would argue when our health care needs are doing nothing but increasing. That was wrong, and the State legislature in Texas recognized that was wrong and got busy and changed it. They didn't come up with a new idea, they copied an old idea. In 1974, the State of California passed a sweeping set of medical liability changes called the Medical Injury Compensation Reform Act of 1974. And with those caps on noneconomic damages, they were able to tamp down the premium increases that doctors had seen over time. And, indeed, when we passed that legislation in Texas, we have seen the same result. It does work and it should be tried in more areas. In fact, I have introduced legislation similar to the Texas legislation in the House of Representatives, H.R. 3509. This bill actually scores as a saving by the Congressional Budget Office. We are in our budget time in the springtime here in Washington. We are scrapping around for every dollar we can find to pay for Federal programs. Here is a gift I will give to Congress. It is a $5 billion gift this bill would save over 5 years as estimated under the Congressional Budget Office, and it does the same things on a national scale as the Texas legislature was able to deliver for their patients back home in Texas. One of the unintended beneficiaries of this whole process was the small, community-based hospital. The small, not-for-profit community hospital had to hold many hundreds of thousands, millions of dollars in escrow against a potential bad outcome, a bad event in a liability case. They have been able to back down those holdings and invest that money in just the things you want your community hospital to invest in, like nurses and capital investment. The result has been an expansion of medical care in Texas. Since that bill was passed, we had gone down to two medical liability insurers. We are now back up in excess of 20, and they have come back into the State without an increase in fees. My old insurer of record, Texas Medical Liability Trust, has reduced its liability premiums 22 percent in the aggregate since the passage of this law in 2003. Clearly it works. Remember, our Founding Fathers said that the States should act as great laboratories for the Nation, and things that work in States should be considered for use countrywide. And, indeed, this is one of the concepts that embodies that. The principles here on the chart are pretty straightforward. It does cap noneconomic damages in a medical liability suit, $250,000 per physician, $250,000 for the hospital, $250,000 for a second hospital or a nursing home if one is involved. It does allow for some periodic payment, and it allows for good Samaritan care. Very sensible, straightforward legislation. It is not a complicated bill, and it behaves as advertised. And that is one of the things in this Congress, we just heard a gentleman talking about solutions. Here is a solution. I offer it as a gift to the United States House of Representatives. It saves $5 billion over the next 5 years. Use that money somewhere else because in a $3 trillion budget, there are plenty of places you can spend money. Another place where we apply just a band-aid where we really need to do something major is in how we reimburse physicians for taking care of Medicare patients. They are taking care of our Medicare patients. Medicare is one of the largest deliverers of health care in the country, indeed the world. We have asked doctors to take care of our Medicare patients. They are some of our most complex patients. They have multiple conditions, multiple diseases, frequently on multiple medications, and we have asked the medical community since 1965 to provide care for these patients. What do we do in return? We passed legislation a number a years ago that reduces year over year the amount we reimburse for that care. That doesn't make any sense. Can you imagine a doctor, a small businessman, going to his banker with a business plan. He says I am going to expand my business and I have this business plan, and part of the business plan is I am going to make 10 percent less every year, year over year as far as the eye can see. Well, even back in the subprime days, no banker is going to make a loan on that type of business plan. How do we expect physicians across the country who are small business owners, how do we expect them to survive? And they certainly cannot thrive in that kind of an environment. We do this because we have created a condition called the sustainable growth rate formula. I have put it up on this poster, and I am not going to go through this line by line. It is available on the Website of the Center for Medicare and Medicaid Services. But just to demonstrate the complexity of this formula and to point out that going through all of these calculations, the final line in this formula is that you go back to 1996 and capture all of the money that you should have saved and add it on at the end. It is a formula that is destined to fail over time. Until we in Congress recognize that this formula is destined to fail over time, repeal it, reverse it, revise it, get rid of it, stop the cuts, pay the doctors what they are owed, and get on with things. Currently in this country, we have Medicare divided into four parts. Each part is supposed to be an integrated member of the whole. We have Parts A, B, C and D. Part A deals with hospitalizations; Part B compensates physicians; Part C is Medicare HMOs; and Part D is drugs. Every part of Medicare with the exception of the physician payment receives a cost-of-living adjustment year over year. Part B is different. It is governed under the sustainable growth rate formula. So a hospital will receive ever-increasing amounts of compensation because the cost of inputs increases, because a drug company or HMO will receive an upgrade every year, year over year because the cost of doing business increases, physician reimbursement will decline over time. Clearly, that is unsustainable. I have a real problem here in Congress. I show this formula to any Member of the House of Representatives, although they recognize that patient access is a problem, physicians are in peril, although they recognize those features, this is very difficult to understand. This quickly goes into the ``too-hard box'' in someone's mind, and we are just not going to deal with it. But Congress must deal with this. An example of how we don't deal with it, last December we were right up against a deadline. Cuts were going to go into effect on January 1, so at the last minute we came to this House and we passed a bill that would delay these cuts by 6 months. What an insult to the practicing physicians in America. What an insult that this was all the time we would expend on this very important issue that affects virtually every aspect of their practice life. I say that because it is not just the Medicare reimbursement that is affected, but literally every private insurance company in this country pegs to Medicare. And so if Medicare does a 5 percent or 10 percent cut, guess what happens to Blue Cross/Blue Shield, United, on down the line. They will follow suit. Can't blame them for doing so, it is the market price. But as a consequence, this House of Representatives, this Congress, exerts wage and price controls over health care in this country that most of us here don't really have an understanding of. So last December we passed a 6-month delay on phasing in the Medicare cuts. We have to deal with that before the end of June. It is the first of April. Half of that time has been consumed. Half of that time has been squandered, and have we seen any meaningful effort in my committee, the Committee on Energy and Commerce, which has jurisdiction over Part B in Medicare? No, we haven't. We did steroid hearings, for crying out loud, on baseball players. This is the work we should be doing. We heard the other gentleman talk about solutions. Here is a solution we could wrap up and give to patients in America, and they would be the better for it. Now, one of the other things that happened in December which we didn't get done, and sometimes in a way it is a good thing that we don't get things done. We talk a lot about trying to bring the architecture and information technology in health care, to bring it on up into the 21st century. It is a difficult concept for a lot of people to understand. It is difficult for some people to understand why we don't just flip a switch and turn on a computer and make it happen. One of the bills that we saw come to Congress last December which didn't get passed was a bill that was going to mandate that physicians in the Medicare program use electronic prescribing. Conceptually, it is a good idea. I am a physician. I am left-handed and have bad handwriting. Every year older I get, my handwriting doesn't get any clearer. So e-prescribing will remove some of those problems. And yes, it could reduce error rates. And yes, it will immediately flag things like medicines that are in conflict with each other and allergies that a patient has. So it is a good concept, but what do we do with it here in Congress? We make it punitive. We come to the medical community and say here is our grand plan for e-prescribing. First of all, we give you $2,000 to invest in the infrastructure. Two thousand dollars; $2,000, do you have any idea how much these programs cost and how much it costs to buy the infrastructure and do the training? It is far in excess of $2,000. In addition to that, if you do this e-prescribing program, we are going to give you a 1 percent bonus over time for doing this program. But if you haven't done it in 4 years' time, we are going to come back with a $10 penalty for every patient that you see. Well, a 1 percent bonus, that is better than nothing, but think about it for a moment. In my practice if I saw a Medicare patient, return visit, moderately complex, on a good day, if that was a $50 visit, they reimbursed $50, that would be a miracle in itself. But let's do it that way because it makes the math easy and I'm not good at math. So a $50 patient visit. And if I am really moving and if I am really on my game, I can see four of those patients in an hour. So that is a $200 hour that I have put in in the clinic that morning. And we are going to get a 1 percent bonus for that. So for each of those four patients I saw in that hour, I am going to get an extra 50 cents. That is a $2 an hour increase. Well, that is not a lot when you think about all of the extra work that goes into maintaining and training for these e-prescribing programs. But what if I don't do it, what's going to happen then? In 4 years' time, we're going to come back with a 10 percent reduction. What does that 10 percent reduction mean to that same hour of intensity, that same hour of work applied 4 years later? Well, a 10 percent reduction, instead of now a $2 increase, I get a $20 penalty for seeing those four patients but not using e-prescribing. If you couple that on top of the program, 10 percent cuts that are supposed to go in year after year, is it any wonder that when you pick up a phone and try to make a new patient appointment in a doctor's office, they say, I'm sorry, we're full, I'm sorry, we're not taking any new Medicare patients. And this is becoming a crisis for our seniors all because Congress will not do the work for our physician community and for our patients. And it's work we've asked our physicians to do. Since 1965, we have asked them to participate in this program. But let's stay on the concept of information technology for just a moment. And I will tell you, Mr. Speaker, I haven't always been a big fan of some of the advanced and higher information technology, electronic medical records. Yeah, those were good for someone else, maybe not for me. E-prescribing, I did it with a couple different vendors in my private practice. It never was all that it was cracked up to be. But in August of 2005, late August of 2005, I changed my mind on this subject. And I changed my mind on this subject because of a very harsh event that happened in America, and that was the passage of Hurricane Katrina over the City of New Orleans. And we all know the story there, the multiple breaches in the levees and the city flooded. And one of the consequences of that city flooding was the flooding of one of the venerable old health care institutions in this country, Charity Hospital in New Orleans. The basement was flooded for weeks. Guess what we have in our basements of our hospitals around the country? That's where we put our records. That's where we store these paper records. So, here is a visit. In January of 2006, we did a field hearing on one of my subcommittees on Energy and Commerce. We went down into the basement of Charity Hospital in New Orleans. The room had been dewatered. Prior to that visit, I didn't even know ``dewatered'' was a verb. The room had been dewatered, and here is the medical records department. Now, this black stuff that you see smudged on the charts, and these are rows and rows of medical charts, you can see the identifying patient numbers on the end, this black material smudged on the charts is not soot from a fire, it's black mold. That means that anyone who comes in here and pulls a record off the shelf is going to get a lung full of mold spores. And clearly, because of that hazardous condition, these records will never be accessed again. And of course you can imagine, this room was under water for weeks and weeks and weeks. The effect of salt water, brackish water on the ink that went to record these medical events, these records were likely unreadable even if someone had been willing to hazard the mold spores to pull one off the shelf. So, all of this data is lost forever. And we don't know what's in there. Perhaps a kidney transplant, perhaps a premature birth, perhaps just a well-baby check. Absolutely impossible to tell. This was so critical because when many of the people who left New Orleans after that storm, after the difficulties that were encountered in the aftermath, a lot of those individuals came to Dallas, Texas and they arrived on the parking lot at Reunion Arena, where they were to be triaged to receive health care if they needed, housing, start to get their lives back on track. There were many people who arrived there who actually had significant medical conditions. And it was very, very difficult to obviously go back and access these records that were, in effect, under water in the City of New Orleans. Now, there were some big chain pharmacies who arrived on the scene with a mobile truck. And using the information that they could download off their central computer system, from a patient's name and birth date they were able to recreate medicine lists. And I will just tell you, if you can get an accurate medicine list on a patient, a lot of times you can know a great deal about their medical history given the types of medications they were on. Or, if nothing else, here was verification that this was the anti-hypertensive that this patient needed, this was the type of diabetes medication that this patient was on. It accelerated care for these patients in an unbelievable fashion. And these two series of events made me a believer in electronic medical records. If you have an electronic medical record that stays with the patient, that follows the patient throughout life, that can be accessed by the patient, be accessed by that patient's physician if the patient gives permission. If you have that capability, that would have gone a long way towards the rapid reinstitution of medical care. For some patients who are, frankly, quite ill, not just because their underlying medical condition made them ill, but they were ill from spending several days in water up to their waists, or in the Superdome where they lacked air conditioning or lacked access to some of the most basic facilities for hygiene, these were patients in distress because of their medical condition and because of the conditions in which they had existed after the storm. So, how much better was it to be able to resume their care because there was the availability of at least a small amount of data that could be retrieved electronically. If a patient had their own medical record over which they had control, much, much more facile to be able to treat those patients in that type of situation. Now, we do hear a lot, here in Congress there are various bills and ideas out there, as far as how to get the health care community up to speed on electronic medical records or health information technology, as you frequently hear it referred to here in Congress. There was a big study done a few years ago by the RAND people. And in this study they talk about the billions of dollars, $77 billion, that can be saved over 15 years if we go to an electronic medical record model. Now, that's a significant amount of money. And the study is a very meaningful one, very well thought out, very well constructed. Most people don't go much more deeply into it than that, but if you actually take the trouble to read the RAND study, if you look into it, most of those savings actually occur on up towards that 15th year of that study. Most of the investment in information architecture is going to be done on an individual basis and wasn't included in the cost or the benefit of the RAND study, so it skews the figure a little bit on the plus side because of that; no allowance for training, no allowance for maintenance. But, nevertheless, still they do show a significant savings available by going to electronic medical records. Their sum-up paragraph, the very last paragraph of the study, they say for this world to go away and the electronic world to occur, it is going to take incentives. And they talk about incentives that they must begin early, that is, you want to be sure and make that incentive available so that you don't penalize someone for getting in early, or more importantly, you don't reward a late adopter. So, the incentives have to be available early. And the time limit that the incentives are available, the time frames that the incentives are available have to be limited. But the final point, and the one that is always missed on the floor of this Congress, is the incentives must be substantial. I would submit to you that a 1 percent increase in a Medicare patient's compensation for an office visit for using e-prescribing does not fall into the category of a substantial benefit. And then, as we so often do here in Congress, we go on to add insult to injury by saying, if you don't do it, we're going to punish you. Here's a little carrot, but a big stick if you don't do what we've asked you to do. So, I do think that the day will come when we will see a great deal more adoption of electronic medical records. Some of the things I think we could do are: encourage the private sector, that is really light- years ahead of the Federal Government on this, perhaps with a little relaxation of some regulatory regimens called the Stark provisions, perhaps with at least some definition of what privacy is and what privacy means so people have some certainty about the systems that they're developing. Maybe a little bit on the liability side. And true enough, ask something from the private sector in return. If it's an insurance company that's developing this model, make certain that the information itself is owned by the patient and may travel with the patient if they transition from one company to another, or if they transition from one employer and they go to individually owned insurance, make certain that that information is not lost in that transaction and the patient can control the information. But I do believe if we put some of our partisan differences aside, we could devise a scenario that would be conducive to the development of this type of technology. And again, as the gentleman who was talking before me kept talking about solutions, these are the types of solutions that the American people want to see us working on. Again, they're not really interested if we hold another hearing about steroids in baseball. They are interested if we can provide them this type of value in their doctor/patient interactions. Now, one of the other concerns that I have when you hear people talk about health care, and certainly when you hear people talk about it at the national scale, is, well, why don't we expand the Medicare program. Please be advised, in my opinion, the Medicare program, for all the good things that it does do, has enough areas of uncertainty around it that, number one, I don't think it is the type of program in which we want to be placing everyone. But going back to the SGR formula, I spent probably 40 to 60 percent of my week dealing with problems that are brought about by difficulties administered through Medicare, Medicaid, SCHIP, all of the Federal systems that we have to provide health care in this country. We are not doing a great job. So, at this point, I don't see the value in rewarding the Federal Government by giving it a greater and greater share of health care in this country. And I would simply ask the question, does the private sector have a role to play in the delivery of health care in the United States of America? My answer to the question is yes. And, in fact, a long hearing that we had today dealing with Medicaid funding, if you do not have the private sector, you have no way to pay for Medicare and Medicaid because, let's be honest, Medicare and Medicaid do not pay the full cost of the care that's rendered. Hospitals, physicians and clinics across the country have to cross-subsidize their Medicare and Medicaid populations with money from their private practices, with money that they receive from the private sector. So, I would submit that the private sector does have a role to play in the delivery of health care in this country because, at the very least, right now we depend upon the excess payment from the private sector to fund the cross-subsidization for Medicare and Medicaid. One last thing about the physician's compensation let me talk about, because I've been very critical of the way the current majority, the current leadership handled the Medicare reimbursement at the end of 2007, but I must say at the end of 2006, when my side was in charge, we didn't do a great deal better. We decided to provide a 1-1.5 percent increase in physician compensation if doctors were willing to undergo some quality reporting. Now, quality reporting generally would be thought of as a good thing, but again, the incentive was so low as to not cover the cost of collecting the data. And now, after the first year and a half of this initiative called the Physician Quality Reporting Initiative, started out life as PVRP, and then became PQRI, the results are pretty disappointing. Not that quality wasn't there, the results are disappointing because it wasn't worth the time of the doctors and clinics around the country to participate in the program. Almost 90,000 physicians across the country could have participated in a reporting program for asthma patients, but, in fact, less than 100 did. Again, if incentives are going to work, if incentives are going to be worthwhile, they have to be meaningful. If you provide a meaningless incentive, then the person who is to receive the incentive says, this is information you really don't value, so I'll tell you what, I'm not going to bother with it, it's not worth it to me. Incentives will work; they will work if they're meaningful, they will work if they start early, they will work if they're time limited, but they must, above all else, they must be substantial. Now, again, I referenced earlier that a physician's office is nothing more than a small business. They need the resources to pay the overhead. We heard a very moving story today in committee of a pediatrician who practiced in Alabama. Her patient population was 70 percent Medicaid, and she had reached the point in her practice where she wasn't covering overhead any longer; she had to borrow from her savings in order to keep her practice open. And from what she described to us, it sounded as if she had done all the things she could do to hold costs down in her practice, extended hours, hired physician extenders, she had a physician's assistant working with her. But the reality is, because the payment for Medicaid patients is so low for physicians, the result is, if they don't have a sufficient private population, again, to bring those earnings up, they're not going to make it. So, a practice that is 70 percent Medicaid in rural Alabama apparently can't make it paying the overhead and trying to keep the doors open for, again, the very critically ill patients, the disadvantaged patients, the patients that we in Congress have asked this doctor to take care of. It is disappointing, to say the least, it's a travesty, it's a tragedy, that a doctor in that situation will only be able to keep that up so long. There are only so many nights you can go home and explain to your family that, once again, you had to raid the retirement savings or raid the children's college fund simply to pay for operational expenses to keep the office open, because if you were doing that, bear in mind, that physician is not drawing a paycheck for those months either. So, it's difficult for doctors to build their businesses. It's difficult for doctors to pay their bills when the very policies developed on the floor of this House are so detrimental to the practice of medicine. And if we can continue to accept these types of Band-Aid solutions in liability, in Medicare, in Medicaid, if we continue to accept those Band-Aid solutions, just like Dr. Einstein said, we're going to get the same results, or worse. Doctors are leaving Medicare as a result of some of the activities taken on by this country. It is time, it is time for this Congress to step up and do something new, try something new. I mean, 435 leaders, elected by their respective constituents across the country; 435 leaders, we need to lead. We need to do the hard work, take a short-term, a mid-term and a long-term approach to these problems. And they're not insoluble. They're hard, to be sure. They're complex. They may require hours of work. They may require some hard bargaining and, at the end, they may require some compromise. But solutions are within our grasp. But when we do stuff like a 6-month Medicare payment fix, we do more than harm the physicians who we've asked to take care of our Medicare patients. We do more than harm our seniors who now pick up the phone and can't find a doctor who will accept their Medicare. We actually harm the very credibility of this institution, and we undermine the credibility of this institution when we take such short-sighted approaches to very significant national problems. And the American people, correctly, stand back and say, what's going on? And so is it any wonder that approval ratings of Congress are at historic all time lows? Well, to be certain, there are health care policy reform questions and goals that, over time, and with some thoughtful deliberation, can result in successes. But we're going to have some big questions we have to answer. And that's one of the fortunate things about being in the middle of an election year because these things now get elevated to a national forum; there's a national referendum, if you will, about the future of health care. We'll have really, I expect, some fairly different choices out there to make. We'll have to ask ourselves, how are we going to go through these changes and continue to value that interaction that takes place between the doctor and the patient in the treatment room? After all, that's the fundamental unit of production that occurs in this big, vast machine that we call American medicine. So how do we keep that relationship sacred? And what do we do that delivers value to that relationship? We're going to hear a lot of talk about mandates. We already have. We hear people talk about individual mandates, where every individual is required to buy health insurance. We hear things about employer mandates, where every employer is required to have health insurance. Do mandates work? Are they a good thing? Will they work in a free society? How do you force everyone to do what you think is a good idea and ought to be done? Well, it turns out it can be terribly difficult to do that, and the history of mandates is sketchy, to say the least. A very good article in Health Affairs, a magazine or periodical called Health Affairs last November, the title was Consider It Done, talking about mandates. We're there; we've reached the promised land and we're going to have mandates to require health insurance. But even in that article, as they go through the history of mandates in this country, certainly raises some valuable questions about whether or not mandates will ultimately work. And going back into the 1960s, there was the helmet law brought to motorcycle riders by this United States Congress. And the outcry was so severe when Members of Congress went home from their constituents who were part of the motorcycle riding community that they very quickly came back and said, well, that's a State's issue. We're going to repeal that at the national level and, Mr. State Legislator, you're going to have to deal with that; Governor, you'll have to deal with that as a problem, and States have over the intervening 40 years. Some States, my home State of Texas does not require a helmet. Some States do. But Congress very quickly found out that mandates can have some negative consequences. Well, can you get 100 percent compliance with a mandate? Some people argued that if the penalty for not complying is severe enough and well- known enough, that you will, indeed, get near that 100 percent compliance. But think about it for a minute. We're just a few weeks away from April 15. We've all got to pay our income taxes. There's a mandate. Everyone is aware of the income tax law in this country. Everyone is aware of the Internal Revenue Service. Everyone is aware, they may not be aware of the specific penalties, but if they know that they don't do what they're supposed to do there is a very swift and sure penalty out there awaiting them from the Internal Revenue Service. And all of us know the story of Al Capone, who was arrested not for being a bootlegger and doing bad things to people, but arrested because he did not pay his income taxes. So you would think, with the mandate for paying Federal income taxes, that there would be near 100 percent compliance. But the reality is you get about 85 percent compliance. You get about 15 percent of people who decide not to follow the rules with the Internal Revenue Service. In fact, you'll hear us talk about it on the House floor, especially this time of year when taxes are due and we're talking about budgets and we're looking for more money. People on the floor of the House will talk about the tax gap, that is $300 billion, and if we had that $300 billion we could do good and great things for the country. We have the tax gap because we have 15 percent of the people in this country who are willing to look at the penalties for not filing their income tax and say, you know what? I'm not going to file my income tax. How many people do we have this it country without health insurance? A lot. It's about 15 percent of the population. We have 300 million people in this country, give or take, probably more than that now. That figure's a couple of years old. And how many people do we have without health insurance? People argue about the number, but around 45 million, and that's about 15 percent of what our population is in this country. We already have that compliance, even without mandates. So are mandates going to take us to a higher level of compliance? And what do we give up in terms of freedom if we go down the road of mandates? But to me, more importantly, what's the flip side to mandates? If you're not going to have mandates, okay, well how are you going to get people to recognize that they should have health insurance? Well, one thing you can do is work on the affordability side because it's no question, if the bills get too high the employer's going to say I'm not going to provide insurance for my employees any longer because it becomes cost prohibitive. And if an individual looks at the individual market and says the cost is so high I'm not going to comply with it. So certainly the affordability side is a big part of the equation. But more importantly, it's creating problems that people want. It's creating programs that people recognize as delivering value back to their lives. And we do have a little experience with this over the past 5 years. We did, in a number of Medicare reforms in 2003, provide Medicare Part D, a Medicare prescription drug benefit. And there were those in this House who argued that this should be something that is mandated by the Federal Government and completely controlled by the Federal Government. There were others who argued that maybe it would be better to let companies compete with seniors for that business. And that was the argument that eventually prevailed. And as a consequence, we had, at the roll out of Medicare part D, we had complaints because there's too many choices; there's too many companies out there that are offering this, and I can't make up my mind. The cost ranges from $10 a month to $50 a month, and how in the world am I ever going to know what I'm supposed to do? But after some of the louder rhetoric died down and people began to look at these programs, indeed, these were programs that delivered value to a segment of the population who had never had an affordable prescription drug benefit available to them before and, as a consequence, the penetration with this benefit is extremely high in the Medicare population. And the overall satisfaction rate is also extremely high. So that's perhaps a model for us to consider when we talk about things about how do we provide insurance. We tell everybody you've got to have it, but there are going to be some people who just won't do it. We make programs that are affordable and that appeal to people, that people want. People want to be able to provide protection for their families. They want to be able to provide additional help if health care is needed in their families. So that would be another way to approach. One of the great privileges of serving in the United States House of Representatives, you occasionally get to go places or meet people that you otherwise may not have gotten to meet. And for me that hour came last fall when I had the opportunity to spend an hour with one of my heroes, Dr. Michael DeBakey down in Houston. Many people know Dr. DeBakey as a famous heart surgeon. He was also the individual who developed the Mobile Army Surgical Hospital that has been responsible for the saving of so many lives in our Nation's conflicts over the last 50 years. Dr. DeBakey himself is going to turn 100 years old this year, so it was a phenomenal ability to talk with an individual who has witnessed and lived through and directed the last century of medicine. And many of the comments Dr. DeBakey made to me were similar to the same things that I wrestle with; how do you provide mandates? How do you require mandates in a free society? Wouldn't it be better to give people things, make available to people things that they would want and would willingly sign up for, rather than forcing them into individual programs that really might not appeal to them? One of the other things that Dr. DeBakey said to me that gives me, really gives me a lot of hope, really gives me a lot of optimism in looking forward to the future, because he said, Congress can do this. Congress is up to this task. And he said he knew that because when he was a young man, having just graduated from LSU, I'm sorry, graduated from Tulane down in New Orleans, Louisiana, as a young man, after graduating from medical school he had to go to Europe in order to get the credentials in order to be a research physician. Those credentials were not available to him at American institutions, so he went to France and Germany and did his study there in order to get the credentials to be seen as a credible researcher. But that changed in the 1940s, and it changed because of the efforts of Congress in funding research at the National Institutes of Health, and developing the types of programs that now allow America to be at the forefront of research across the globe. And scientists come here to train, come here to get those credentials, those same credentials that Dr. DeBakey had to cross the ocean to receive a half century ago. So he told me, Congress can do this and I know Congress can do this because they've done it in the past. They've tackled big things and they've come to the right conclusion. Well, I pray that he's right. I wouldn't be here if I didn't believe that he was right. But it is going to be difficult to do that. Now, I can't make all of these things happen by myself. And one of the reasons you're in Congress is because you want to work with others. Well, maybe that's not the reason you're in Congress. But nevertheless, Mr. Speaker, you're in Congress and you do work with others, as is the nature of this body. There's 434 other individuals who have to be consulted, whose vote has to be one before you're going to be able to see your policies become law. So I will just tell you one of the things I've learned. You can have the best ideas in the world, and you can have all of the enthusiasm and all of the energy required to get those things over the line, but if you don't have people working with you, if you don't have people helping you, it's going to be very difficult to get those things done. So I am very grateful, with the legislation that I have, to help reform the Medicare payment formula, the bill Number 5545, I do have help. I've got help now over in the Senate. I've got help from the doctors in the American Medical Association. And very important to me, I've got help from my doctors with the Texas Medical Association. And I think together we can get this work done. There's not a Member of Congress that I've talked to when I've asked them how things are going with their doctors back home who doesn't bring up the problems that their doctors bring in to them about the Medicare payment formula. So the groundwork has been done, and now it's up to us in this Congress to get that accomplished. And a little preventive medicine will go a long way, will go a long way in fixing some of these problems. And if you know that two trains are coming at each other down the track and it looks like tragedy's inevitable, what do you do? What does this responsible person do? Do they run down to the track and see if they can find the appropriate switch, or warn somebody off to avert the disaster? Or do you run home and get your video camera so you'll be the first one to get it up on YouTube? I would submit the responsible thing to do is to try to avert the disaster, and not simply document its destructive events. Mr. Speaker, as our time draws short and this week is going to draw to a close, let me just reflect on a couple of things from the last century of medicine. The last century of medicine I do feel I have some interest in, some ability to talk about that. My father was a physician. His father before him was a physician, so between the three of us, we pretty much occupied the last century in the delivery of health care. And over the last century, we saw some incredibly transformative things occur within the science of medicine, and we saw some incredibly transformative things occur at the social level, at the legislative level. And you think back to what the state of medicine was coming into at the end of the first decade of the last century, what things were like coming up to 1910, medical schools across the country where the curricula was so varied. There was no standardization. The graduate of one medical school could be well-trained and the graduate of another medical school could be woefully inadequate. We were right upon the time of intense scientific discovery: Anesthesia was coming into its own, the ability to administer a blood transfusion, the knowledge about blood blanking was coming into its own. Immunizations, the whole science of immunology was just coming upon the scene. And at the same time, from Congress, a group of individuals were convened called the Flexner Commission. They came up with a report called the Flexner Report which called for the standardization of medical school curricula across the country, and that stabilization of medical school curricula allowed for the stable platform on which those scientific discoveries could be based and set the stage for some of the great scientific breakthroughs that were yet to come. And right around the corner, some 30 years later, we were engaged in the activities of the second world war. A scientist in great Britain had found an odd thing had happened when he grew a mold in a petri dish and it inhibited the growth of bacteria. And he had discovered Penicillin. That was 1928. But that was a little more than a laboratory curiosity. There wasn't really anything you could do with it on a commercial basis. There certainly wasn't any patient application for this until American scientists discovered in the 1940s how to produce this on a mass scale, the cost came way down, and the first antibiotic became commercially available, and relatively cheaply, to large numbers of people. It changed the course of things in the second world war. This happened right before D-Day. And think of the life and limb that was saved by the ability to fight inspection reliably for the first time with a chemotherapeutic agent. Also, around the same time, cortisone had been discovered earlier, but cortisone was one of those things that was very rare, very difficult to get. You obtained it at the slaughter house. Very, very labor intensive. A Ph.D. chemist, a gentleman that we honored in this House last Congress, Percy Julian, an African American scientist, found a way to extract cortisone from soy beans. Well, that changed the course. Suddenly this very potent anti-inflammatory agent became readily available in large quantities at a relatively low cost. On the social side in the 1940s, we saw some big changes in the practice of medicine because we were in the middle of the Second World War. President Roosevelt wanted to keep down trouble from inflation so he put wage and price controls in place across the land. Employers wanted to keep the few employees who were still able to work for them. They wanted to keep them coming to work. So they said, can we provide benefits to our employees since we can't raise their wages? Can we provide them benefits? The Supreme Court ruled that, indeed, did not violate the spirit of the wage and price controls. Those benefits could be given to individuals and, oh, by the way, they could be given with pre-tax dollars. And that set the stage for employer-derived insurance, and some people would argue it has given us some of the difficulties that we now encounter 60 or 70 years later. But nevertheless, in the 1940s we saw for the first time commercially available, large-scale quantities of antibiotics, anti-inflammatory and health insurance. And think about how the next several decades were changed. In the 1960s, we saw similar changes. For the first time we saw reliable drugs to fight hypertension become available. Anti-psychotics became available. Antidepressants became available. And in the midst of all of that scientific change, there also occurred a big change in that this Congress, or this House of Representatives, passed a bill that we now know as the Medicare bill. In 1965 when Medicare was enacted, for the first time the Federal Government had a large footprint in health care in this country, and, of course, it has grown significantly since that time in ways that probably most of the people who are on the floor of this House voted for that bill would never have imagined that it would spend in excess of $300 billion a year, but that's where we find ourselves now. Think of where we are now on just the beginning of the dawn of the 21st century. The human genome has been sequenced. You can go on line and find a place that, for a little less than a thousand dollars, will investigate your human genome, will tell you your risk factors for diseases like multiple sclerosis, heart disease, diabetes, even being overweight. It's phenomenal to have that information literally at our fingertips. When I was a resident at Parkland Hospital in the 1970s, I never would have imagined that that type of information would be available to people so cheaply and so easily. I never would have imagined that there was anything called the Internet, but nevertheless, that information that could be so easily accessed. We are indeed at a transformative time in medicine in this country. I referenced information technology. Think of the speed of change of information technology, how things are progressing and evolving so rapidly that it really isn't reasonable to ask the Federal Government to keep up and moderate those changes. We need to depend on the private sector to do that because it's happening so fast. But as medicine is transformative, Congress, by its very nature, can't be transformative. We are transactional. We take money from one group and we give it to the next. That's what we do. We collect the taxes, we spend the money. Congress is inherently a transactional body. But Dr. DeBakey said Congress can do this; Congress can participate in the transformation of delivering health care in this country. Well, I thank Dr. DeBakey for his wise counsel. I thank the American Medical Association for being up here this week. It is not easy taking time away from their families and their practices and their practices to come here and interact with legislators such as myself and other Members on both sides of the aisle to help explain and help us understand some of the very complex issues that they face on a day-to- day basis, yes, dealing with sick people but also dealing with this vast morass of regulations and rules that we lay at their feet every year. And most of all, I want the American people over this next year's time to focus on this grand debate that we are going to have at the national level. Your future is dependent upon it. Certainly your children's future and your children's children's future is dependent upon it. Think of the Congress back in 1965. It enacted Medicare and had no idea what it would be like 40 years hence. The same things apply today. The decisions we make on the floor of this body today, 30 and 40 years from now are going to look decidedly different. And I would say help us to make the right kinds of decisions so that the American citizens, 30 and 40 years' time from now, will look back and say the 110th Congress stepped up and did the right thing. Mr. Speaker, it has been a long week, and with that, I am going to yield back the balance of my time.

Mr. BURGESS

Mr. BURGESS. Madam Speaker, I rise today to applaud Don Buttress of Little Elm, TX, for his commitment to bettering the environment. Don applied for a rebate through the Texas Emissions Reduction Program (TERP) to replace an early-model dump truck with one that is cleaner and more efficient. Don's efforts demonstrate the effect a single person's actions can have on the planet. Buttress' rebate will keep 11.1793 tons of nitrogen oxides from polluting our skies throughout the next seven years. TERP is committed to replacing 4,500 older diesel engines with newer, less polluting models, and Don's participation moves them one engine closer to reaching that goal. The Texas Emissions Reduction Program presents businesses with the opportunity to go green by trading in their vehicles for cleaner, more economical diesel engines. TERP provides rebates and grants to help replace aging diesel engines that consume more fuel and generate more pollution than newer models. North Texas businesses have saved over $3.3 million and reduced nearly 353 tons of pollution to date. The Texas Emissions Reduction Program serves as a national model for replacing and retrofitting older diesel engines. Madam Speaker, it is with great pride that I rise today to congratulate Joel Estrada of the 26th District of Texas. His efforts are something I encourage other small businesses to follow, and I gladly congratulate him for his contribution to the betterment of North Texas.

Mr. BURGESS

Mr. BURGESS. Madam Speaker, I proudly rise today in memory of one of our nation's bravest and finest men who gave his life protecting our nation and its citizens. Sgt. 1st Class Justin S. Monschke of Krum, Texas, who served our country during Operation Iraqi Freedom, was killed on Sunday, October 14, 2007 in Arab Jabour, Iraq by a roadside bomb. Born October 20, 1978, Justin's lifelong dream was to be a United States soldier. He joined the United States Army after high school graduation and earned the distinguished rank of Green Beret in 2002. Sgt. Monschke was an instructor in the U.S. Army Rangers, Special Forces, and served tours in both Iraq and Afghanistan. Among the numerous awards he earned during his courageous service are: the Green Beret, a Silver Star, a Bronze Star Medal, the Purple Heart, and a Meritorious Service Medal. Sgt. Monschke was assigned to Company B, 2nd Battalion, 3rd Special Forces Group (Airborne), at Fort Bragg, North Carolina. Devoted to both his country and his comrades-in-arms, Sgt. Monschke was, above all else, a family man. Always a soldier at heart, Justin assumed a new role in life when he married Melissa Morro on February 23, 2002, in Gatlinburg, Tennessee: the role of husband and father. Sgt. Monschke served in the army for more that 10 years, committed to protecting his country, community, and the future of his family. Sgt. Monschke is remembered by his family as a hero who died doing something he loved--serving his country--and that is how he should be remembered by all. The Krum community and Sgt. Monschke's numerous friends and family members have lost a son, brother, husband, father, and friend; the United States has lost a patriot and protector. It is my honor to have represented Sergeant 1st Class Justin S. Monschke in the 26th District of Texas, and I extend my sincerest condolences to his family and friends. He will be deeply missed and the nation will be forever grateful for his honorable service.

Mr. BURGESS

Mr. BURGESS. Madam Speaker, I will yield myself 1 minute for the purpose of closing. This is an important bill and I do encourage my colleagues to support this bill. Have the test, find the polyp, get the cure. It's really that simple. One of the problems with serving in Congress is you recognize that we move so slowly on so many things. Madam Speaker, there are going to be new medicines, new tests. We're on the threshold of great things in all areas of medicine. The study of colon cancer is no small part of that. But the reality is today there is a test, there is a test that can be easily done. A cure is just around the corner for someone who might suffer from this disease. So I urge my colleagues to support this important legislation. I thank my friend from Maryland for bringing it forward, and I'll yield back the balance of my time.

Mr. BURGESS. Madam Speaker, I yield myself so much time as I may consume. Madam Speaker, colorectal cancer is the third most commonly diagnosed cancer. It's the second most common cause of cancer deaths in the United States; clearly a major player in our cancer burden here in this country. Every 3\1/2\ minutes someone is diagnosed with colorectal cancer. Every 9 minutes someone dies from colorectal cancer. This is a disease that affects men and women equally. This year, almost 150,000 new cases will be diagnosed, and almost 50,000 deaths will be caused by colorectal cancer. The real tragedy is that many of these cancer cases and deaths do not have to happen. The vast majority of colorectal cancer deaths can be prevented through proper screening and early detection. This resolution recognizes March as Colorectal Cancer Awareness Month. My good friend from Maryland talked about disparities; indeed, disparities do occur. And one of the things we can do to diminish those disparities is to talk. We can talk more about this disease. And the more we encourage our family and friends, our neighbors to get screened, the more lives we can, in fact, save. But recognizing Colorectal Cancer Awareness Month is not enough. We do need to increase Federal funding for early detection and screening. So, along with Congressman Wynn, Representative Granger has introduced a bill that would authorize funding for early detection screenings and make preventive care a priority. Specifically, the Colorectal Cancer Prevention, Early Detection and Treatment Act, H.R. 738, would establish a national screening program for colorectal cancer for individuals over 50 years of age and/or who are at high risk. It would also authorize State funding for these screenings, and it would create a public awareness and education campaign for colorectal cancer. Despite scientific evidence supporting the benefits of screenings, screenings remain low for this disease in the United States, and every 5 seconds someone who should be screened is not. When colorectal cancer is diagnosed late, the survival rate for cancer is only 10 percent, but if it's diagnosed early, before spread has occurred, the survival rate is in excess of 90 percent. Early detection and screening saves lives. If everyone over 50 years of age were screened regularly for colon cancer, the death rate for this disease could plummet by 80 percent. In addition to saving lives, early detection and screening clearly would save money. Treatment costs for colon cancer are extremely high and could be greatly reduced if mass screenings occurred. Colon cancer treatment costs totaled roughly $8.5 billion for new cases in 2007. Let me say that again, almost $8.5 billion for 2007. The costs of two-thirds of these cancer cases are borne by the Medicare program. The Lewin Group recently conducted a comprehensive study of the potential cost savings to Medicare and found that every 10 years a colon cancer screening program will result in a savings of about 1\1/2\ years worth of Medicare expenditures. If screenings were increased among people 50 years of age and older in the United States, it would save billions of dollars in Medicare expenditures, not to mention the thousands of lives that would be spared. The Colon Cancer Prevention, Early Detection and Treatment Act ensures that people who are screened will get the full continuum of cancer care, including the appropriate follow-up for abnormal tests, diagnostic and therapeutic services, and treatment for detected cancers. Observing Colorectal Cancer Awareness Month provides us with the opportunity to discuss the importance of early detection and of screening. It also provides us the opportunity to thank the thousands of volunteers and the national and community organizations for their work in promoting awareness of this disease. Groups like the Prevent Cancer Foundation, the National Colorectal Cancer Society Roundtable, the American Cancer Society, the Colon Cancer Alliance, and C3: Colorectal Cancer Coalition, these groups have created the ``Earn a Blue Star Day'' as a way for individuals and corporations to raise awareness of the importance of screening for this cancer. I encourage my colleagues in the House to ``earn a blue star'' by using this opportunity to promote awareness of colon cancer and to support early detection and screening. Madam Speaker, I reserve the balance of my time.

Mr. BURGESS. Madam Speaker, at this time I will reserve my time.

Mr. BURGESS

Mr. BURGESS. Madam Speaker, I rise today to congratulate the Denton County Transportation Authority (DCTA) of Lewisville, Texas. The DCTA was recently awarded a Federal Transit Administration Ridership Award. The Federal Transit Administration Ridership Awards honor and acknowledge the industry's commitment to excellence. The recipients of the Ridership Award are transit systems that have substantially increased their ridership since 2003 through a variety of techniques and innovations. The DCTA is one of four agencies being recognized that service an area with a population between 200,000 and 1 million people. The Denton County Transportation Authority is a synchronized county transit agency that provides a wide variety of local services to Denton and surrounding communities, as well as a commuter service to downtown Dallas. The DCTA has strong relationship with the community. In 2005, the DCTA took over the daily operational and management responsibility of the campus shuttle service for the University of North Texas. The DCTA and the University worked together to provide free fares for students, and ridership on the shuttles increased by 15 percent between fall 2005 and fall 2006. The program was expanded in 2006 to allow free access onto the DCTA Commuter Express service and to expand the service on campus by two stops. The number of students, faculty, and staff that rode transit increased substantially in 2006 and, by the end of the year, 35-40% of passengers on the Commuter Express were associated with the University. I extend my sincerest congratulations to the Denton County Transportation Authority. Their commitment to improving the public transportation system is to be commended and I hope other transit agencies will follow in their successful, innovative footsteps.

Mr. BURGESS

Mr. BURGESS. Madam Speaker, I rise today to celebrate Thomas Bolerjack's memory and his lifelong contributions to his community, family, and country. Tom's passion for life was apparent to everyone who met him. A man with a tremendous love for flying, it should come as no surprise that, at 16 years old, Tom was sitting in the cockpit of a plane testing for his pilot's license. He later enlisted in the Air Force, where he worked his way through the ranks and retired as a Colonel. Tom's enthusiasm, both for flying and serving others, did not diminish upon his retirement from the Air Force. Aviation was an interest that brought Tom obvious joy for the remainder of his life, and his penchant for service became focused on local endeavors. Working with the Boy Scouts of America was a joy Tom shared with his entire family. The Bolerjacks' two sons have been scouts for several years, and Tom was an active part of their experience. He served as an assistant den leader for Pack 170 and was the driving force behind Troop 589, starting the troop a few years ago with a handful of boys. Under Tom's leadership, both troops expanded their memberships to approximately thirty scouts. In addition to serving as Cubmaster, Webelos leader, and Den leader, Tom was also very involved in Boy Scout training for youth and adults. Tom was the Cub Scout Leader Training Chair, the Boy Scout Leader Training Chair, Troop Committee Chair, and the Mustang District Training Chair. Tom also served on the Baloo, Arrowhead & Twin Arrows staff, and was a trainer for the youth protection and new leader programs. He assisted in the Trainer Development Conference. Tom earned his Wood Badge Beads and went on to staff Wood Badge as a Troop Guide. He also served on the organization's Twin Arrows/National Youth Leadership Training and was very active in the Order of the Arrow. Over the years he was honored with multiple awards, including the Cubmaster Award and the Den Leader Award. Tom has been described as a giver, an outstanding example to others, and an inspiration to everyone who knew him. His friend Graham Crudgington described Tom best when he said, ``His energy, his spirit, his dedication are all things that I admire, and are things that have pushed and inspired me to do things I wouldn't normally have done.'' Tom's ceaseless devotion to the community motivated others to get involved; his passion encouraged the passion of others. I extend my sincerest condolences to Tom's wife Becky and his two sons, Tommy and B.J. My thoughts and prayers are with Tom's many friends and family members as they endure this difficult time. The North Texas community has lost a devoted citizen and a great man. He leaves behind a legacy of generosity and kindness. The compassion, commitment, and selflessness shown by Mr. Thomas Bolerjack are truly remarkable, and he should serve as an example to all. He will be deeply missed, but his service and dedication will always be greatly appreciated.

Mr. BURGESS

Mr. BURGESS. Madam Speaker, I rise today to congratulate the Fort Worth Transportation Authority of Fort Worth, Texas on being recognized by the Federal Transit Administration with the 2008 Ridership Award. The Federal Transit Administration Ridership Awards honor transit systems that have substantially increased their ridership over the past five years through a variety of methods and improvements. The awards acknowledge the industry's commitment to excellence. The Fort Worth Transportation Authority is one of four agencies recognized that service an area with a population between 200,000 and 1 million people. The Fort Worth Transportation Authority's bus system, known as ``The T,'' has experienced a significant increase in ridership since the agency executed an advertising campaign aimed at automobile commuters. The effective campaign's goal used fuel prices to show commuters the cost of driving to work by car compared to the cost of using The T system. Additionally, the Fort Worth Transportation Authority partnered with the Fort Worth Independent School District (FWISD) and Texas Christian University (TCU) to promote public transportation use among students of all ages. Fort Worth school teachers were provided with free day passes for field trips, and all TCU faculty, staff and students, as well as FWISD ninth graders, were given a free annual transit pass. The actions taken by the Fort Worth Transportation Authority improved student ridership and established the convenience of public transportation with the future labor force. Madam Speaker, it is with great honor that I stand here today to recognize the Fort Worth Transportation Authority for receiving this honor. Their diligence and commitment to promoting public transit benefits both the community and the environment, and I sincerely hope other agencies follow their example.

Mr. BURGESS

Mr. BURGESS. Madam Speaker, I rise today to commemorate the life of Dr. William ``Doc'' Wilkerson. Dr. Wilkerson, who passed away on February 29, 2008, was one of the founders of Flower Mound, Texas and also the town's second mayor. Doc Wilkerson was born in Madill, Oklahoma on December 21, 1917, and began working for a locksmith at age ten. This prompted his mother to enroll him in the Boy Scouts of America, where he later achieved the rank of Eagle Scout in 1935. In 1954, Doc bought 150 acres of unincorporated rural land north of the newly-created Grapevine Lake. It was here that his fight for Flower Mound began. During the early 1960s, Wilkerson worked tirelessly to halt Irving's attempt to annex what is now the town of Flower Mound. Doc was ultimately successful in stopping the annexation. After this success, he worked to incorporate present-day Flower Mound. Dr. Wilkerson was elected mayor of Flower Mound in 1968. He was only the second individual to hold the position of mayor for the young town, and he held this office until 1973. In honor of his passing, the town of Flower Mound will fly its flags at half-staff. The first mayor of Flower Mound, Bob Rheudasil, once said about Doc, ``No words are big enough to talk about him.'' This is certainly true; Doc's tireless dedication to Flower Mound greatly contributed to turning the small town into the thriving community it is today. My thoughts and prayers go out to Doc's two sons, his brother and three sisters, as well as a long list of family members and friends. North Texas has lost a long-time friend and advocate. While Doc Wilkerson will be greatly missed by the community he helped found, he will forever be remembered for his dedication to the city of Flower Mound.

Mr. BURGESS

Mr. BURGESS. Madam Speaker, I rise today to congratulate Jack and Donna Clark, long time administrators of Flower Mound High School. The Lewisville Independent School District is honoring their service by naming Flower Mound High School's auditorium the Jack and Donna Clark Auditorium. Naming the Flower Mound High School auditorium after Mr. and Mrs. Clark is especially fitting because they both enjoy and have an interest in the performing arts. Donna was a member of the world-famous Rangerettes at Kilgore College in Kilgore, Texas. The couple met when both were teaching at Lake Highlands High School in Dallas, Texas. Donna was an English teacher and director of the Highlandettes Drill Team and Jack was the head basketball coach. The Clark family moved to Flower Mound in 1999 to help open Flower Mound High School. Four years later, Mr. Clark was named principal, the same year the couple's son, Cody, graduated from Flower Mound High School. Additionally, Mr. Clark was named Principal of the Year by Lewisville ISD. The final paragraph of the nominating letter, which was signed by every assistant principal and member of the counseling staff, states: ``The dedication that Jack and Donna Clark have shown through their years of education and to Flower Mound High School should not go unnoticed.'' This dedication is a great way to honor this couple for their devotion to the community of Flower Mound. Madam Speaker, I am honored to rise today and pay tribute to Jack and Donna Clark and their legacy of service to the arts. I am proud to represent this couple in the 26th District of Texas and I am glad to know that their legacy will continue to live on.

Mr. BURGESS

Mr. BURGESS. Mr. Speaker, it's springtime in Washington. We're all anxiously awaiting the start of the spring baseball season, cherry blossoms, and of course April 15 when we all face the deadline for filing our Federal income tax. Now questions are often asked, paper or plastic, regular or decaf, conservative or liberal. Americans don't always agree and don't always see eye to eye. But there is one thing which a majority of us do agree on and agree on hands down, that our Federal tax system needs serious help. According to a 2007 Tax Foundation Study, 78 percent of Americans think the tax system needs a major overhaul. Everyone knows the problem. Each year Americans dedicate billions of hours and billions of dollars complying with a very complex Tax Code. In fact, in 2005, the average taxpayer paid almost $1,900 per household in compliance costs. That means a taxpayer must work 6 days each year just to pay for the cost of preparing his or her Federal taxes for that year. Time is precious. Time is money. Time is fleeting. Time is precious, and we never have enough for raising our families. Time is money, and valuable resources are lost that could be spent on productive activities such as growing the economy and creating jobs. Time is fleeting. And we can never reclaim those hours that we have spent complying with our very complex Tax Code. We all complain about paying taxes. We all complain about navigating the complex code. And the fact is, if the system was fair and simple, it would be a lot easier to follow and a lot easier to swallow. Americans don't mind paying for roads, for a strong defense, or even for health care for your grandmother. The fact is, right now, we have a situation where two families can be living side by side, earn exactly identical incomes and face a very different tax liability on April 15. The Smith family makes the same amount as the Jones family, and they're forced to pay a higher share of the tax burden. The Declaration of Independence states that all men are created equal. Maybe it also should say all taxpayers should be created equal, and it should apply to the tax burden. Changes could be made within our existing system to improve it in the short term. Full expensing of business capital, permanently repealing the estate tax, abolishing the alternative minimum tax are a few of the possibilities. But fundamental tax reform would pay larger dividends. Just think of the jobs and economic growth that resulted when President Ronald Reagan cut the code in half back in 1986. Let's apply some of that same common sense that President Reagan used back in 1986 to streamlining today's unruly code in the 21st century. Simplicity and fairness demand that we replace our current system with a single rate system that taxes income only one time. Even the National Taxpayer Advocate, Nina Olsen, recommended that lawmakers simplify the tax code. That was one of her recommendations in the 2007 annual report to Congress. A faster, a flatter, a fairer tax structure would work and it's pretty simple. Tax returns could be done on a single page, maybe even on a postcard. It could be accomplished in just a few steps. Time me now. Multiply your income by a fixed percentage, subtract a standard deduction, and the process is over. Fourteen seconds. Gone will be the stressful hours figuring out whether your military service or your marital status will adversely affect your return. No more headaches trying to determine where the estimated tax payments go. Tax prep fees might be money spent on, I don't know, something more rewarding. Maybe a vacation, maybe a personal day off, maybe even creating a new job. A single tax rate structure would eliminate taxes on capital gains, taxes and dividends and taxes on savings because again, remember, we're going to tax income only one time. Businesses could expand and create jobs. Personal savings would increase. How many times we hear it said over and over again, Americans don't save enough money. Americans don't save enough money because when they put some of their hard-earned money into savings, half of the interest earned goes away to Federal income tax. It's taxed as ordinary income. Where's the incentive in that? We ought to incent savings in this country, not punish it, not grind the saver into the dust when, in reality, if we increase savings in this country we might not face some of the problems that we face today. Without the heavy corporate income tax which is currently the second highest in the industrialized world; let me say that again, the second highest in the industrialized world, companies would have less incentive to move their headquarters out of the United States and, more importantly, less incentive to offshore their earnings. Recent polling by American Solutions show that 80 percent of Americans favor an optional one page tax return with one rate. After all, who could complain about making something easier, especially a process that comes at a high cost. Former Speaker Gingrich said in this body over and over again, real change requires real change. Americans agree the Tax Code is unfair and should go. Let's take a cue and translate this agreement into real change. After all, fundamental tax reform is a worthwhile goal, and this Congress, this Congress should take it up and pursue it for the benefit of the American people.

Mr. BURGESS

Mr. BURGESS. Mr. Speaker, this week, March 10-17, is National Multiple Sclerosis Awareness Week. The goal of this annual event is to raise awareness of this disease for those individuals and their families who are impacted by it. Every hour in the United States, someone new is diagnosed with MS. It is a chronic, often disabling disease that attacks the central nervous system. Many Americans know a person living with multiple sclerosis, a mother or father, a son or daughter, another family member or friend, or even a colleague. For me, it was a member of my staff. This brave and strong woman inspired me to get more involved in the battle to live in a world free of multiple sclerosis. As a medical doctor prior to coming to Congress, I'm working here to find sensible solutions for the health care challenges that Americans face. As the cochair of the newly formed Congressional Multiple Sclerosis Caucus, I intend to bring the needs of those individuals into the larger discussion of quality health care. Mr. Speaker, we must work together to improve access to quality health services, to break down barriers, and to make MS therapies more affordable. I ask other Members of the House to join me in this noble cause. We must always remember that behind every statistic is the face of a family member or friend. We have a shared responsibility to offer help and hope. There is no better time than now to begin offering it.

Mr. BURGESS

Mr. BURGESS. And I thank the Speaker. Madam Speaker, it has been said over and over again that nothing in this life is certain except death and taxes. I was a practicing physician for over 25 years back in Texas and I've got to tell you, sometimes death seems a little less complicated than our Tax Code. The complexity of the Tax Code has done nothing but grow since the Federal income tax was first introduced in this body in 1913. When it was first created, the Tax Code was 400 pages. This year, it is 67,506 pages, nearly a 17,000 percent increase, pretty typical of government math. Because I'm a visual person, I would like to show you what the statistics look like. Here is a picture from the ``CCH Standard Federal Tax Reporter'' illustrating the exponential increase in the Tax Code. What this demonstrates, Madam Speaker, is way back here in 1913, we had one little 400-page book that was the Federal Tax Code, and then we fast forward to 2007 and 2008 and you see the number of pages now that fill the bookshelf, making the complexity of the code something that the average person, quite honestly just does not understand. Madam Speaker, remember that one of the fundamental tenets of the American legal system, including the tax system, is that ignorance of the law is no excuse. Therefore, in theory, every single American who is merely trying to comply with the Tax Code and file their taxes by April 15 is supposed to be familiar with all of the 67,000 some odd pages that are contained within the Tax Code which comprise the tax rules. Now, I don't know if my tax preparer back home knows all of the 67,506 pages and you have to wonder about other people in other congressional districts. What about the small business owner? What about the single mom who is just struggling to get by? How are they ever going to know all of the regulations contained within 67,506 pages of the U.S. Tax Code? The complexity of the Tax Code is a result of countless deductions and exemptions aimed at steering a social agenda, quite honestly, when it's supposed to be a Tax Code. That's one of the fundamental problems with our tax system, is that we try to enforce social policy through the Tax Code rather than seeing the Tax Code simply as a vehicle for collecting those revenues that the government has to collect in order to run. Special interest groups run rampant through every single page of that 67,000 pages. Anytime Congress wants to punish a special interest group or reward another, Congress adds a new credit or a new law to the mammoth Tax Code. The result is a Federal law fraught with opportunities for avoiding taxes and loopholes to be exploited at the expense of fellow Americans. Everyone is familiar with the problems inherent in our convoluted Tax Code, and criticizing the American Tax Code is as American as apple pie and baseball, and for good reason. Let me share just a few interesting facts on why we need fundamental tax reform. Each year, Americans spend 6.5 billion hours preparing their tax forms, and businesses spend 800 million hours complying with the Tax Code. The cost of compliance for Federal taxpayers filling out returns and related chores was $265 billion in 2005. The average taxpayer pays over $1,800 per household in compliance costs. In other words, that taxpayer works a little over a week just to pay for the cost of preparing his or her taxes for that year. A study was done back in 1998 when the forms in 1998 were less complicated than they are 10 years later, and it surveyed 46 tax experts. Each expert came up with 46 different answers when determining tax liability. Forty-six preparers, each given the same set of data, 46 different figures to determine tax liability. The tax calculations themselves ranged some $34,000 to $68,000, almost a doubling of the original estimated amount. The Tax Foundation prepared the following information that actually I think will be of interest to this body: In the year 2007, a person spent 79 days working to pay for their Federal taxes and 41 days on State and local taxes for a grand total of 120 days. That's more than health care, more than housing, more than transportation. And, honestly, you can see an immediate return on those categories. It's a little bit more difficult to see the tangible return on Federal tax dollars, albeit those are the moneys that are required to have the Federal Government run. But when you look at the bite that taxes take out of the average income compared with all of the other expenditures, it truly is significant. We all complain about paying our taxes. The fact is if the system was fair and simple, it would be a lot easier to take. Americans don't mind paying for roads. They pay for a strong defense. They pay for health care for your grandmother. It's the fact that one family makes exactly the same amount as the family next door, but they're forced to pay a higher share of the tax burden. The Declaration of Independence says all men are created equal, and that should apply to the tax burden as well. Now, let me just show you a breakdown by congressional district. Most Members of Congress should be interested in this chart, also produced by the Tax Foundation. In 2004, the Tax Foundation ranked Federal individual income tax burden by congressional district. My district, the 26th District of Texas, falls here somewhere in the middle, and it is highlighted in yellow so its easy for me to see, but it compares the ranking of Federal income tax burden as a percentage of the adjusted gross income versus the ranking of the average income tax liability per return. In other words, with identical incomes, we have some States with a much higher burden and some States with a much lower burden. Now that is an average across the population, so clearly there will be some differences, but we see New York represented in both the upper and the lower categories. We see California likewise represented in both the upper and the lower categories. So it's not inconceivable that the discrepancy should not be that large; but, nevertheless, because of the complexity of the Tax Code, that's one of the things we're left with. 435 Members of Congress and here is the data from the top seven compared to the bottom seven. You can definitely see varying tax liabilities throughout the country. Again, my district ranked 139th in regards to the Federal income tax burden as a percentage of gross income, but ranked only 127 as the average income tax liability per return. Again, that's more of the Federal Government's math for you. And yet another aspect of complying with our Tax Code. Time is precious. We often don't have enough of it for personal things, those mundane things like earning a living, raising your family, spending time with your friends, and then there's the dollars-and-cents side of the equation where, in fact, time is money and valuable resources are misspent navigating tax law instead of spent growing the economy and creating jobs. Taken together, this is a strong prescription for real change in our Tax Code. We know what works when it comes to changing the Tax Code because we got a glimpse of it when during Ronald Reagan's administration he cut the Tax Code in half in 1986. As a result of that reform, the economy grew, revenues increased and jobs were created. I can't think of a better prescription for our slowing economy today than replicating the reform of the Tax Code on an even greater scale. So what should we do? The prescription is fairly simple. Flatten the tax, broaden the base and shift the burden away from families and small businesses. Simplify the Tax Code and make it easier for individuals and businesses to file their taxes and pay their fair share. Even the National Taxpayer Advocate, Nina Olsen, stated simplify the Tax Code as one of her recommendations in the 2007 Annual Report to Congress: ``The complexity of the code increases the likelihood that honest taxpayers will make inadvertent mistakes, creates opportunities for taxpayers to avoid paying their fair share of taxes, and makes it difficult for the Internal Revenue Service to administer the tax system. Simplifying the tax law could improve the audit process and allow less taxpayer burden.'' Pretty simple stuff. Pretty straightforward. If the National Taxpayer Advocate thinks it is best for our constituents if we simplify the system, it would make sense that Members of Congress on both sides of the aisle would agree with this sentiment and work toward this goal. Now, this next data I need to credit to some polling done by American Solutions. They conducted a nationwide poll on six different topics, with one being taxes and jobs. This poll crossed gender, ethnicity, economic and party lines, and they discovered the following opinions in America. Under taxes and jobs, 69 percent think the Federal income tax system is unfair. Seventy percent favor tax incentives for companies who keep their headquarters in the United States of America. What a great concept. Eight-two percent think the option of a single rate system would give taxpayers the convenience of filing their taxes with just a single sheet of paper. Pretty powerful stuff. Eight-two percent want to be able to file on a single sheet of paper. Madam Speaker, it sounds to me as if America has spoken fairly clearly on this subject, and the evidence is that we do need real change in our tax system. The encouraging news is that we have a practical and effective blueprint for making this real change across- the-board. The blueprint is called the flat tax. In 1981, Robert Hall and Alvin Rabushka proposed a new and radically simple structure that would transform the Internal Revenue System and our economy by creating a single rate of taxation for all Americans. Today, several States have implemented a single rate tax structure for their State income taxes and from Utah to Massachusetts, citizens are seeing the benefit. In Colorado, a single rate generated so much income, so much revenue, that lawmakers actually reduced the rate 10 years after its implementation. In the State of Indiana, the economy boomed after a single rate went into effect in 2003, and in that time corporate income tax receipts have risen 250 percent. In 1981, a simple concept put forth by Robert Hall and Alvin Rabushka, revisited in 1995 by my predecessor in this body, former majority leader Dick Armey, and, most recently, within the last couple of years, a book published by Steven Forbes on the flat tax revolution. All of those authors, all of those authors calling for the same type of reform in our Tax Code, to allow it to be flatter, fairer and simpler. Now we have got several Members of Congress who are actually working on the problem. Certainly it is something that I remain focused on. Congressman David Dreier from California, the ranking member on the Rules Committee, and Paul Ryan of Wisconsin, the ranking member on the Budget Committee, are all working to establish the single tax rate structure for the United States. Members are working on it in the other body as well. Each of us have our own ideas. The legislation proposed is a little bit different, but it all has at the center of it the concept that you should be able to file your taxes on a single form at a much flatter rate that will be fairer across-the-board, and, in fact, evidence has shown that it will actually increase revenue. The bill that I introduced actually two Congresses ago, and I have continued to introduce it every year, H.R. 1040, it makes it easy to remember the number, H.R. 1040 allows for a person to opt in to a flat tax. They can't go back and forth from the old IRS code and the flat tax, but if they elect to go into the flat tax, they may do so. If quite honestly they have constructed their family or business finances such that they have been trying to utilize the code to maximize their effectiveness, no one is going to require them to go into the flat tax. They may stay under the old IRS code. But for a lot of people like myself, regardless of whether I would come up better or worse under the flat tax, just to give up that shoe box full of receipts every year, to give up that quality time spent with my accountant every year, to give up that $1,800 or $2,500 that I spend every year on tax preparation, and I promise you, mine are not that complicated, I would gladly give that up to be able to simply file my taxes on a single page form, or, better yet, populate a field on a computer screen on the Internet, click a mouse, send it in, and be done with it for the year. Now, we all may not agree on just a single rate. I have mentioned some other individuals that have other bills, and they do have different approaches. We may not all agree on whether it should be a single rate or two rates, as it was back when Ronald Reagan simplified the Tax Code. We may prefer a tax method that does allow for deductions for mortgages or charitable contributions. But regardless, regardless, each of them embodies the fundamental principle that each American should bear the burden of taxation equally and at the lowest rate possible; we think everyone should be able to do their own taxes without the help of a professional and should be confident that people who earn the same income pay the same taxes. Madam Speaker, just as an aside, I remember back in the year 1993, I was just a regular guy working in a medical practice back home in Texas. It just so happened that that year, the President of the United States and myself had an almost identical income reported. And yet when you calculated what I paid as a percentage of income, it was in excess of 30 percent. When you calculated what the other individual paid, it was around 20 percent. So why the discrepancy? With the same amount of earned income, why should there be such a vast difference in the taxes owed and the taxes paid? That is really what got me to thinking about this subject, many, many years ago. We all remember when the Tax Code was changed in 1993. It was changed retroactively so that we got both the rich and the dead involved in paying additional taxes. But it really got me focused. Then in 1995 when Congressman Armey published his book on the flat tax, I read it, I became a believer, and have continued to study the issue and have continued to talk about the issue. And this is the time of year to have these types of talks, because I do think it is important, regardless of which party is in power, that we take seriously the will of the American people. Eight-two percent, 82 percent, want to be able to fill out a single page form and be done with their taxes. Just by way of comparison, according to the Wall Street Journal, citing a blog off the National Taxpayers Union website, there are about 1.2 million or more professional tax preparers during tax season, which equals roughly the population of Hawaii. There are 836,000 doctors in the United States. As a physician, I think that there is something a little askew with this number, that we require half again as many tax preparers in the country as we do physicians. Healers shouldn't be outnumbered by tax preparers. The government math stuff is starting to scare me, and really should start to scare a lot of Americans. Also, according to the Wall Street Journal, more than half of the individual taxpayers now use a paid preparer for their income tax return. I do myself. Mine is not that complicated, but I don't dare go into the process without a professional guiding me, lest someone at some point say, hey, you made a mistake. I want a professional with me if I had to go in to justify what those numbers read on the form. We actually anticipate the number of people using a paid preparer to increase this year. In 1960, less than a fifth of taxpayers used preparers. More than half now. Less than a fifth, less than 20 percent, back in 1960. In 2005, one of the most famous tax preparation companies garnered $2.4 billion in revenue from the United States in tax preparation, up from $841 million 10 years before in 1996. Pretty astounding. Pretty astounding figures when you stop and think about it. Now, I respect and I fully appreciate everything that my tax preparer does for me, what my accountant does for me, what tax preparation companies do, and I think it is a shame that Congress has created a system that is so complicated that more than half of the public feel a need to pay someone, to pay someone else, just to figure out how much they owe for their tax liability. The system doesn't have to be that complicated. Now, bear with me, if you would, through one last poster, and this really sums it up. A faster, flatter, fairer tax structure, let me show you how it works. It is pretty simple. Here we go. You put in a little bit of information, like your name; a little bit of identification data, income, personal exemptions, married filing jointly, single head of household; number of dependents. You add up your deductions. Taxable income is line 1 minus line 3. One subtraction equation on the form. And then calculate the amount of tax owed on this particular form, calculate by multiplying line 4 by 0.19. The tax is already withheld. Your tax refund you are owed or the taxes you are to pay. What did that take? According to the clock up there, a little less than 30 seconds. Thirty seconds, and your income taxes are done. Now, in all honesty, I haven't started my taxes this year. Please don't tell my accountant. But I will spend the better part of a Saturday afternoon, probably this coming Saturday, going to all those places in the house where I have secreted away little receipts and things that I knew I would need when it came time to prepare my taxes. I will gather all of this stuff together and put it in a form that is presentable, take another half day and spend that with my accountant. He will spend several weeks churning it through whatever computer program that he uses. And then right before midnight on April 15th, I will get my tax form to sign, and I will send it in and I will either pay a little in taxes or I will get a little bit of refund. But look at this. Thirty seconds. Your name, a little bit of identification data, a couple of numbers that are easy to obtain, and taxes are already withheld, your tax liability or your tax refund. No expensive tax attorney bills. No more hours of stressful research trying to figure out whether your military service or your marital status will adversely affect your return. No more headaches trying to determine where the estimated tax payments go. No more Congress taking one special interest group over the other trying to create social good works through the Tax Code. Instead, just a very simple and straightforward system. And remember that number: 82 percent of Americans want something simple like this for their tax preparation. Now, in my opinion a single tax rate structure would eliminate taxes on capital gains, eliminate taxes on dividends and taxes on savings. You know, we always hear that our savings rate in this country is really pretty low, and that in fact is one of the things that may be behind some of the financial crisis that we find ourself in now. I will just tell you there was a time when I was in business for myself that I thought the prudent thing to do would be to hold three months, three months, of operating capital in some easily convertible security, like a CD, something that was fairly liquid, earn a little bit of interest along the way, and have that money in case the dire wolf was ever at the door and I needed those funds to continue to operate my business. It seemed like a prudent think to do. But here is the deal. You earn some interest, but guess what? It is taxed at regular income rates. So it is suddenly eroded by, at that time almost a half, now around a third. And then if you ever get to the point where, okay, I am going to bring that money back into the business and pay it out in salary, well, guess what? If you have held it for over a year in that money market or CD, your business had to report that and pay taxes on it at the end of that first year, and then when you do dispense it as earnings to the owners of the business, guess what? It is taxed again. So it got taxed twice. So for doing the prudent thing, the prudent thing, holding 3 months of capital in a relatively liquid account so you can get to it if you need it, for doing the prudent thing, you are punished on the interest you earn. So that is not a good deal. You have got to pay taxes on it from your business, and, oh, by the way, if you ever do pay it out to yourself in salary, you get taxed again. So you have been taxed three times on that money that you thought you were doing the right thing. You were putting it away against perhaps a lean month or two. Maybe those Medicare payments didn't come through as fast as I would like, or, God forbid, the SGR cut my payment again for Medicare reimbursement, I would have a little cash to fall back on. But, guess what. If you do that, if you do that, you are actually hurt. If we were to change the Tax Code, again, with a single rate structure, no capital gains tax, no taxes on dividends, no taxes on savings, which is extremely important, and I personally would eliminate the Clinton tax on Social Security earnings, what would happen? Personal savings would increase. Would that be a bad thing? Does anyone in this body think personal savings would be a bad thing, particularly given our current economic situation? Businesses might just actually expand and create jobs. Would that be a bad thing given our job creation numbers this past month? We lost a bunch. We didn't create anything. Without the heavy corporate income tax, which is currently the second highest in the industrialized world, companies would have less incentive to offshore their headquarters and offshore their earnings. If they had less incentive, and those earnings and headquarters stayed in this country, wouldn't that ultimately be a good thing for the state of our economy? So it really comes down to an all-American principle of freedom, and it comes in a prescription. The decision to move to a single-rate system would be entirely up to the business, not up to the government. This would be an optional program. If someone has constructed their domestic finances or their business finances to maximize their earnings under the current Federal Tax Code, stay in the code, that would be your choice. But if you are tired of the shoe box, if you want to fill out a single-page return, single-page form, and then have the rest of that time, that half day I am going to spend on Saturday and that other half day I am going to spend on a week, if you would rather have that day to spend with your family, take a personal day off, go fishing, whatever, earn more money, whatever, that's yours. You don't owe it to the government any more. A flat tax would be less costly. It would save taxpayers $100 billion a year and would reduce cost of compliance by over 90 percent. The resulting increase in personal savings, well, wait a minute, didn't we just pass a big stimulus package? That would have an immediate effect on our American economy by putting that money back in the hands of productive people in this country. As I said earlier, recent polling by American Solutions shows that over 80 percent of Americans favor an optional, single-page, one-page tax form with one rate. After all, is anybody really going to complain if this one time, this one time Congress does something worthwhile and actually makes something easier? After all, who could complain about making something easier, especially a process that comes with such a high cost? One of the things we haven't even talked about, and you now hear talked about all the time, is the compliance gap, the 200 to 300 to $350 billion that it's estimated that is owed in taxes but it's not paid in taxes because it's simply too hard to go through all that you have to go through to comply with the IRS code or you are worried about making a mistake and going to jail for misrepresenting yourself on your tax form. So that compliance gap, the tax gap as it is called, you will hear people talk a bit on both sides of the aisle. They want to utilize, well we are going to go out and do a better job of collecting the taxes, so we will use that $350 billion to offset an increase in the farm program or AMT patch, or, God forbid, we would fix the SGR formula for patients and doctors across the country. But you always hear people talk about that tax gap that they are going to collect that $300 billion and put it to some other good work, but this gets rid of the tax gap. It's gone tomorrow. You wouldn't have to worry about people not complying with the code because it would be so simple. The cost of not complying would be high. The cost of complying would become much more bearable. Well, guess what? This is a very political year. Everywhere you go, people are talking about change. I will tell you what, I haven't heard the word ``change'' so much since I was an intern at the newborn nursery at the Parkland Hospital back in the 1970s. Everyone is talking about change. You turn on the television, people are talking about change. Let's consider how that change could improve one of the most complicated of institutions, the Internal Revenue Service. More importantly, let's consider how that change could deliver prosperity, deliver time back to America's families and to America's taxpayers. You know what, when it gets right down to it, that's a stimulus, that's a stimulus that every American could understand and every American could be for. That's a stimulus package that everyone on the floor of this House should consider and vote for. I have got a bill, H.R. 1040. Ranking Member Dreier has a bill, Ranking Member Paul Ryan has a bill. I think all of those are worth looking at. I would like to see those brought up in the appropriate committee of Ways and Means, the Subcommittee on Taxation. Let's have the debate; let's have the argument. Let's do it out in the open. Let the American people hear our debate, and let them decide who is arguing on their behalf and who is arguing on behalf of the special interests. I think it would become quite clear after just a few minutes of that debate. Again, here is an opportunity to give time and money back to the American people. That is a stimulus package of which this body, both sides of the aisle, could be justifiably proud.