Michael Burgess

Mr. BURGESS

Mr. BURGESS. Madam Speaker, I rise today to thank Mr. Monty Slough of Little Elm, Texas for his years of service in the United States Armed Forces and for his continued service to our country by building a memorial to veterans from Denton County, Texas. After checking records at the Department of Veterans Affairs, Monty identified the names of nine fallen service members and created a personal way to memorialize their service. Without prompting or financial support, Mr. Slough began building a granite tiled memorial to Denton County soldiers, sailors, airmen and marines who died in service in Iraq or Afghanistan. Mr. Slough has taken up the honorable but unfortunate task of paying respect to fellow veterans who pay the ultimate price while serving our country. In his own eloquent words, Monty said, ``This isn't going to bring them back, but they sure as hell are not going to be forgotten.'' The mobile memorial built by veterans Monty Slough and Dee Cork is an example of why we hold our Nation's veterans in such high esteem. I believe the character displayed by Mr. Slough and Mr. Cork should be highlighted as an example of American civic duty and community support; I rise here today to show them that courtesy. It is with great honor that I recognize Mr. Monty Slough of Little Elm, TX for his dedication to veterans and their families. I thank him for his work, I support his mission, and I am honored to represent him in the 26th District of Texas.

Mr. BURGESS

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

Mr. BURGESS

Mr. BURGESS. Mr. Speaker, why don't we just continue on talking about health care over the next hour. It's a relevant subject, and many of us are concerned about health care in this country. Many of our constituents are concerned about health care. Mr. Speaker, I was a physician in my former life before coming to Congress almost 5 years ago. Perhaps it's time that we approach this as maybe a checkup on American health care. And like any good physician, as when I approached someone with a medical condition, maybe make a little problem list and try to run through that and see if we can't break things down and come to some problems that are more manageable or come to some solutions that may, in fact, be possible. The first problem that I want to talk about are problems that affect really the law of supply and demand, the problems that affect the physician workforce in this country. The second problem that I would like to focus on is the one we hear a lot about on the floor of this House, the problem with people who lack coverage for their medical expenses, the people who lack health insurance. The number varies depending upon the source that you check, but by anyone's estimation, the number is too large, and Congress does have an obligation to try to ameliorate that if it can. And then the final problem is how much more government involvement do we want in our health care. And that government involvement, by its involvement, will that lead to the type of solutions that we'd like to see in America? So starting with problem number one, it, again, addresses some of the physician workforce issues that we face in this country. And, again, it's one of those fundamental supply and demand questions, and if we don't have the correct supply of physicians, it is going to affect the overall cost, price and quality of the health care that we receive. Probably now almost 2 years ago, right before he left as the Chairman of the Federal Reserve Board, Alan Greenspan came and talked to a group of us one morning, and the inevitable question comes up about Medicare: Mr. Chairman, how do you see us as ever being able to fund the obligations that Congress has taken on in the Medicare system with the baby boomers now retiring, and starting January 1, 78 million of us will be coming through over the next 40 years? And the Chairman thought about it for a moment, and he said, It's going to be difficult, but I think when the time comes, Congress will make the correct decisions and the Medicare system will be preserved and it will endure. Then he stopped for a moment, a thoughtful pause, as the Chairman always has wont to do, and he said, What concerns me more is will there be anyone there to deliver the services when you require them? And that was a very insightful comment and one that has stayed with me over the past 2 years. Now, my State medical association, the Texas Medical Association, every month they put out a periodical or journal that talks about some of the issues affecting medicine in the State. And this is the cover from the March issue of 2007, and the title of the article is ``Running Out of Doctors.'' The Texas Medical Association is concerned about the number of physicians that are in the State that are being educated in the State and that are staying in the State to enter their practice lives. And it is, indeed, a problem for the State of Texas, but it's a greater problem. It's a ubiquitous problem across the country. Now, some of the things that we do here actually have a direct and consequential bearing on the number of physicians. And here we are bearing down very quickly on the very last of this year. We passed a bill today called a continuing resolution, and that continuing resolution was passed because tomorrow all of the funding for all of the Federal agencies and all the Federal programs, with the exception of the Department of Defense, all of that funding was going to expire because we have not passed 10 of our 11 appropriations bills. So today we passed, really, a deceptively short bill that actually funds the government for those 10 appropriations bills for another week. So perhaps not a great lift, but when you consider that this Congress spends about $3 trillion a year, you can imagine what 1 week's pay amounts to. As we did that, there, of course, is an acknowledgement that we may indeed have to pass another continuing resolution on into next week if we can't indeed pass our spending bills. And that continuing resolution, because of the fact that Congress is going to wind down one way or the other toward the end of next week and then not be in for the remainder of the year, we are indeed going to have to ensure that the funding for those Federal programs continues. But, Mr. Speaker, there's one aspect of that continuation that you really can't punt, you really can't just push it down the road and put it in the ``too hard'' box and we'll deal with that in January or February, and that one aspect is how Medicare compensates the physicians that see our Medicare patients. They are physicians that we've asked to see our Medicare patients. We require them in some instances to see our Medicare patients. And the fact is that Congress for the last several years has had a program in place that actually reduces year over year what we return to physicians in terms of payment for delivering those services. Stop and think about it. A physician's office is a small business. Most people don't think of it that way, but it is a service industry business. It is a small business. And any other business that faced year-over-year cuts in projected revenue or cuts in what the reimbursement rates were going to be would have a difficult time surviving, because guess what? The energy costs for a physician's office are no different than the energy costs for the hospitals or for the bank across the street. They've gone up every year just as they have for our homes and our businesses across our communities. What about the cost of paying the people who work there in the physician's office? That has gone up year over year. What about the cost of insuring those employees that work in the physician's office? Well, that has gone up year over year. But it's kind of ironic that the same time the cost of providing health insurance for the employees in that physician's office goes up every year, the actual return on investment goes down. The reimbursement rate from those insurance companies goes down. And one of the reasons for that is, again, how we compensate physicians in the Medicare system. There is a very technically complicated formula that calculates physician reimbursement rates, and last night I went through that in some detail. I have heard from some of my colleagues that perhaps that's a little too complex and maybe something that doesn't project well on television and doesn't project well here on the floor of the House, but let me give you just a flavor of what's involved with our calculating the reimbursement rates for America's physicians who choose to participate in the Medicare system because we have asked them to who take care of, arguably, some of our most complex and some of our most fragile patients. And the reason this is so important, if we don't do something before midnight, December 31 of this year, there is a 10.1 percent payment reduction to America's physicians who participate in the Medicare system. Not a really great way to go about rewarding them for doing the work that we've asked them to do. And the truth is, every year there has been a projected reduction in reimbursement rates for America's physicians who participate in the Medicare system. Every year for the 5 years that I have been here, Congress has come riding in at the last minute and stopped those reductions in reimbursement rates. But the fact is, Congress has to act before December 31 or those rates that were posted by the Center for Medicare and Medicaid Services November 1, which this year is a 10.1 percent across-the-board reduction in physician reimbursement rates, if Congress does not do something affirmatively before midnight December 31, those cuts go into effect, and physicians wake up on January 31 earning 10 percent less for doing the same amount of work that they did the week before. Again, no other business would be asked to absorb this type of activity. You can just imagine how tough it is to plan for the future. Here you think about a physician's office and they've got the rent, they've got the employee cost, they've got, or course, liability insurance, and various and other sundry things, one of the toughest things for a small physicians' office, and I would talk to you in terms of a group of between two and five individuals, which compromises a vast number of the physicians' offices in the country, one of the biggest expenses they have is the cost of capital when they want to do what? Expand. And what does expansion mean? Hire another doctor to come in and help them do the workload because, again, 78 million people are entering the retirement age where they will be eligible for Medicare, and that starts January 1 of this year. What a coincidence. How ironic. January 1 of this year we start into the baby boom surge, and at the same time, oh, by the way, Doctor, we're going to be reducing your reimbursement rates by 10 percent. That cost of capital to bring in a new physician is one of the biggest hurdles that a small physicians' office has to overcome. Granted, there may be large pieces of equipment that are purchased from time to time, and those also incur a cost of capital, but planning for the future, planning your own future workforce within your office is one of those things that keeps managing partners up at night in those types of practices. And it becomes even more complex and certainly more difficult to predict the future on what future earnings and what future requirements are going to be when every year Congress comes in and says, oh, by the way, at the end of the year we are going to be enacting a physician reimbursement reduction which will significantly affect your ability to pay your bills and perhaps have something at the end of the month to take home to your family. Well, what is the formula? And let me just back up for a moment. Let's talk about the Medicare system in the broad perspective for just a moment. Because the Medicare system, every time you hear somebody talk about Medicare, they say it's an integrated system that works seamlessly and flawlessly. But the reality is that Medicare, in many ways, is stove-piped or siloed. You have part A, part B, part C and part D, which was just enacted a few years ago. Part A pays the hospitalization expense. Part B pays the physician expense. Part C is the Medicare HMO. And part D is the prescription drug benefit that was enacted back in 2003. If you look at the other funding silos, A, C and D, each year those undergo sort of a cost-of-living adjustment for hospitals that's called a ``market basket update.'' So the cost of inputs is calculated by the Center for Medicaid and Medicare Services. They probably have a complicated formula for that, or at least I would imagine that they do. They calculate what the cost of inputs is and they come back to the hospital and say, well, next year we're going to pay you this much more than we paid you last year. The same is true for the Medicare HMOs; the same is true for the Medicare prescription drug account. Physicians, part B, is constructed entirely differently. And I have to confess, I don't quite understand why it's constructed differently; but when Medicare was first enacted over 40 years ago, this seemed to be a sound way to approach the problem. Part A, hospitalization, funded out of a payroll deduction, just the same as Social Security tax every month. There is that 1.5 percent Medicare charge, your employer kicks in a similar amount, so about 3 percent of your gross pay is deducted to cover Medicare expenses for the future. Part B is funded from two sources, one is general revenue, and the other source is premiums that are paid by people who are Medicare recipients. By law, the Medicare recipient's premiums must account for 25 percent of the total expenditures in part B; the remaining 75 percent is made up in the general revenue. Part C and part D, again, have different funding streams. Part D, when we created the prescription drug a few years ago, has dedicated funding to that. You may recall there was some argument about what the total cost of that would be. Thankfully, it has come in under cost, and that's been a great boom and a great savings; but nevertheless, there is a dedicated stream of money for the Medicare prescription drugs. Part C, the Medicare HMOs, also has some dedicated funding, plus some cost-of-living adjustments that occur there as well. So physicians are clearly in sort of a class by themselves when it comes to Medicare reimbursement. So, how does the Center for Medicare and Medicaid Services, how does it calculate what the payment rate for physicians is going to be? It's calculated under a formula called the sustainable growth rate formula, referred to as the SGR. And you will probably hear people talk about the SGR a lot next week because, again, if we don't do something about the SGR, it is going to automatically proceed with a 10.1 percent reimbursement reduction for the Nation's physicians who choose to see Medicare patients. Now, for the people who are very astute, there is a typographical error on this page, and I cannot take ownership of the typographical error; this was actually a pdf file simply taken from a CRS report to Congress about physicians' payment. But here's how we calculate physicians' payments: the relative value unit of work times essentially what is a geographic factor, or fudge factor for the geographic location of the practice, a relative value unit for the practice expenses, and then, again, the geographic adjustment for practice expenses in that area factors in things like the cost of labor force and what have you in different areas of the country. And then a relative value cost for providing liability insurance. And as you might imagine, there is also some geographic discrepancies there across the country, so that is factored in, times CF, which actually down here is written as CV, but that's the conversion factor. And we'll get to the conversion factor in just a moment. But I think you can see a pretty complex formula. And perhaps that's why I was criticized for going through that last night. And I will abbreviate the discussion of the formula, but I just want to give you a sense of how complex this is and why, certainly, the average person doesn't understand it, the average physician doesn't understand it, and I will submit to you that most average Members of Congress don't understand how this formula is calculated either. Here is a calculation again of the update adjustment factor, perhaps a little bit different way of looking at some of the same sort of data. But the thing that I want to point out on this, because it is extremely important to understand this, the update adjustment factor here is equal to the prior year adjustment component, what we did last year, plus a cumulative adjustment component. Why is that important? Well, every year that we sweep in at the last minute and we say we're going to fix this reduction in reimbursement for physicians and we're going to make that go away, or maybe even provide a little bit of a positive update, every year that we do that, because of the cumulative nature of this formula, we make the overall expense of eventually repealing the formula, we make that expense increase. And every year the amount of increase actually grows, it snowballs, if you will. To give you an example, when I first came to Congress in 2003, the year before, in my practice, we had sustained a 5.4 percent reduction in Medicare reimbursement rates. A great hue and cry from across the country and Congress recognized that and said, we're going to do something this year to prevent that from happening. And that something did, indeed, occur in an omnibus bill right as I got to Congress in January of that year. The cost of repealing the sustainable growth rate formula at that time was calculated by the Congressional Budget Office to be $118 billion, give or take a billion here or there; $118 billion, a significant amount of money, but that actually is a 10-year figure. So it's about 11 to $12 billion a year that we would have to come up with in Congress to offset the cost of repealing that formula. Big sum of money to be sure. But every year now, over the last 5 years, we've done something at the last minute, and that something has increased the cost of the ultimate repeal of the sustainable growth rate formula, such that now it is calculated by the Congressional Budget Office this year as being $268 billion over 10 years' time. If, indeed, we get our work done and prevent that cut from going into place at the end of this month, the cost, again, that cumulative adjustment factor will come into play, and that cost will be bigger in 2008 than it was in 2007. And it will be bigger by a larger amount than it was in 2007, depending upon the amount of rescue that Congress chooses to bring to the table. And then again, I just can't help myself, one last slide, talking about the complicated nature of this. And again, I show you this not to invoke sympathy from someone who has spent some time studying this, but I show you this because I want to give you a sense of how complicated the problem is. Again, I will submit to you that many Members of Congress just simply do not, cannot, will not understand this. And as a consequence, it kind of gets put in that ``too hard box'' over here and we'll think about that later. That's why there is always the temptation to try to kick it down the road. The fact is, we have to do something by December 31. If we don't, that 10.1 percent reduction comes into play. You might say, well, okay, that's for Medicare patients, but doctors see more than just Medicare patients in their office, so they will be able to deal with that in some way, won't they? Just raise the rates on someone else. Here's the deal: almost all of the major insurance companies in this country peg their reimbursement to what Medicare reimburses. So the contracts may be a little more generous than Medicare, they may reimburse at 110 percent of Medicare, 115 percent of Medicare, 120 percent of Medicare; but they peg to what the Medicare reimbursement rate is. So if we come in with a 10.1 percent reduction in physician services reimburses, guess what happens to private insurance at the same time? That same reduction goes into play. So I called my old medical practice yesterday and I just asked them, what do you think about this? And of course they were more or less unaware that this was happening, and that's really not unusual. Most physicians' offices don't pay a lot of attention to what we're doing up here in Congress because they're busy, they're taking care of sick people. And that's what we want them to do. We don't want them necessarily watching every move we make here in Congress. But when I related that, no, we actually need to do something or there will be a 10 percent reduction at the end of this year, then I got their attention and then they were very interested. And I said, well, give me an idea of what this will do to your commercial insurance. And very quickly the response came that almost all of our contracts that we have with commercial insurance actually pegged to Medicare. So it will have more than just a ripple effect. It will be almost like a tidal wave effect through the rest of the reimbursement rates for the other plans and insurance companies that this office, for which they receive reimbursement for taking care of those patients. Now, what happens if we don't do it by January 1? The cuts go into effect. But maybe we go ahead and do it and take care of it in January or February, we kick the can down the road a little bit and then we come back later and do it. Actually, this happened in 2005. We had the fix in a big bill that was being passed that year. It was called the Deficit Reduction Act. And we kind of ran out the clock at the end of the year and on a technicality the bill had to come back to Congress, but we weren't in session anymore, so it had to wait until January. And the effect was that those cuts did go into effect January 1 of that year. And I know that because my fax went crazy. There was no one in the office that day to answer the phone, but the fax machine went crazy from physicians across the country sending me notices, Congressman, I want you to see the letter I sent out to my patients this week. I will no longer be able to provide Medicare services because of the cumulative effect of these reductions on my practice. It had a very immediate and detrimental effect on practicing physicians across the country. The same would be true this year. In fact, it would be worse because that year the reduction was 5 percent; this year it is 10 percent. And I would just imagine that it would at least double, if not more, the anxiety that's felt within our physician community across the country. Moreover, the Center for Medicare and Medicaid Services said, we will come back and make whole those practices that continue to see Medicare patients without interruption, and we will go back and reimburse them the difference when Congress finally passes a law. And that's all well and good, but there's very little way to control if those private companies come back and make the adjustments retroactively the same as Medicare did. Again, very, very difficult to know that because we're talking about very small amounts of money. It's very difficult for a practice to actually track that through the overall cycle of a patient's care, but the result is, cumulatively across the country, the numbers could have been quite, quite large. And it was never the intent of Congress to provide a benefit for commercial insurance by reducing the Medicare rate. It's just an unfortunate consequence of having what are essentially Federal price controls on Federal reimbursement rates. Well, again, I promised not to spend too much time on the formula, but I think it is important. I think it is important for Members to understand. I have had several bills over the years trying to deal with this. One thing that I have introduced just this week is a resolution in the House of Representatives. And I will admit this resolution does not have the force of law. It actually doesn't spend any money. It almost is like sending a get well card to the doctors who take care of our Medicare patients. But the resolution is multiple whereases detailing the problems that I have just been through followed by a single, Resolved: That it is the sense of the United States House of Representatives to immediately address this issue and halt any scheduled cuts to Medicare physician payments and immediately begin working on a long-term solution and implement it within 2 years that pays physicians in a fair and stable way, that ensures Medicare patients have access to the doctor of their choice. Mr. Speaker, I know I have to confine my remarks and I only speak to the Chair, and I will do that, but if I could speak to my colleagues, the Members on both sides of the aisle, I would ask them to take a very serious look at House Resolution 863. Again, it spends no money. It does not have the force of law. But I think if a significant number of Members were to participate in signing on to this particular resolution, it would be a powerful message to send to House leadership on both sides of the aisle that we want this problem fixed before we go home at the end of the year. This is one of those things on our to-do list that we must address, that we must take care of. Now, one of the other things that I do want to spend just a minute talking about, and in some of the physician workforce bills that I have introduced in Congress, I have provided some additional help for doctors who will voluntarily participate in improvements in their office's investment in health information technology. In fact, the last bill that I introduced dealing with the sustainable growth rate problem had it in two components for a voluntary positive update for physicians who, again, participate on a voluntary basis in upgrades in health information technology and for physicians who voluntarily participate in quality reporting measures. Let me just tell you something. Mr. Speaker, it is just human nature, anyone who works for a living always likes to be kind of pulled into the process and asked to help work on a problem. Most people don't like to be told what to do. Most people inherently reject orders that come from the top down. A lot of times, it is better to build things from the bottom up. Now, I have to tell you, when I was a practicing physician, I wasn't a big advocate of electronic medical records. I dabbled in it a little bit. I had a run or two with electronic prescribing. These things were complicated. They were expensive. They added time to my day that wasn't reimbursed. But the reality is I have come to accept the concept more since I have been in Congress. Let me just share with you what one of my revelations was. Many of us who serve in this body will never forget the week that Hurricane Katrina roared into the gulf coast and struck the gulf coast areas of Mississippi, Louisiana and Alabama. It was the result of the effects of that hurricane and the subsequent flooding in the City of New Orleans and subsequent trips to that area, once just as an individual to see if I could be helpful, and once as part of a field hearing with my Subcommittee on Oversight and Investigations as part of the Energy and Commerce Committee. This is a picture that was taken on that second trip, January of 2006. So we are now 5 months after the hurricane hit, 5 months after the dewatering of the City of New Orleans, if ``dewatering'' is actually a verb. Here is a picture of the basement of Charity Hospital. Charity Hospital, one of the venerable old institutions in our country that has been long associated with teaching doctors, teaching new doctors, here is the records room at Charity Hospital. You can't really see it from this picture, but there is still water on the floor, water about up to the level of the top of our shoes. Do you see these records? And there is just oceans and oceans of records. This is one stack. There are stacks that go on, 50 behind and 50 in front. There are a lot of records in the basement of Charity Hospital because they take care of a lot of patients, and they have for a lot of years. Look at these records. It almost looks like they have some smoke or soot damage on them, but, in fact, that is black mold that is growing on them on the manila folders and growing on the paper in the charts, and as a consequence, you could not possibly send anyone in here to retrieve a chart. It would be too hazardous. In all likelihood, the ink is washed off the paper anyway during the couple of weeks that these things were submerged. These records are, for all intents and purposes, lost to the ages. There is no way of knowing what is included in those medical records. There may have been a treatment for leukemia here. There may have been a kidney transplant down here. We don't know. This may have been someone on a waiting list for a transplant. No way of knowing. Those records are lost forever. Here is the deal. Those individuals who were brought to the Dallas- Fort Worth area who were displaced after Hurricane Katrina and arrived at Reunion Arena in sort of a little triage area set up by doctors from the Dallas County Medical Society, there was a small trailer outside, and one of the chain drugstores said, Well, for those people who had prescriptions at our drugstore, we can at least help you reconstruct what medicines they were on. It was enormously helpful to have that information so those patients who had their prescriptions at that particular pharmacy, they could go online into their master list and at least reconstruct the medication list. And a lot of times, if you have the medication list, you have a pretty good idea of the problems that were under treatment. Certainly, you would have a better idea than if you were waiting for the City of New Orleans to be evacuated of water and then get down to the basement of Charity Hospital, run the health risk of pulling out one of these records and breathing in the spores of the black mold. So I have become a believer. You have to have some way of, especially in times of great national upheaval, you have to have some way of getting that data that has been accumulated on patients over the years. You have to have ways of getting it into the hands of the caregivers. I don't know that we have the perfect system yet. I don't know if the Federal Government is capable of developing the perfect system, or perhaps that may be something that comes to us from private industry, but I do know this. The time for electronic medical records is nigh at hand, and as difficult as it is for doctors my age who did not grow up with this technology, it is time that we are going to have to come into the 21st century and acknowledge this type of technology is a benefit and delivers value to the interaction that occurs between the doctor and the patient. But how much better is it to bring those physicians along who are in practice and allow them to participate in the solution, allow them to participate in the construction of these platforms? Contrast that with the typical congressional activity, which would be a top-down approach. In fact, just last week we had the unveiling of an e-prescribing bill with a lot of fanfare over on the Senate side. And it was vaunted as a ``carrot and a stick'' approach, that, Doctor, we will give you a little something if you participate, but we are going to have a little something to say to you if you don't participate. So the carrot was we are going to increase your reimbursement rate by 1 percent if you participate in an e-prescribing program. And what is the stick? A 10 percent reduction if you are not participating in an e-prescribing program in 5 years' time. So that was seen as a way to rapidly get physicians' attention. Yes, we will offer them perhaps a little bit up front and we will have a significant penalty if they don't participate. Well, what does it really mean when you say we will offer a 1 percent increase? Well, I will just tell you that for those Medicare patients that I saw as an office patient, the office reimbursement visit typically wasn't as generous as $50, but for the sake of argument, to make the math easy, let's say it was a $50 reimbursement for a moderately complex Medicare patient return visit, which would be the bulk of the patient load that a physician would see during the day. And the average physician can probably see four of those moderately complex return visit appointments in an hour's time, sometimes a little bit more, sometimes a little bit less if those visits turn out to be more and more complex. That 1 percent increase that the doctor will receive amounts to about a $2 an hour, 50 cents per patient, four patients an hour. So that is a $2 an hour increase that we are willing to provide the physician who is willing to participate. Now, what happens if in 4 or 5 years' time they are not participating, they are not partaking? I have to tell you, you look at the cost of installing an e-prescribing program in your office, putting a handheld device of some kind in the hands of perhaps every doctor and perhaps every nurse that is working in that office. This program that was unveiled last week would allow a $2,000 credit or grant to the physician to buy the equipment, but the reality is the equipment costs many times that. But we are going to give an extra $2 an hour to that doctor for participating in this program. But if they don't do it within 4 or 5 years, the stick is going to be a 10 percent reduction, which doing the same math, you are going to come up with about a $20 an hour reduction in reimbursement. Now, wait a minute, this is the same doctor you said we were going to cut 10 percent at the end of this year, and at the end of next year and the year after that. How many doctors do we expect to see, going back to my first slide, ``Running Out of Doctors,'' how many doctors do we expect are going to be participating in the Medicare system if we keep treating them like that? Well, they would be foolish to stay. You would have to wonder about their mental stability if they did indeed stay. So we need to have a better approach. It was talked about as a ``carrot and stick'' approach. To me, it almost seemed like spinach and a whooping. You know, it is not going to be that attractive on the front end, but it sure is going to be bad on the back end. So I can't see that physicians will rush out and embrace this. And I really would caution the Members of Congress who are working on this end-of-the-year Medicare fix, whatever it is, to really be careful, to really be cautious about including this type of language in whatever type of Medicare fix that we come up with at the end of the year. Is the theory good? Yes, it is. E-prescribing is something that certainly younger physicians in medical school and residency, they are going to be exposed to on an ongoing basis. And they are going to look for practices that have this to offer, or they are going to come to work in practices where it is not offered and wonder why it is not there and ask their older partners to please provide them an e- prescribing platform because it is the right thing to do. It reduces errors. It reduces some of the complications of prescriptions that are filled poorly, of doctors' handwriting can't be read, the pharmacist has to call the doctor back and say, did you mean Zanax or Zantac? And these types of problems can be avoided with e-prescribing. It is not a panacea. There will be different types of errors that come to light as more and more people use e-prescribing, but it clearly is the way of the future. But do it correctly. Remember, there is not a single dollar that is spent in the health care system unless it is ordered by a physician. So our physicians are the gateway through which all of the medical reimbursement, all the medical pricing, all the medical cost flows through the physicians. So let's make sure that they are on our side with this. Let's not alienate them the first shot out of the box as we go forward with these types of programs. Let me just give you an example, too. And I talked a little bit about I am not sure if the Federal Government is exactly the correct entity to have involved with creating this new electronic environment that we want medical practices, in which we want them to exist. Perhaps it would be, perhaps there will be improvements from the private sector that we ought to investigate. Perhaps we need to remove some of the regulatory burden. I won't go into great detail, but they are called the Star clause. Maybe we ought to remove some of the regulatory burden. Maybe we need to have some medical justice, some medical liability reform so companies aren't afraid of this. But the fact of the matter remains, I am not sure the Federal Government is the correct avenue to proceed with this. When I came here 5 years ago, I was told that the Federal Government controls 50 cents of every dollar that is spent in health care and we are going to develop a platform. We are going to develop what electronic medical records should look like, and private industry will follow our lead. Five years later, where is it? I don't know. But I do know this. Do you remember a year ago all the trouble we had out at Walter Reed Hospital and all the negative headlines that were coming out in the Washington Post? And yes, there were some real physical problems in a place out there called building 18. But here is the real problem. Master Sergeant Blaine, who was kind enough to give me a tour through that area at the end of showing me the peeling paint in the building under question which was no longer at that point occupied by our soldiers out there on medical hold, he said, Here is the real problem. I have guys who have been in the service for sometimes 20 years. They are trying to decide whether or not they are kept in the service, whether they can be returned to their unit, or whether they need to be discharged because of whatever their medical condition is, and if they are discharged, what is the disability, what is the correct disability designation to give them? And how can we put that information in the hands of the VA system so that patient's transition to retirement status is made easier? The problem is, the master sergeant told me, that someone who has been in the service for a number of years is going to have a great big, thick medical record. And the problem is, that even the part of the Department of Defense records that are electronic don't talk to the electronic medical records that are kept by the VA system. So the result is they have got to go through a paper interface to go from one platform to the other, and there is this great stack of papers that the soldier will collect themselves, go through with a yellow marker, yellow highlighter, and mark and identify those things that will perhaps make their case for themselves, as to whether or not they should go back to their unit, be discharged on a disability, transition to the VA system. All of that data has to be done by hand by the soldier, and it may take many man-hours to accumulate that data. The real problem, the master sergeant said, was after collecting this voluminous data that may look like the Washington, D.C. phonebook, when it's all said and done, that goes and sits on someone's desk for two weeks' time, and then it's lost and the soldier has to start all over again. So their time in medical hold is increased, their frustration level is certainly increased, and, yeah, the peeling paint and crickets were a problem, because the building was a crummy building. But the real problem was the difficulty that the soldiers were experiencing because one electronic medical records system within the Federal Government didn't talk to the other medical record system within the Federal Government. Just an indication of, to me, perhaps government doesn't have the entire solution here. Mr. Speaker, a couple of other things that I just want to touch on, and I know time is growing short. The medical liability condition in this country is something that really adds to the frustration list. When you talk to doctors about what are some of the things that really bug you, what would be some of the things that shorten perhaps your number of years in practice, your number of years in service, certainly the medical liability issue will come front and center. Mr. Speaker, our Founding Fathers were very wise, and they talked of States as being great laboratories where different ideas can be tried and tested; and I am happy to say within the arena of medical liability, my home State of Texas made some changes a little over 4 years ago that have resulted in a significant, a dramatic improvement in the medical-justice environment in the State of Texas. Consider this: my last year of active practice was 2002. We had gone from 17 medical liability insurers in the State down to two. I am here to tell you, you don't get much competitive advantage when you only have two medical liability insurers. But the claims are going up, the amounts of dollars awarded in claims is going up, and you only have two insurers. Guess what is happening? Premiums for doctors, doctors who historically had not had much in the way of any activity, still, those doctors were being asked to fork over increasing amounts of premiums, and we are talking about significant increases year over year, such that my premium might go up from $18,000 one year, $25,000 the next year. My last year in practice, it was likely to be $28,000. You multiply that by five doctors in a practice, and that is a pretty hefty check to have to write at the beginning of every year. In an OB/GYN practice, as I was in, that's a lot of babies that you have got to deliver just to pay the freight, to pay the tab on medical liability. The State of Texas recognized that they were in crisis. The State legislature in 2003, at the end of their legislative session, passed a medical liability reform bill, and it was patterned after what was called the Medical Injury Compensation Reform Act of 1975, passed out in California. It essentially was a cap on non-economic damages, patterned after the California law from 1975; but it was a little bit different, a little bit different in that there was a cap on non- economic damages as applied to the physician, a cap on non-economic damages as applied to the hospital, and a cap on non-economic damages as applied to a second hospital, or nursing home, if one was involved. So the cap was trifurcated, each maximum being fixed at $250,000, but an aggregate of $750,000 for non-economic damages. Punitive damages and actual damages were not affected by the law and the subsequent constitutional amendment that was passed in Texas that allowed this law to go into effect. Indeed, it went into effect on September 12, 2003; and since that time, Texas Medical Liability Trust, my old insurer of record, doctors who were insured with Texas Medical Liability Trust, between dividends and reductions in premiums, have seen a return of about 22 percent, a reduction of 22 percent of their premiums that they paid with Texas Medical Liability Trust. Remember, this was an environment that was going up by 10 or 15 percent or more a year. So a significant reduction for the physician. The other unintended beneficiary was the small, not-for-profit hospital that typically was self-insured and had to put vast sums of money in reserve against the unknown aspect of what they might be hit with in a medical liability suit where the non-economic damages were not capped. These small not-for-profit hospitals were able to move some of that money that they were holding against a loss in a legal action and put that into the very things you want your small, not-for-profit community hospital to be doing, like capital improvements, paying nurses, hiring more nurses; perhaps doing some of the very things that would result in better care that would reduce the number of medical- legal claims. So this was a good thing across the spectrum for physicians, for hospitals, for patients in the State of Texas. Now, we have tried several times to do that similar sort of law here on the floor of the House. We have never managed to quite get it done. But House bill 3509 is a bill that is patterned after the Texas law. Again, Mr. Speaker, I know I need to speak directly to you and not to other Members of the House of Representatives, but if I could speak to them directly, I would ask them to have their staffs seriously look at H.R. 3509 and see if there wouldn't be some way for them to cosponsor it. Because, again, I think the weight of significant cosponsors, taking it to the House leadership both on my side and the Democratic side of the aisle, might help tip the balance that we really want something done on this issue. We will still have a tall order in the Senate, which has always been the stumbling block, but the time has come to do some type of sensible medical liability reform, medical justice reform. Well, I have spent a lot of time talking about physician workforce. Let me touch on the other two problems that I alluded to as I began this. Certainly, the second problem we always hear a lot about is the uninsured, and we can argue about what the number is, and the census number will come up with different numbers and different people will have different figures. But by anyone's estimation, it is higher than it should be in this country. If you look at kind of the breakdown of the uninsured, one of the big problems I think we make is we always approach that as some sort of amorphous demographic, where everyone is identical throughout the spectrum of the patients who are uninsured in this country, and the reality is there are vastly different groups contained within that number. Now, a bill that I introduced just a couple of weeks ago that, again, Mr. Speaker, I will address to you, but if I was able to talk to other Members of the House of Representatives, I would suggest they have their staff look at H.R. 4190. Now this is a simple little bill that actually takes Members of Congress and takes them out of the Federal Employees Health Benefit Plan, in other words, makes Members of Congress uninsured. How else are we going to be able to really understand and really deal with the problems of the uninsured when we have very good health insurance? So if every Member of Congress suddenly found themselves without health insurance and placed into that demographic, however large it is, perhaps we could think of some more creative solutions, whether it be a change in the Tax Code, perhaps a tax credit, whether it be some additional help, whatever. Members of Congress would have a renewed vigor with approaching the problems and providing solutions and options for patients who find themselves uninsured. Perhaps it is a health savings account, perhaps an individually owned insurance policy. And, oh, by the way, the tax treatment for that for those provided by an employer and those provided by an individual, the tax treatment is vastly different. Maybe we could come up with some creative ways of looking at that if we ourselves were not kept in this cocoon and anesthetized by the Federal Employees Health Benefit Program. Suffice to say, Mr. Speaker, I have not had a lot of people showing up outside my office to sign on as cosponsors, but it is an intriguing idea, and I do ask Members, I will not ask them to necessarily sign up as cosponsors, but realistically, Mr. Speaker, if I could speak to my colleagues about this, I would ask them to give some thought to how they would approach the problem if they themselves or their families were actually members of the group in this country that did not have health insurance. You break the number down, and the individual demographics, suddenly you start looking at numbers of people where perhaps there are some choices and options. There are some things we could do. Some people tell me that as many as 10 percent of that uninsured demographic are people in universities or just recently graduated university students who, for whatever reasons, don't have health coverage. Well, there is a group of individuals that is fairly easy to insure because they tend to be healthy. Yes, they can have some bad things and they tend to be very expensive when they occur, but almost the ideal population to think about some type of catastrophic coverage, again along the lines of the HSAs that we expanded a few years ago. Perhaps if we equaled out the tax treatment a little bit, because a lot of these individuals are entering the workforce for the first time, they are finding what it is like to pay taxes for the first time, maybe we could get their attention with a little bit more favorable tax treatment. Certainly that is one option we could look at. A number of people in this country actually make enough money to purchase health insurance, but choose not to. Perhaps there would be ways of pricing health insurance so the costs were not so daunting, that the cost was not such a barrier to entry for those individuals; and there are a variety of ways of perhaps approaching that. Congress just simply again perhaps needs to remove some regulations, needs to provide a little bit more level playing field between some of the States and allow this to occur. There is no question that there is a lot of people in this country who are here without the benefit of having a valid Social Security number. That is a large number of our uninsured. Perhaps there are ways that we need to be thinking about how to address and how to approach that population, because clearly it is a difficult issue that we can't just keep putting in the too-hard box and we are going to think about it later. If we don't address that issue, we will never solve the problem. Mr. Speaker, let's not forget, we had a hearing on the Federally Qualified Health Centers in my committee on Energy and Commerce earlier this month. Fifteen million people actually get their health care through a Federally Qualified Health Center. Well, they have a medical home. For all intents and purposes, although they may lack an actual insurance policy on paper, they have access to medical care, they have access to a medical home through a Federally Qualified Health Center. So let's stop counting those as members of the uninsured, because they all obviously do have access to care. One final point that I do need to make, Mr. Speaker, and, again, I realize that time is short and it has been a long week: Do we increase the participation of the Federal Government in health care? Is that the answer for us in dealing with a lot of the problems that we face today? Well, I would ask us to look at a couple of things. You look at what is still on our to-do list as Congress wraps up this year, and what are some of the big things you see? First off, we haven't funded the money for veterans services and veterans health care. That is still up there on the to-do list. I have talked about it already, but we have not dealt with the looming reduction in physician reimbursement rates that is out there and fixing to happen to doctors across the country in just a few short weeks' time. We haven't dealt with whatever our final resolution is going to be on continuing the State Children's Health Insurance Program, a program administered by States, but they receive a significant amount of money from the Federal Government. And we have as yet not been able to come to a conclusion as to what we are going to do about funding the future for the State Children's Health Insurance Program. Take a step back and look at that. We haven't funded veterans, we haven't figured out what we are going to do for our Medicare patients, because the doctors may leave because we decided not to pay them, and, oh, by the way, we still haven't done anything to cover our kids. Do we want to be giving the Federal Government an increased reach and grasp of our health care in this country? Are we doing such a good job here that you want to reward us with more? You see Members of Congress write op-eds in the Washington Post where they talk about expanding Medicare to people that are age 55. But, by the way, good luck on finding a doctor, because we are not paying them anymore and they are dropping out of the system. So we have people in this Congress who want to sort of drag and drop people into Federal programs, take people off of private health insurance in the State Children's Health Insurance Program. One of the big issues there, we want to expand the program so big that it pulls kids off of private insurance, because, you know what, it is too hard to go down and find those really poor kids that we are supposed to be covering. That is a lot of work. They move around a lot. They may not really live with their parents any more. It is just a lot of hard work to find them. It would be a lot easier to go get some middle-class kids and pull them in to have a number of 10 million and say, look, aren't we great, what we did with the State Children's Health Insurance Program. I don't know. I don't know. You talk to pediatricians who work in private practice in this country. You ask them how they are reimbursed in the State Children's Health Insurance Program versus private commercial insurance. And guess what? Private commercial insurance, for all its faults, is still a better reimbursement rate than the State Children's Health Insurance Program by about a two to one margin. So are we going to be helping our pediatricians by pushing more kids on to the state-run program and pulling them off of those private programs? I don't think so. Right now the Federal Government has control of about 50 cents out of every health care dollar that is spent in this country. The remainder of that is not all private insurance. The lion's share of it is. Certainly some people still write a check for their health care, just like they did when my dad was in practice back in the 1950s. Some doctors give of their time willingly. They give charitable care. We never account for that in any of the demographic studies that we do. But half of the health care in this country, the dollars spent on health care in this country, 50 cents out of every health care dollar originates right here in the House of Representatives. Are we doing a good job with what we already have? Might we not be asked to improve what we are doing in those programs before we are asking you to let us take over even more of how we deliver health care in this country? It is certainly food for thought as we wrap up this year in the United States Congress. I would emphasize one more time, Mr. Speaker, and again I will address my remarks to you, if I could talk directly to Members who are involved in leadership on both sides of this House of Representatives, Mr. Speaker, I would ask that they seriously look at fixing the problem with physician reimbursement rates that we are coming up on now like a freight train and it is going to have a significant negative impact on the care rendered to our seniors in the Medicare program. But we have got to pay attention to what we are doing for our veterans. We have got to pay attention with the State Children's Health Insurance Program. Again, lots of areas for improvement, I think, before we talk about expanding the reach and grasp of the Federal Government.

Mr. BURGESS

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

Mr. BURGESS

Mr. BURGESS. Madam Speaker, I come to the floor tonight to talk, as I often do, a little bit about health care, the state of health care in this country, where we are, where we've been, where we're going. Tonight, I do want to focus on one particular issue that is before this Congress. It's a critical issue facing our doctors in this country who provide care for Medicare patients, because if this Congress does not act before midnight on December 31, those physicians are facing a rather significant reimbursement reduction, and that would have an adverse affect on their ability to see patients, to care for patients and, indeed, would have an adverse effect upon access. So I do want to spend some time talking about that, why that is the case and what we in this Congress can do about it and what we need to do about it. And again, that action has to take place prior to December 31 of this year. It's not something we can punt into next year and then come back and try to collect our thoughts and make another run at it. We have to fix it with the time we have remaining in this first half of this Congress. Another issue that I want to address is the issue of the physicians workforce. Of course, the Medicare reimbursement rates directly affect the physician workforce, but we can't forget physicians who are at the very beginning of their training, physicians in residency, and we certainly can't forget those individuals who might even be contemplating a career in health care and how can we help them make the correct decisions. I do want to talk a little bit and focus a little bit on medical liability reform because that does play an integral role in the overall quality and makeup of the physician workforce. I'd like to talk a little bit about the history of medicine, some of the things that have happened in the last 100 years and some of the things I see just happening and just over the horizon as we begin the dawn of the 21st century. And finally, I do think we need to talk a little bit about the status of the uninsured and, again, some of the other current events that surround health care in this Congress. Madam Speaker, we pay doctors in our Medicare system under a formula known as the sustainable growth rate formula, and this has been the case for the past several years, and it has led to problems, certainly every year that I have been in this Congress, and I took office in January of 2003, and the problems actually predate that for some time. The difficulty with that formula is it ties physician reimbursement rates to a number based upon the gross domestic product which, in fact, has no bearing on the cost of delivery and the volume and intensity of medical services delivered. And Medicare, of course, many people know Medicare is supposed to be an integrated program but, in fact, in many ways it is high load. You have part A that's paid for with a payroll deduction just much the same as Social Security. Part A, of course, covers hospitalization expenses. Part B covers physician expenses. That is paid for out of member premiums that citizens purchase every year, and it is paid for out of, 25 percent by law by the premium dollar and 75 percent comes out of general revenue. Part C, the recently enacted Medicare prescription drug benefit, had money budgeted for that purpose. Remember that was all the fight of November of 2003 when we enacted that law, but money was actually on the budget and dedicated for that purpose. And those moneys exist and, indeed, are appropriated automatically year over year. I beg your pardon, part C is the Medicare HMO. Part D is Medicare prescription drug. Part C is funded again, likewise, out of the general Treasury. Part A, part C and part D each have essentially a cost-of-living adjustment that's made every year. So that the cost of delivering the care doesn't exactly keep up, but it more or less keeps up with the costs and with medical inflation, but not so part B, which pays the physician. And the part B part of Medicare is governed under this sustainable growth rate formula. And really, Madam Speaker, I know I'm not supposed to talk to Members directly, only supposed to address the Chair, and I will confine my remarks to the Chair, but just talking to the Chair, if I were able to talk to people directly, I know I run some risk of people turning off their televisions, but I do want to take you through what is known as the sustainable growth rate formula because I think it's instructive. Even though not every person can understand every nuance of the formula, I think it's instructive to actually look how the formula is constructed and how we come up with the dollar figure every year. Madam Speaker, I know people who are particularly astute will notice there is a typographical error on this graphic. I would point out that the typographical error was actually made by the Congressional Research Service and not by my crack staff. Again, the very gifted will be able to pick that up right away, but we'll get to that in just a moment. Here's the calculation of the payment formula under the physician's fee schedule. Here we see payment equals and here's a whole bunch of letters that follow along, and the explanations are given underneath the formula. The relative value unit for work versus, rather multiplied by a geographic index; a relative value unit for practice expenses, again multiplied by another fudge factor for geographical location and geographical practice expenses; a relative value unit for the cost of medical liability insurance, again also adjusted for geographic location; all multiplied then by what's called the conversion factor, CF, at the end. And this CV down here actually should say CF, and that would stand for ``conversion factor.'' Well, that's all very interesting, and obviously the conversion factor plays a big role in this, so let's just dig a little bit deeper into how that conversion factor or that adjustment factor is calculated. And here we see a sample calculation for the formula for the year 2007, and again, we won't get into all of the nuances of this formula, but you see the update adjustment factor, UAF, the prior year adjustment component plus a cumulative adjustment component, and the formula for 2007 is calculated as follows, where the target 2006 minus the actual spending in 2006 divided by actual spending in 2006 multiplied again by conversion factor. I want to draw your attention, Madam Speaker, though, to the fact that every year the prior adjustment component, and then added into that is the cumulative adjustment component, that's significant, because every year for the past 5 years that I have been here the United States Congress has come in at the last minute, at the last minute with some way to prevent these physician cuts from going into effect. But as the Congressional Budget Office calculates this number year over year, this cumulative adjustment component grows over time such that we are told in order to repeal the cost of repeal of the sustainable growth rate formula, when I first came to Congress in 2003 was around $118 billion over 10 years. A pretty significant amount of money, no question about it. But that number has increased with every year that we have postponed the cut, that we have come in at the last minute, the last of December and prevented the cuts from happening. Those moneys actually don't just go away. The moneys that were to be saved in that cut don't just disappear. The Congressional Budget Office adds them onto the total expense of the repeal of the sustainable growth rate formula such that the price tag for repeal of the sustainable growth rate formula last year, the last session of Congress, when I introduced a bill to repeal the sustainable growth rate formula, was $218 billion. It increased almost $100 billion over 3 or 4 years' time, and this year is calculated to be $268 billion. If we do manage to get something done before the end of the year, those moneys again the Congressional Budget Office will add on with that cumulative adjustment component. One last graphic on this issue is the calculation of the update of the conversion factor, where, again, we see the current year is equal to the prior year plus the conversion factor update. And the conversion factor update is calculated as being 1 plus the Medicare economic index increase divided by 100, multiplied by 1 plus the updated adjustment factor. You can see this is pretty complicated stuff, and for that reason many Members, when you try to talk to them about changes in the sustainable growth rate formula, will just simply tune you out because we all have a little place where we put in our minds things that are too hard to deal with. And the SGR formula is one of those things that most Members will put into the too hard box. It's something that I have got to come back to later because I really don't understand it. And it is an understandable human reaction to a situation that's terribly complex. But, Mr. Speaker, let me just illustrate for you what will happen if Congress does not do its duty and does not do something to prevent the physician cuts, the Medicare payment cuts, that are already on line to occur January 1 unless Congress acts legislatively prior to that time. The Center for Medicare and Medicaid Services on November 1 of this year, after running through the formula, they said, okay, this year based on what we budgeted for and what the actual spending was, we are going to have to downwardly adjust physician payment rates by 10.1 percent. That's 10.1 percent, a pretty significant amount of money. If we don't do something, that's what is going to hit January 1. You say, well, okay, Medicare payments aren't that great anyway and a lot of physicians' offices don't rely just strictly on the Medicare reimbursement they get to keep their doors open; so it won't really affect my doctor's practice. But one of the things that we forget in this House of Representatives, one of the things that we just conveniently again stash away in that part of our brains where we put things that are too hard, almost every commercial insurance company in the United States pegs their reimbursement rates to Medicare. So what happens when Congress or the Center for Medicare and Medicaid Services mandates a 10 percent physician fee cut in Medicare and we don't do anything to correct it before the end of the year? That has an extremely deleterious effect on almost every practicing physician's office in this country. There are very few who will be absolutely isolated from that. I realize some in academic medicine may not actually feel it. Some doctors who practice in federally qualified health centers may not see that or may not feel it. But the bulk of the practicing physicians, the men and women who are out there every day seeing us when we get sick, seeing our kids when they get sick, those are the ones who are going to feel the brunt of this inactivity by this Congress. I bring this up tonight not because we were inherently any better at doing it when the Republicans were in charge, but it's so important to get this work done and to get it done in the limited time that we have left this year. I introduced just this week a resolution in the House of Representatives, House Resolution 863 for those who are keeping score at home, and House Resolution 863 is a pretty simple bit of legislative language. I will be honest. It doesn't do a whole lot. It doesn't really save any money. It doesn't spend any money. It's more or less like sending a get well card to the doctors who participate in our Medicare system and take care of our seniors. But the sentiment, just like when you send a get well card, the sentiment is important. And for Members who feel they could sign onto this bill, I think it would send a powerful message to House leadership over the next several days if we could, in fact, put a number of names with this House Resolution because I think that would get the attention of leadership. Even though leadership is of the other party than myself, I think they would have to pay attention if the bulk of the Members of House of Representatives sign onto this resolution. And the resolution, as most go, is multiple whereases followed by a ``resolved.'' And the resolved says that it is the sense of the United States House of Representatives to immediately address this issue, the physician pay cuts under SGR, and halt any scheduled cuts to Medicare physician payments and immediately begin working on a long-term solution, and implement it by 2010, that pays physicians a fair and stable way and ensures Medicare patients have access to the doctor of their choice. Fairly simple language. What does it mean? It means stop the cuts, repeal the SGR. We know we can't repeal the SGR straight up right now, that it will take a time line in order to do that, and that is why I suggest 2010. I would be open to other suggestions. But that seems like a good time line for us to follow. It gives us a little over 2 years to get that done. When we face a problem as complicated as the formula that I put up in front of you tonight, some of those things are just too difficult to tackle head-on all at once. So you need a near-term, a mid-term, and a long-term strategy to deal with these very complicated problems, and I have outlined it here tonight. The near-term, the short-term strategy, stop the cut. Find some money. There's plenty of money. In a $3 trillion budget, you tell me we can't find someplace to save some money in a $3 trillion budget to pay the doctors what they are fairly owed for taking care of the patients we have asked them to take care of. So the near-term solution is stop the cuts. The mid-term solution is we sit down and work together with the common goal of the long-term solution, which is the repeal of the sustainable growth rate formula, and begin to pay physicians on the same sort of schedule that we pay our hospitals, that we pay our HMOs, that we pay our drug companies. Put them on a cost-of-living-type adjustment. It's called the Medicare economic index. It's not something that is unique to me. I didn't make it up. I didn't make up the term of how it is calculated. But this is a known number put out by the Medicare Payment Advisory Committee, and year over year it suggests a modest update in physician reimbursement to keep up with the cost of delivering care. Let's be honest. From a Federal Government standpoint, Medicare reimbursement rates were never meant to match private insurance rates. Someone explained to me one time if you practice medicine and do a lot of Medicare, you're going to go broke. You'll just go broke a little more slowly because we bleed you to death more slowly. Not a pleasant analogy, but Medicare never has been designed to completely cover the cost of delivering the care. The problem is we have now ratcheted that number down so far that physicians across the country are honestly looking at the situation and saying I don't think that this is something that I can legitimately continue to do. I've got to find other ways to make a living. It's House Resolution 863, and I do urge Members to look that up on- line. It's up on Thomas. Have a look at it and see if it is not something that you can't support because, again, I think it would send a powerful message to House leadership. If over the next several days prior to the time that we are slated to adjourn for this year, I think it would send a powerful message that Members of the House want this fixed. And I know they do because every time I talk to a Member of the House, whether it be on my side of the aisle or the Democratic side of the aisle, if you just ask a simple, straightforward question: Do you ever hear from your doctors? Do your doctors ever talk to you about what is happening to them in Medicare reimbursement? And the answer is almost immediately, Oh, yes, I hear it all the time. Do you have something that will fix that? And the answer is, Yes, sort of. I've got something that will focus our attention, I hope, on getting this problem resolved. It's a shame we didn't take this up earlier in the year. I introduced several pieces of legislation to try to do that both in the last Congress and in this Congress. It's a shame we didn't take it up this year. It seems like many times this year we'd rather fight about almost anything we can think of to fight about and not solve the problems that the American people sent us here to solve. Well, here's one we can work on, and cosponsoring House Resolution 863 would go a long way toward moving us in that direction. Let me just put up another slide, and this one is a little bit dated. This slide is a year old, and I should update it for the current year except that I don't know what is going to happen in the current year. But this is illustrative. This is demonstrative of what happens to physician reimbursement rates under the sustainable growth rate formula for physicians. And this is a comparative payment analysis of the various updates that have gone on since 2002, the year before I came to Congress. And this particular graph goes up through an estimated fiscal year 2007. And, again, actually it needs to be updated for this year. But as you can see, Medicare Advantage plans, they're doing pretty good. Hospitals, it's up and down a little bit, but generally their market basket update that they receive every year is hitting about 3.6 to 3.8 percent, and all in all the hospitals are doing generally well under that scenario. Nursing homes, a little less generous. And, again, it does bounce up and down a little bit. But as you can see, year over year a positive update, certainly a positive update that's in excess of 2 percent. And many times for nursing homes it approaches 3 percent. But look over here at the doctors in 2002, and this was the last year I was practicing medicine. And sure enough, we got a 5.4 percent pay cut just right across the board for any Medicare procedure that we performed. Now, for the next several years, 2003, 2004, and 2005, we did manage to find the money to provide a little bit of a positive update. Notice even in these years when physician practices were flush with cash from Medicare payments, they really never even approached what nursing homes were receiving in updates and certainly were nowhere near what hospitals and Medicare Advantage plans received. Medicare Advantage plans, I would point out, did not exist prior to 2004. That's why they start with that darker line there. Then in 2006 there is nothing recorded on the physicians. We euphemistically termed that a zero percent update. Anything else that we do in the Federal Government, if we say we are going to hold you at level funding for this fiscal year, people would be coming out of the woodwork crying that's a cut, that's a cut because you're not keeping up with the cost of living. It didn't seem to bother us a bit to do that to America's physicians. But at least a zero percent update is a whole lot better than that what was originally proposed in 2007, which was, again, about a 5 percent negative update. We actually were able to stave this one off and keep that again at a zero percent update for 2007. And now for this next year, 2008, whatever color we decide to put on the bar for that will dip down to almost the bottom of the chart because a 10.1 percent negative update is going to have a significant deleterious effect, a significant pernicious effect on our practicing physicians. Again, our physicians that we have asked to take on the burden of seeing our Medicare patients. Now, I do spend a lot of time on the floor of this House talking about physicians workforce issues. This is the cover of the March 2007 periodical that is put out by my State medical society, the Texas Medical Association, appropriately titled ``Texas Medicine.'' And the cover story last March was ``Running Out of Doctors.'' And this was a fairly significant graphic for me when I saw that at the time. About a year before this publication came out, Alan Greenspan, in one of his last trips around the Capitol right as he was retiring as Chairman of the Federal Reserve Board, Chairman Greenspan came and talked with a group of us one morning. And the inevitable question came up, how are we ever going to find the funding for the unfunded obligations that Congress has taken on? How are we going to pay for Medicare when the baby boomers retire? And the Chairman thought about it for a moment and he said, you know, ``when the time comes, I trust that Congress will make the correct decisions, and that the Medicare program will continue.'' He stopped for a moment, thought some more, and then added to that, ``What concerns me more is, will there be anyone there to deliver the services when you want them?'' And that is one of the critical issues facing us today. And of course it's this inequity in supply and demand, supply and distribution of the physician workforce that's driving a lot of the problems that we find in health care today. And no question it has some effect of elevating prices, and just the fact that it takes so long to get in to see some types of physicians. There was a very compelling article here in the Washington area a few months ago about the travails and toils a reporter had with trying to get their child in to see a pediatric neurologist. You hear these sorts of stories. I travel, not a lot, but some around the country to visit with medical groups in the country, and you will hear all those stories from all over the country. It's not unique to one geographic location. Three bills that were introduced earlier this year to deal with physician workforce issues, H.R. 2583, H.R. 2584 and H.R. 2585. Now, H.R. 2585 deals with what I like to term ``the mature physician.'' So, it deals a lot with the sustainable growth rate formula and the inequities of the sustainable growth rate formula as it pertains to how the Federal Government compensates its medical workforce. The thrust behind 2585 was to, again, take that short-term, mid-term and long-term approach to the problem such that we would fix the problem, we would stop the cuts in 2008 and 2009 and 2010. We would gear towards absolute repeal of the SGR formula. Again, remember I said that it's going to cost money when that time comes. And that has always been the difficulty when trying to talk to Members about, I want you to help me repeal the SGR. The next question always is, Well, how much does it cost? You tell them, and, oh, my gosh, it's a bridge too far. We've got other priorities and we just can't get there. Well, let me tell you a little secret. That money that we have to come up with to repeal the sustainable growth rate formula, guess what? We've already spent that money. We've already sent that money to physicians' offices across this country and they've already spent it. So, it is merely a bookkeeping adjustment that the Congressional Budget Office has to make to reconcile its books to compensate for, remember, that cumulative index that I showed you, one of those earlier poster boards. That is the difficulty. It's essentially a bookkeeping entry that has not yet been made. The money has been spent, it's gone. It's not sitting somewhere in the Federal Treasury drawing interest. It is a bookkeeping entry that has yet to be made. We have to take this on. We have to do this. It's the moral thing to do; it's the right thing to do. We want our Medicare patients taken care of. They are arguably some of the most complex clinical situations that a doctor encounters on a daily basis, and we ought to do the right thing. Now, how do you do that and be able to encourage Members to look at this seriously when the published price tag is so large? When I initially tried to do this in the last Congress, a bill I introduced called 5866, when, remember the cost of repeal was $216 billion, I thought at that time perhaps the correct way to go about this was just to work on the repeal straight up, maybe look for the pay-fors later as we got toward the conclusion of the process. And I was hopeful that hospitals, nursing homes, other medical entities that draw on Medicare funding would perhaps come forward with their own suggestions of where savings could be made because I don't think there is a single person in this Congress who doesn't feel that there are some inefficient ways that the Federal Government spends money in the Medicare system, and perhaps if we collected those together, we could find the monies to help cushion the offset expense of repealing the sustainable growth rate formula. But I was wrong, no one was willing to come forward. And as a consequence, I never really got the traction or the momentum that I needed on 5866. And again, the 109th Congress ran out before we could get anything done. So, early in this Congress I thought, I need to get something out there quickly. I need to get people to understand this problem. We certainly don't need to leave it until the last minute this year, but unfortunately that's what has transpired. So, the idea behind 2585, introduced earlier this year, was to get that concept out there earlier, get Members talking about it. How was I going to approach it? Well, 2008 and 2009, remember, we don't repeal the SGR. So, many doctors looked at that and said, Well, if you don't repeal the SGR formula in 2008 and 2009, I'm going to take significant hits those years, and I can't afford to do that. But actually, there is another bookkeeping entry you can do; it's called readjusting or resetting the baseline on the SGR formula. And by doing that, you actually then can score a modest positive update for 2008 and 2009 for physicians who participate in this program. In fact, interestingly enough, in 2008, it's almost equal to the Medicare Economic Index update. In 2009, it's a little bit less than that, but still a positive update, a fairly generous positive update of just under 1 percent for 2009. During those 2 years' time, the run-up to the repeal of the sustainable growth rate formula, we recognize that we are saving money, we are doing things better in medicine today than we did yesterday. And how do I know this? What is a metric that I can use? Well, the Medicare Trustees Report that came out in June of this year pointed out that the bad news is Medicare is still going broke, but the good news is it's going to go broke a year later than what we told you the year before. So in other words, somewhere along the line there had been some savings in the Medicare system. And where did that savings occur? Well, one of the places it occurred, as identified in the Trustees Report, was 600,000 hospital beds weren't filled in the year 2005 that were expected to be filled. Why weren't they filled? They weren't filled because, again, the doctors were doing things on a more timely basis, more accurate diagnoses, the whole ability to timely treat disease with the prescription drug benefit now available for seniors in the Medicare program. All of these things had a bearing, and as a consequence, more patients were treated as outpatients, treated in the doctor's office, perhaps treated in an ambulatory surgery center, perhaps treated in a day surgery center, but these patients were kept out of the hospitals, and so those hospitalizations were avoided. Remember when I talked about the funding silos for Medicare. Although we will talk about Medicare as an integrated program, part A, which pays for the hospital expense, is funded out of a payroll deduction just like the FICA tax, just like Social Security. Part B is funded out of member premiums and general revenue. By law, only 75 percent of it can be funded out of general revenue; 25 percent of that number has to come from member premiums. So, if we're saving money on the hospital side, we're saving money for part A. But why are we saving the money? We're saving the money because we're working better, smarter, faster in part B. So it would only make sense to have CMS identify those savings that right now are going on the books as savings for part A, identify those savings, aggregate those savings, collect those savings, and use them to offset the cost of repealing the sustainable growth rate formula in part B. You know, remember, Madam Speaker, the lock box from the year 2000, in the Presidential race everyone was talking about a lock box and they were going to put Social Security in a lock box, and with all the discussion of whose lock box was bigger than whose? But we've still got the lock box. We can put these savings that we're creating in part A, put them in a lock box, 2 years later open it up, and we offset some of the cost of paying down the so-called debt in repealing the SGR formula. There were some other things that I identified in the bill as other ways to perhaps enhance savings. Certainly we asked CMS to try to identify the 10 diagnoses where most of the money was spent, and let's really focus our efforts on those 10 diagnoses and see if we can't create greater and greater efficiencies in treating those 10 conditions that lead to the greatest expenditures in the Medicare system. And let's look honestly at what we can do on the preventive side. Remember what our mothers always taught us, an ounce of prevention is worth a pound of cure. If we want that pound of cure, let's go ahead and spend a little bit for that ounce of prevention on the front end so we don't have to spend so much for that pound of cure on the out end. And then let's take that pound of cure that we've saved and use it to offset the cost of repealing the sustainable growth rate formula. Well, another way we could save some money is, any of the monies that are recovered by the Department of Justice, the Inspector General for Health and Human Services, and the so-called Medicare audits, money that is fraudulently taken from Medicare and then recovered, again, that's money that's stolen from part B. Let's not just put that money into the coffers of somewhere else. Let's let that accrue as part of the savings that we put in that lock box that we use to offset the cost of repealing the sustainable growth rate formula. Two other things that I did in the bill, which I think are important as far as gaining some overall efficiency in the system, was added some voluntary positive updates for physicians who were willing to voluntarily participate in quality reporting exercises, and physicians' offices who were willing to voluntarily participate in improvements of health information technology. We don't have, and certainly in Congress, certainly the Federal Government does not have all the answers as to what creates the perfect health information technology platform. In many ways, private industry is light years ahead of where the Federal Government is. And maybe, you know, Madam Speaker, some days, honestly, I just wonder if we should get out of the way with some of our regulatory burdens, some or our stark laws and let private industry develop these platforms, because clearly, in the last 5 years that I've been here, we've had a lot of talk, we've had a lot of bills introduced, we've had a lot of debate, we've even passed some bills in the House during the last Congress, but we are no closer to having any sort of a national standard for health information today than we were when I first got here 5 years ago. I believe the individual's name was William Brailer who was in charge of that project. He is now, unfortunately, no longer with Health and Human Services. The project has, for all intents and purposes in my mind, been a disappointment, but it doesn't mean that health information technology has just been stagnant. Other stakeholders, other participants in the health care system in the United States have created and drafted and are working on their individual platforms. And at some point they will reach critical mass in the private sector where there will be general acknowledgement that, yes, this is the health information technology platform of the future and the one to which we all should subscribe. It would have been a useful function of the Federal Government had we been able to do that, but honestly, I don't see us there yet, and I don't see us there in the foreseeable future. You would think the Federal Government would have had a significant role to play in that because if you look at health care expenditures in this country, almost 50 cents out of every health care dollar that's spent in this country has its origin right here on the floor of the House of Representatives. When you consider what we spend in Medicare, what we spend in Medicaid, what we spend in the VA system, what we spend in Indian health service, the Federal prison system, a lot of health care dollars are generated through the authorization, the appropriation process in this Congress. And as a consequence, Congress has a big stake in trying to get some efficiencies and some improvements. But in this instance, in developing the health information technology platform of the future, I almost think that we need to get out of the way and let the entrepreneurs, let the bright folks who can do these tasks, let them proceed with that. Let me just talk about a couple of things that will illustrate that. I will just tell you, Mr. Speaker, I did practice medicine for 25 years. In fact, I started medical school 30 years ago this year in 1974. I can't tell you that I was a big acolyte of electronic medical records when I was a practicing physician. I dabbled in it some. I would listen to people talk who came to sell us various packages. We had to buy a new computer right before the Y2K scare where all of our computers were going to lock up at midnight and we wouldn't be able to get anything done the next day. So like everyone else, I went out and bought a new computer system. I asked what it would cost to add an electronic medical records package on to the basic computer system that I purchased for my five-physician office. The basic computer system itself cost about $60,000 or $70,000. Some other contracts we had to sign for maintenance and upkeep were not cheap. Adding a medical records package to that was 30 to $40,000 for a five-physician practice. Quite honestly, at the time, it seemed way too expensive for a small group such as mine to participate in. So I really wasn't sold on the concept of electronic medical records. Then in the end of August 2005, we saw probably the worst hurricane to hit the United States that certainly has happened in recorded history, Hurricane Katrina that hit New Orleans, and then the subsequent flooding after the levees broke. Touring New Orleans 5 months later with the Energy and Commerce Subcommittee on Oversight and Investigations, we were permitted to go into the basement of Charity Hospital into their records room. This was the basement of Charity Hospital. You can see the temporary lighting that they have got strung along the ceiling. There is actually still, it doesn't show in this photograph, there is still water on the floor 5 months into this process. And you can see the paper medical records. There was shelf after shelf after shelf. Remember that Charity Hospital was one of the venerable old institutions in this country. It was one of the hospitals that has trained many of the premier physicians in this country. Charity Hospital had been there for a long time. They had multiple racks and stacks of medical records. But look at these things. This isn't smoke damage. This isn't fire damage. This is black mold that is growing on the paper, on the manila folders and on the paper in the medical records. Clearly, these are medical records that in all likelihood now are lost to the ages. I don't know. The water was up to the top shelf when the building was underwater. A lot of the ink and writing may well have washed off. But you honestly could not ask someone to go in here and pull a record and provide you some of the medical information that might been contained therein, because clearly it would simply be too hazardous to ask anyone to go in there and retrieve it. Well, when I visited the basement of Charity Hospital that day, I became a convert for recognizing that medicine does need to come into the 21st century. It is going to be expensive. There is going to be a learning curve for, again, mature physicians like myself to have to learn this new technology and to have to learn how to use a keyboard. But it would be an investment that we would have to make. I think we have to pay for it. I don't think we can simply say to a doctor's practice, you are going to have to just do this. It is part of the cost of doing business. And although you can't attribute any direct revenue increase to the fact you are making this $100,000 expenditure for a five-physician practice, you are just going to have to spend the money. Well, we are probably going to have to help that. Number one, we are not paying doctors enough, anyway, and number two, if we ask them to go out and do this, there will be a lot of resistance, and a lot of practices just simply won't do it. They will drop out of Medicare and whatever insurance company requires electronic medical records. If we pay for it, if we allow an increase in reimbursement for physicians who voluntarily undertake this kind of training and upgrade, I think that's a very reasonable return on investment. So included in the bill that I introduced to initially repeal the sustainable growth rate formula was a 3 percent positive update for physicians who voluntarily undertake to modernize their recordkeeping and to embark upon the 21st century sojourn of creating electronic medical records. But I think that is the way we have to do it. It has to be voluntary. You can't force people to do these things. You can't force them to learn these techniques. You can't force them to devote the time necessary to learn these techniques. It does have to be done on a voluntary basis. That is the correct way to learn things, not through mandates, but through creating programs that people actually want and getting their participation voluntarily, not because the Federal Government has said thou shalt. Now, it stands to reason that after a certain period of time, part of that funding for that infrastructure will be completed. And this positive update does go away after a period of time, but it does provide a bridge for physicians who are using paper records today. It provides them a bridge, an opportunity to go into a electronic medical record system. The reason I spend so much time on this is we had introduced in the Senate last week a bill that would require electronic prescriptions. Well, it's a good idea. The theory is a sound one, electronic prescriptions. The Institute of Medicine says that doctors' handwriting is terrible. I am here to tell you mine is. The ability, though, to whip off a written prescription takes about 10 seconds. The time involved for filling out an electronic prescription, even on a little handheld is going to be somewhat longer than that, particularly at the beginning of the learning curve. Well, the average physician practice as I had back in 2002, you would have to see between 30 and 40 patients a day in order to pay the overhead and have something to take home at the end of the day. You add a minute or 2 on to every patient's encounter, and that is going to be adding about an hour a day on to that physician's practice time, an hour that they are simply going to be filling out an electronic form for E-prescribing. Clearly, again, they have to be compensated for that time. The bill that was introduced I think recognized that and said there would be a 1 percent update for doctors, a 1 percent bonus for doctors who indeed undertook that. Well, just doing a little bit of the math, a moderately complicated Medicare patient return visit probably didn't pay as much as $50 a visit, but let's say for the sake of argument that is what it paid. Well, a 1 percent bonus for that patient's encounter if you use an electronic prescription will be, what, 50 cents. So you can see about four of those patients in an hour's time, so that is an additional $2 an hour that we are paying for that. It doesn't seem like a lot. I say that, too, because you look at all of the various stakeholders and interest groups, the insurance companies, the pharmacy benefit managers, the community pharmacists who want this done see value in it, and they see the potential for deriving great value, particularly the vendors who are selling the electronic prescribing modules. There is going to be significant financial return for them. So why are we low-balling it at the doctor's end with simply a 1 percent bonus? And then the other part of that concept that I found disturbing was, it was kind of billed as a carrot and stick approach, the carrot was the 1 percent bonus, the stick was when 5 years, 4 years or 5 years, I forget which, Doctor, if you're not doing this, we're going to penalize you 10 percent. So wait a minute. I go from if I do this, I am going to make an extra 50 cents on that patient encounter or $2 an hour additional if I do this. If I don't do it in a few years, I am going to be down $20 an hour for not participating. The inequity of that just strikes me as being, again, ``disturbing'' is probably the kindest word that I can use in this context. I honestly think while, again, I will agree with the theory, the application is flawed, and we have to think of a better way to do that. That is why when I was crafting 2585 it was a voluntary participation. It stayed voluntary. I think if you show physicians that you are able to deliver something of value, eventually, we are a very competitive lot. That is why we become doctors. And we will want to have the practice that has the newest and latest and greatest, and if other physicians' offices, hey, they are doing this e-prescribing and it is great, by the time I get to the pharmacy after my doctor's visit, the order has already been e- mailed to the pharmacist, it's been filled, it is sitting there waiting for me, and the insurance stuff is already filled out, patients are going to see value in that, and they will begin to ask that of their doctors. But to do this in a terribly punitive way, I think we are going to drive more doctors out of taking care of our Medicare patients, and that really should not be our goal. The two other bills I introduced dealing with the physicians workforce dealt with physicians who might be contemplating a career in health professions and dealt with physicians who were in their residencies. We recognize that we are facing a shortage of primary care doctors, a shortage of general surgeons, OB-GYNs, gerontologists. And these bills were geared toward getting more of those doctors to consider medical school, getting more of those newly minted doctors into residency programs near their homes. Because doctors do possess a lot of inertia, and if you train those doctors in the places where they are needed, they are likely to stay within a 50-mile, 100-mile radius of where they have undergone that training. That is one of the thrusts of the article from the Texas Medicine piece, that doctors do tend to locate close to where they are trained, so if we can expand the number of primary care residencies in medically underserved areas with high-need residencies, we will find that we actually attract more physicians to those areas. That is a vastly preferable way of dealing with some of the manpower shortages than just simply telling people where they have to go. Under the issue of medical liability reform, let me just share briefly some of the experiences we have had in the State of Texas because it has been a good story. The State of Texas in 2003 passed some reforms that were based off of the 1975 law that was passed in the State of California called the Medical Injury Compensation Reform Act of 1975, you see the acronym for Medical Injury Compensation Reform Act, and this has been an astounding success in the State of Texas. Medical liability insurers were leaving the State in droves. We were down to two liability insurers my last active year of practice 2002, and let me tell you, you don't get much price competition when you have only got two liability insurers in your State. By invoking this bill and passing a constitutional amendment that allowed the bill to stand placing a cap on noneconomic damages, $250,000 for the doctor, $250,000 for the hospital, $250,000 for a second hospital or nursing home, if one is involved, by trifurcating that cap for noneconomic damages, we really feel that we have a system in place that does adequately compensate patients who are injured, and at the same time provide some stability in the medical liability insurance market that they needed to be able to look to Texas as a place where they wanted to do business. And they have. They have come back to the State. We have got many more insurers now than we, in fact, had before the exodus started in the early 2000s. Most importantly, they have come back into the State without an increase in premiums. Texas Medical Liability Trust, my old insurer of record, the premium reductions and the dividends paid back to their shareholders aggregate to about a 22 percent reduction in medical liability insurance. And mind you, my last year of practice, I recall medical liability premiums going up by significant amounts year over year over year, and now we have seen an aggregate 22 percent reduction since passage of this bill in 2003. A lot of times when I talk about medicine, I talk about the fact that I am optimistic. I think medicine is on the cusp of a significant transformation. When you look at the last century, and there was kind of some instructive periods, the period of 1910 when, boy, we are really coming out of the dark ages of medicine. Prior to that time, the accepted methods of practice, blistering, burning and bleeding were what were practiced by physicians, and everyone thought you were a good doctor if you did those things. We were leaving those days behind. We were coming into the time of anesthesia, we were coming into the time of modern blood banking, vaccinations had become available, new ways of looking at public health and public sanitation. And at the same time, all those advances happening in the science of medicine, we had some social change that was occurring as well, and part of it occurred up here at the United States Congress with the commissioning of a group called the Flexner Commission. Ultimately they produced what was called the Flexner Report that directly addressed the discrepancies in medical training and in medical schools across the country. It was the standardization of medical school curricula as a result of the Flexner Report, and albeit that function was then taken over by States, but it was that standardization of medical curricula that allowed for medicine to capitalize on all those good things that were happening around that time. Well, jump ahead to the middle of the 1940s, we are in the middle of the Second World War, penicillin had been discovered a few decades before, but it wasn't really commercially available because no one had really perfected the process. During the war, an American company working in this country was able to produce penicillin on a scale never before imagined. It was cheaply commercially produced for the first time in 1943 or 1944 and, in fact, was available to treat our soldiers who were injured at the landing of Normandy, and many lives and limbs that otherwise would have been lost as a consequence of infection following those wartime injuries were, in fact, saved because of the introduction of penicillin. It went from being a laboratory curiosity to something that was readily available, inexpensive and available to almost any doctor practicing. At the same time, cortisone, again introduced many years ago before but a commercial process developed by Percy Julian, a Ph.D. biochemist, an African-American that we honored in this House during the last Congress because of his contributions to medicine. He developed a way to mass-produce cortisone using a soybean as a precursor. So suddenly you had an antibiotic and you had a potent anti- inflammatory. These two powerful medical tools placed into the hands of our practitioners in this country, and, again, at the same time you had a significant social change because of the Second World War and wage and price controls that President Roosevelt put into place to prevent inflation, those wage and price controls were putting a damper on employers being able to keep their employees satisfied and happy. So they said, look, can we offer benefits like retirement plans and health insurance. The Supreme Court weighed in and said yes, you can, and not only that, you can provide those as a pretax expense. Well, suddenly you go just almost overnight to the era of employer- derived health insurance. And it was extremely popular, extremely popular. It persisted after the war was over and wage and price controls were removed. But, again, it was a time when the science of medicine was changing rapidly and the social structure around medicine was changing rapidly. The same can be said for the middle 1960s. For the first time we had anti-psychotic medications available. Prior to that, we had only restraints to treat people who were badly mentally ill. We also had the introduction of antidepressants. We had the introduction of newer hypertensive drugs. Remember, just a generation before we lost our President, Franklin Roosevelt, to the ravages of unchecked hypertension. In the 1960s we could treat that. At the same time, we had the introduction of Medicare and then subsequently Medicaid. Suddenly the Federal Government had a large and profound footprint and a profound influence over the practice of medicine. Mr. Speaker, I think we are on the cusp of just such a transformational time right now. I think the changes occurring in information technology, the speed with which we learn things, is now unlike any time in this country's past. Think of this: People are going to be able to go and with a relatively inexpensive test have their human genomes sequenced. They will be able to know, as more and more is found out about the human genome, what diseases may pose a risk for them in the future, what things they are not at risk for, powerful information that is going to be in the hands of our patients. They are going to come to the office with this information in hand. It won't be a test that we order them to take or that we request them to take, but think of the difference in the practice of medicine. In the 1980s, I would tell someone a diagnosis. They would ask me what I was going to do about it. In the 1990s, I would give a diagnosis. They would go home, look it up on the Internet and come back and tell me what I was supposed to be doing about it. Now patients are going to come in with genetic information in hand say, this is what I am at risk for. What are you going to do to prevent it, doctor? It will be an entirely different way, an entirely new paradigm, an entirely different way of approaching the practice of medicine, a transformational time. Yet, at the same time, if Congress does not, does not invoke the right policies, Congress is inherently a transactional body. We heard the House Policy Chairman talking about that in the last hour. Congress is inherently transactional. We redistribute income. We take things from one group and give it to another. The transactional can become the enemy of the transformational. Our former Speaker, Newt Gingrich, is famous for saying ``real change requires real change.'' I believe that to be true. I think that is his second principle of transformation. And, more to the point, this is a time of real change, and medicine is really changing under our feet. Whether we like it or not, whether we think we can control it or not, it doesn't matter. Medicine is changing. That real change requires us to change how we think about and how we approach these problems. The old ways, the SGR formulas of the 20th century, aren't going to work in the 21st century. They cannot be allowed to impede the incredible transformation that stretches before us. Mr. Speaker, before I wrap up, I do want to mention one additional bill that I introduced recently, and Members may want to consider adding themselves as cosponsors. It is H.R. 4190. This is an interesting bill, because we talk in this House about what are we going to do about the uninsured. And we all sit back and think big thoughts about what we are going to do about the uninsured. Well, H.R. 4190 actually moves that process along in kind of a different way. H.R. 4190 would take health insurance benefits away from Members of Congress. Yes, it would provide a voucher to Members of Congress to buy health insurance, but we would no longer be participants in the Federal Employee Health Benefits Plan. We would become uninsured, and it would force us to look at the market, what is available for someone who doesn't have insurance. It might cause us to be a little more clever about some of the things we do in our Tax Code, and perhaps we wouldn't be so punitive toward people who want to individually own their insurance policy as opposed to someone who wants to get it from their employer. So it would be an entirely different way for Members of Congress to approach this problem. Quite honestly, I don't expect a long line of cosponsors when I get back to my office later tonight, but I would like for Members to think about this. It is terribly difficult for us to come up with solutions when we are sitting back in a situation where we are insulated, we are anesthetized, where we are never going to have to face those types of decisions and those types of problems that our constituents face on a daily basis. We also need to be more careful about how we talk about people who are uninsured. We toss around numbers and basically use them as political bludgeons or political wedges. We need to be more specific when we talk about the specific demographic groups that are contained within that large number of people who are labeled ``the uninsured.'' A significant number, 10 percent in some estimates, are people who are university students or just graduated from the university. These are people who are generally healthy and relatively inexpensive to insure. We ought to find a way to make that happen. We ought to find a way to at least allow the possibility and ability for that demographic group to purchase insurance. Twenty percent of the number actually earn enough money to buy health insurance. They just don't see the reason or necessity in doing so. A lot of that is cost driven. It is price driven. We have done things to insurance policies to make them so expensive. We are unequal in our tax treatment for individuals who want to individually own their policies. We need to look at those things, because, again, if we made the product affordable, if we made it desirable, again, if we put products out there that people would actually want, then they are more likely to participate. I think that is vastly, vastly superior to simply saying there is going to be an individual mandate or a State mandate or an employer mandate where people will be required to line up and file into these programs. Let's approach it differently. Let's create the programs so that people want them, rather than creating the condition that forces people into programs that maybe they want and maybe they don't want, but we will never know because we never ask. But we can be more insightful. In fact, we can be more valuable to the American people if we will think about things in terms of who is involved in the demographics of that large group of the number of uninsured, and how can we best approach that in a way that we are producing or providing the environment for them to be able to have that insurance coverage that they desire. Well, there is a lot left unsaid at this point. I do appreciate the indulgence of the Chair.

Mr. BURGESS

Mr. BURGESS. Madam Speaker, I rise today to congratulate Lynn Hidell and Carol Meade, who were honored as Citizens of the Year in Little Elm, Texas. Ms. Hidell and the late Ms. Meade volunteered as a team for 10 years at several Little Elm events, such as the July Jubilee, the Holidaze Celebration at Beard Park, the Little Elm Awards Foundation, and the Summer Rhythms Concert Series. The two ladies have been friends for years, and while working together for their community complemented each other through their compatibility. The decision was a plurality, as the selection committee received multiple nominations for both Hidell and Meade. Ms. Hidell began volunteering in Little Elm over 10 years ago as a means to get to know people in her community. She also donates time at the Little Elm Area Food Bank, and hosts a jet-ski adventure fundraiser each year to benefit the food bank. She works as an office manager for Hidell and Associates, Inc. Apart from her volunteering with Hidell, Ms. Meade also served on the Lake Vision Committee. Those who knew Ms. Meade recall her as a caring, giving, hard working, and kind-hearted individual. These ladies exemplify hard work and a commitment to their community. I extend my sincere congratulations to Ms. Lynn Hidell and Ms. Carol Meade of Little Elm. It is an honor to represent them in the 26th district of Texas.

Mr. BURGESS

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

Mr. BURGESS

Mr. BURGESS. Mr. Speaker, I wanted to come to the floor tonight and discuss a growing problem that we seem to be seeing, a disturbing trend in food and consumer product safety recalls. Mr. Speaker, the danger is very real. It has been widely documented, discussed in the media, in committee hearings, and around the water cooler at work. We have just come through a summer of recall after recall after recall after recall. What is the upshot of this, Mr. Speaker? The upshot is that parents are afraid. Parents are afraid that their children are playing with lead-tainted toys. Parents are afraid that magnets in toys or charms may cause internal damage if a child accidentally swallows them. Families are afraid that the food they feed their pets may actually have little bits of plastic in it and poison their beloved pet. People are afraid that their toothpaste may contain antifreeze and poison them. People are afraid that the fish they serve to their families may have dangerous levels of antibiotics contained within them. Mr. Speaker, I could go on and on about specific concerns, but generally people are afraid. They are afraid about the source of these products and dangers, and rightfully so. Mr. Speaker, people are afraid about defective products being imported into our country, and it seems like almost all of those imports come from a single source, a single country, the People's Republic of China. Consumers' health and well-being are being endangered on two fronts; in the food we eat and the goods we use. I want to use some time tonight to talk about both fronts and what we in Congress are doing, what we have done, and what we should be doing to protect American families from harmful products. Let's first consider the issue of consumer product safety recalls. It seems like the Nation has also turned its attention to this issue. Every time you turn on the TV, every time you open up a newspaper, you learn about yet another consumer product safety recall. While people are concerned generally about the issue of recalls, many people, many people, myself included, are concerned with the source of the recall. Again, Mr. Speaker, I stress, it appears that the majority of recalled products originate in and from the People's Republic of China. Now, I have signed up for e-mail notification for recalled products through the United States Consumer Product Safety Commission, and I seem to get almost daily e-mails announcing the latest recalls. And, yes, most of the recalled products were manufactured in China. As a parent, as a physician, one recall that was announced last month was extremely disturbing. I am referring to the infamous recall that literally had a child's product, the Spin Master Aqua Dots, laced with the chemicals that are contained in the drug Rohypnol, the infamous date rape drug. Mr. Speaker, it is an innocent enough looking product, an innocent enough looking toy, a little bit interesting. I bet if my daughters were still little, they would have loved this. However, while it may look innocent, this product is actually a wolf in sheep's clothing. In the recall notification, and I encourage everyone to sign up for the recall notification at CPSC.Gov, the Consumer Product Safety Commission listed the injuries that these beads caused, these beads that were available just a few weeks ago on the shelf of any store that any of us could go to in our communities back home. ``The Consumer Product Safety Commission has received two reports over the last several days of children swallowing Aqua Dots. A 20- month-old child swallowed several dozen beads. He became dizzy and vomited several times before slipping into a comatose state for a period of time.'' Well, that is a pretty serious situation. A 20-months-old child? It doesn't say how long the comatose state lasted, but I submit to you any length of time that a 20-month-old child spends in a comatose state is alarming, frightening, disturbing and upsetting to the parents. And to think it was caused by a toy that they bought to amuse their child, well, it is almost unthinkable, unthinkable as a parent, that that could happen. A second child also ingested some dots, vomited and slipped into a comatose state and was hospitalized for 5 days. Mr. Speaker, according to a report on ABC News, quoting here, ``Scientists say a chemical coating on the beads, when ingested, metabolizes into the so-called date rape drug gamma hydroxy butyrate. When eaten, the compound, made from common and easily available ingredients, can induce unconsciousness, seizures, drowsiness, coma and death.'' While it is not yet clear how the chemical wound up in the child's product, it is clear, it is very clear, where this product was manufactured. It was manufactured in the People's Republic of China. Now, Mr. Speaker, we are here working away trying to finish up our business, because Christmas is right around the corner, and with the Christmas season upon us, I cannot help but think there has to be a huge market in this country for something that not only doesn't say ``made in the People's Republic of China,'' but says ``made in America,'' ``made in America'' on the toy, on the goods that we buy. Wouldn't that be something? I encourage retailers to stock as many ``made in America'' products as they can. Since the majority of products that are being recalled this year were made in China, this year, this year my family and I have made the personal decision to try not to buy anything with the ``made in China'' label. Given all of the circumstances, it seems like the right thing to do for my family. And I am certain that other American families have come to a very similar conclusion. You can't turn on the television at night without hearing Lou Dobbs talk about this, and I bet his family is one of those families as well. Mr. Speaker, let's look at just a few of the products that have been recalled, shall we? The concern about these imported products is real and it has been substantiated with real data. The United States Consumer Product Safety Commission, which is tasked with the job of trying to safeguard our society from unreasonable risk of injury and death associated with consumer products, informed me in that in fiscal year 2007 there were a record-breaking 472 consumer product safety recalls. Of the 472 recalls, more than 60 percent, over half, were manufactured in the People's Republic of China. Mr. Speaker, more than 60 percent of all recalled products this past year were made in China. Furthermore, of the 472 total consumer product recalls, 61 of those recalls affected our most innocent and vulnerable members of society, our children. Sixty-one consumer product recalls were toys. And how many of those products were manufactured in the People's Republic of China, you might ask? Well, Mr. Speaker, I am glad you did. That figure is even more staggering. In the United States, the Consumer Product Safety Commission estimated that over 90 percent of the toy recalls originated in the country of China. It is clearly now becoming a common business practice for Chinese toys. So here is the question: Does the label ``made in China'' translate into ``this product may be hazardous to your health or to your child's health?'' Here they are, just a few of the products. This poster was actually made a little bit earlier, it was close to Halloween and you see some Halloween type motifs here, but products that any child would delight in owning. But these are products that have been found to be unsafe and recalls have been issued by the Consumer Product Safety Commission. Well, let's look at a little bit more recent picture. How about today? Is that recent enough? December 11, 2007. From today's Wall Street Journal, ``China stands for quality'' was the title of the piece, and it had this cute little teddy bear cartoon associated with the article. In the article, China's Vice Premier says some interesting things, and I would like to share some of those interesting things with you tonight, Mr. Speaker, and perhaps I will even offer an opinion or two about those claims. First she says, ``The Chinese government takes product quality and food safety seriously.'' I say prove it. She also states, quoting again, ``China has come a long way in strengthening product quality and food safety control supervision.'' I would tell you, I would submit that that country has not gone nearly far enough in this regard. Here is the kicker, Mr. Speaker. She ends the piece by saying, and I am going to paraphrase here for brevity, China will live up to its responsibilities, but we would appreciate understanding, support and help from our trade partners. That is the end of the paraphrase. Well, Mr. Speaker, with all due respect, with all due respect, we are past the point of understanding. Mr. Speaker, there are lives on the line. These are the lives of our friends, our neighbors, our children, our neighbors' children. It is time, it is time, Mr. Speaker, that we act, that we act in this Congress. Mr. Speaker, I previously was a physician in my former life before coming to Congress 5 years ago, just a simple country doctor. But you have got to keep asking yourself over and over again, what can we do to protect ourselves and our families? For the safety of our families, we have to get to the bottom of what is the cause behind all of these recalls. Mr. Speaker, I am a member of the House Energy and Commerce Committee. I sit on four subcommittees that have conducted intense investigations on the issues of food and product safety matters. One subcommittee on which I serve, the Commerce, Trade, and Consumer Protection Subcommittee, which has jurisdiction over consumer product safety issues, has systematically investigated this issue this past fall. We passed individual bills recently that have dealt with specific issues of consumer product safety concerns, including a bill that I amended in order to increase the safety of ornamental pools in our parks and public spaces in our cities. The House Energy and Commerce Committee will be marking up bipartisan legislation later this week that will strengthen the consumer product safety system in this country. Mr. Speaker, the bill is H.R. 4040, for those keeping score at home, the Consumer Product Safety Modernization Act, and almost 80 other Members of this body have cosponsored the legislation, and I am an original cosponsor of the legislation as well. It is an important piece of legislation, and it has, as promised, promised by our chairman of the subcommittee, it has come through the regular process. All Members have a chance to comment and, if they wish, to submit amendments, to try to make amendments to try to perfect this important bill. This, quite honestly, is the way we should formulate legislation. Not just in the Committee on Energy and Commerce, but in the whole House as well. I want to thank the leadership of the House Energy and Commerce Committee for being committed to the legislative process, because I think it has worked and served to make this a better bill as it has come through the process. The version in the House is truly a bipartisan effort. I commend the chairman of the full committee, Chairman Dingell, and Ranking Member Barton, for their participation and leadership in getting the process to this point. I would also like to commend the United States Consumer Product Safety Commission Acting Commissioner Chairwoman Nancy Nord for her honest assistance in trying to get a good bill through the committee. We asked for technical assistance and we asked for constructive criticism, and it was provided to us. Mr. Speaker, in H.R. 4040, the Consumer Product Safety Modernization Act, the House was able to craft a comprehensive, commonsense bill that boosts the funding for the Consumer Product Safety Commission. It boasts their personnel. It bans lead in children's products. It requires third party testing. It increases the penalties for those that break the law. H.R. 4040, again which has almost 80 bipartisan cosponsors, also has the support from consumer groups, industry, and in fact from the Consumer Product Safety Commission. The full committee, the Committee on Energy and Commerce, has realized finally that in order to protect our children, we have to work together. We were able to put politics aside and do it in a very pragmatic, cooperative way. The House, the Consumer Product Safety Commission, the consumer groups, and the industry all worked together to get this done. A lot has been reported about a bill in the Senate, but in reality it is because our House committee worked in such a cooperative manner with all of the stakeholders that we are now just perched on the very threshold, literally the eve, of passing H.R. 4040 through our committee. The Senate hasn't been able to do this, so the legislation may languish a bit longer, but I hope they take the lead from this inspired and bipartisan piece of legislation. Now, both sides of the aisle, both sides of the dais in the committee had to compromise on several things, but I don't believe we ever compromised the safety of our children. I am an original cosponsor of the bill; I don't think it is a perfect bill. I have proposed amendments in the subcommittee process, and I am going to propose amendments when we mark the bill up later this week. For instance, I firmly believe that we have to improve the United States Consumer Product Safety Commission's ability to notify consumers and retailers about dangerous products more quickly and in a much broader scope. During a hearing earlier this year with the chief executive officer of a large toy company in this country, I started wondering about some of the nonprofits in my district, people that do good work. They collect items for resale; they sell a large amount of resale items and collect money for other good works that they do. But I wondered, how do they find out about recalls? If the product is recalled, do they know it? Will they be able to remove it from their shelves so it doesn't then pass into the hands of some other unsuspecting consumer or child? And if they don't know about them, what can we do? What can we do in the United States Congress to make sure that they are indeed aware? Well, after discussing this issue, I must tell you, I have got an outstanding nonprofit corporation in my district back in Denton County, back in north Texas, Christian Community Action. After talking about it with them, I became very concerned that there may be a large group of people and associations that are not receiving the information about product recalls in a timely manner. As we all know, products are recalled because they have been found to have some element of danger to the consumer, and they need to be immediately discarded or handled in some other way. Nonprofits like the Salvation Army, Goodwill, and my own community Christian Community Action, and even smaller nonprofits that serve an even more specialized segment of the community, they provide many valuable resources. Often, these nonprofits run second-hand retail shops to additionally help some of the neediest members of society, certainly members of society that you really don't want a recalled product ending up in their hands. However, as I said before, I have been informed by some of the nonprofits in my district that, through no fault of their own, they are unaware of the recalls. And, therefore, the fear is that they may inadvertently sell a recalled product to a family or to an individual or to a child. This gap had to be closed, and I was able to offer an amendment that subsequently was accepted and the amendment will help us close the gap. This happened in the subcommittee markup on the Commerce, Trade, and Consumer Protection Subcommittee. That amendment makes it unequivocally clear that the United States Consumer Product Safety Commission must reach out and educate second-hand retailers, like Christian Community Action back home in my district, and must provide additional educational materials about the recalls. This new provision will help make our second-hand retail shops safer, and that makes our communities safer. It makes our children safer. Now, I am pleased that the amendment was accepted, and I have also been working on other ideas. I want to talk about them just a little bit more in a moment. But I have also introduced legislation dealing with food imports, which basically will give the Food and Drug Administration a big red button to push to be able to stop a dangerous food or drug from entering the country. We see the little teddy bear coming down a conveyor belt there. Well, if we know that the teddy bear has got rohypnol in his running shoes or polonium in his paws or formaldehyde in his fur, we want to be able to stop this product from coming into the country. And this is something that I have become very concerned about. I want to give similar authority to the Food and Drug Administration to give them a big red button to push to stop dangerous foods from entering the country. At a hearing that we had at the beginning of November, I asked Chairwoman Nord if she had the authority, that same authority for the Consumer Safety Commission that I was trying to give to the FDA, and she said no. Therefore, over the past several weeks I have been working on trying to incorporate these same ideas into H.R. 4040, which, again, deals with consumer product safety. So this Thursday, when we do our markup in full committee on H.R. 4040, I will be offering two additional amendments at the full committee markup. Right now, the current law lists five ways that an imported product can be refused admission into the United States. Now, I was somewhat chagrined to learn that the list did not include products that had been recalled. That seems just common sense. Do we ever need that stop button. We need to stop dangerous products from other countries from entering into our shores and certainly from entering into our stream of commerce. It seems to be common sense that products that have been found to be dangerous should be stopped at the border and denied entrance into this country; but, unfortunately, that is not always the case. And think about that for a minute, Mr. Speaker. You have got a product that has been recalled because it has lead in some part of the product, but we don't stop it from coming into this country. What happens to all that stuff? It accumulates in a warehouse somewhere, presumably. Presumably it is not diverted into the stream of commerce at some point along the line. But even just aggregating a lead contaminated product in a warehouse somewhere means at some point someone has got to do something with it. They can't just keep paying rent on a warehouse for a product that is not moving and not going anywhere and not making them any money. This product is going to have to be destroyed. Well, you can't bury it in a landfill because then you contaminate the groundwater. You can't burn it because then it goes in the air; we all breathe it. We know that is not a good thing for a lead- contaminated product. We need to stop that stuff from even coming into our country. So I will be offering an amendment that would immediately add recalled products to the list of reasons as to why a product should be refused admission. I know it sounds simplistic and that is something that should already be done, but apparently that is not the case. Unfortunately, while the leadership of the committee agrees that the stop button approach has much merit, to avoid possible violations of trade laws, and for the life of me I don't know why we would be concerned about that; it seems like someone is violating the trade laws on the other end. But the committee thinks, in order to avoid violations of trade laws, that we need to hold an additional hearing on this very subject on this idea before enactment. I am going to offer the amendment when we mark up the bill on Thursday. Because of this concern, it likely will not be accepted. And I would like to get the understanding from the committee that we have got to go forward with this idea and enact legislation that will give the Federal Government a true measure, a true way to stop dangerous products from other countries, from coming into our country and hurting our families and our children. Now, while this amendment may not be successful this run, I have been able to gather support from the committee on another and equally important amendment. As I mentioned before, right now, current law in the United States of America, there are five ways that a product can be refused admission into the United States. As I began my study of this section of the law, my first question was: If the Federal Government already has a law in place to stop harmful imported products from entering the United States of America, then why, why, why are we seeing recall after recall after recall, a record-breaking number of recalled products being manufactured and imported into this country? The second question was: What types of inefficiencies are there in the laws that need to be remedied? Well, after looking at a list of the five ways we could refuse admission of an imported product, two of the five ways immediately caught my attention. The law reads that a product can be refused admission if the product ``is or has been determined to be an imminently hazardous consumer product in a proceeding.'' Now, what does that mean? Well, the law defines an imminently hazardous consumer product as a consumer product which presents imminent and unreasonable risk of death, serious illness, or severe personal injury. I think it fits the bill. So the Federal Government already has a way to stop products from entering into America if they pose a risk of death, serious illness, or serious injury. When I originally learned of this, I thought that this section of the law could and should keep Americans safe. But when I asked the United States Consumer Product Safety Commission how many times the law had actually been used, the answer was five times. Five times. Mr. Speaker, do you want to hazard a guess when the last time this law was used? Let me give you a hint: Ronald Reagan was President of the United States. The year 1998 was the last time the law was used. Realizing that this section posed an incredibly high bar in order for it to be used, especially since a proceeding had to be held prior to enforcement, I turned to the next way that a product could be denied admission. The law also reads that ``a product can be refused admission,'' and again quoting here, ``if it has a product defect which constitutes a substantial product hazard.'' Again, what do they mean by that? The law defines a substantial product hazard as a product defect which, because of the pattern of the defect, the number of defective products distributed in commerce, and the severity of the risk or otherwise creates a substantial risk of injury to the public. It seems to be a little bit lower bar, to me, so I thought surely, surely this section could be used to keep Americans safe. Well, I was wrong again. The United States Consumer Product Safety Commission did not have the exact number of times that this section had been used to deny admission of imported products, but the information I got back was that it was ``rarely used.'' Rarely used. Rarely used. Rarely used to protect Americans from dangerous products. Well, Mr. Speaker, as a Member of Congress, if we see inefficiencies in the law, we have a duty to make changes, to make changes in the law to make it work, make it more efficient. I don't pretend to have all of the answers to make this law more perfect, but I know that we must do something to increase the effectiveness of these provisions. Americans are relying on us. Americans are relying on their Members of Congress, on the United States Congress to do just that. Therefore, I will be offering an amendment to our bill when we mark it up on Thursday to H.R. 4040 that will require the United States Consumer Product Safety Commission to study the effectiveness of these five ways to refuse admission of an imported product, especially the first two ways that I just went over: the Commission must report back to Congress on a specific strategy, including any new legislation needed to implement such a plan which will be used to increase the effectiveness of their ability to stop unsafe products from entering into the United States. I have been informed that I have the support of the leadership of the committee on a bipartisan basis to allow this, what I consider a very vital amendment, very basic but vital amendment to go forward. We desperately need a way to stop defective products at our borders. The American public should know that these products will not come into this country. I want the American people to know that I for one am not going to stop working on this until we have the problem solved. Let's move on from our friend the teddy bear. And just as a matter of public service, while we continue to work on legislation regarding consumer product safety, Mr. Speaker, I realize that I can't speak directly to people who might be watching on C-SPAN, whether they be Members of Congress or just ordinary Americans; but if I could speak to them in their living rooms, what I would want to say is I would encourage them to sign up for product recall alerts. It is easy, it is free, and it can save a life. If you have access, again, Mr. Speaker, if I were able to speak directly to people watching this on C-SPAN or Members watching in their office, I would say that if you have access to the Internet or if you have access to e-mail, all you need to do to receive these alerts is go to the Consumer Product Safety Commission's home page, which is www.cpsc.gov, and sign up for free recall and safety news. Again, the Web address, www.cpsc.gov, and you can sign up for the product alerts. I have done that. You get about an alert a day. It is a little disconcerting at first, but it is important information. And the Consumer Product Safety Commission also has a neighborhood safety network which is for organizations, for civic-minded individuals to help disseminate information about recalls, provide posters to members of society who may not be aware that the recall has happened and that the recall may affect products that they have in their home. Mr. Speaker, we all know education can save lives. Unfortunately, though, certain groups of Americans, some of them elderly, some of them living in urban settings, some living in very rural settings, and I have got both in my district, some low-income families, minority groups, often don't hear about the safety messages from the government, and so we need additional ways of outreach. Please, I would ask, Mr. Speaker, we ask our fellow Members of Congress to help make communities safer by getting the word out about product recalls. I am a member of the Neighborhood Safety Network and we disseminate information about recalls via my Web site, www.house.gov/burgess. Mr. Speaker, we have talked a lot about consumer product safety recalls. Let's talk about food safety. You think it is the same thing, but it is an entirely different process. We have had so much discussion about this that I feel people probably are asking is Congress doing anything, has Congress paid any attention to the safety of the food we eat? The answer is, yes, we have paid a lot of attention. We haven't got a lot of press about it, but I am again a member of the Energy and Commerce Committee, and we are pursuing an active investigation and then subsequent legislation to confront the problem. As a member of the Oversight Investigation Subcommittee, we have taken an active role in investigating the safety of our Nation's food supply. In August, our subcommittee sent a bipartisan group of investigators to China to see firsthand some of the causes of the problem. In the committee's staff report, the investigators came to the following conclusion from their trip and investigation thus far. Quoting directly from the staff report: Number one, it would appear that the Chinese food safety supply chain does not meet international safety standards. It is, in fact, responsible for very serious domestic Chinese food poisoning outbreaks. It is happening in their own backyard. Number two, findings of the bipartisan field investigators, the Chinese government appears to be determined to avoid embarrassing food safety outbreaks in export markets due to the damaging and potentially lasting effect this would have upon their ``Made in China'' branding. Well, that is pretty powerful. In fact, Mr. Speaker, if I can digress for a moment, you almost wish if American importers and manufacturers had that same concern about what damage they may do to their individual brands by continuing to import, albeit inexpensive products, but products that aren't safe. Americans want to feel safe. If it cost an extra $1 for a Barbie doll, I bet they are willing to fork that out. Finding number three, the lack of meaningful regulation of farming and food processing in China and the advanced development of the document counterfeiting industry and the willingness of some entrepreneurs in both China and the United States to smuggle foodstuffs that do not meet quality standards necessitates a much more vigorous program of inspection and laboratory testing in China and the United States ports of entry than the Food and Drug Administration has been willing or able to provide to date. Mr. Speaker, these are important conclusions and we simply cannot sit by and watch the problem worsen. We have to transform the Food and Drug Administration into an agency that can fully cope with the importation problems of the 21st century. The Energy and Commerce Committee is doing our part. In addition to the staff trip to China, we have had five hearings to discuss the topic ``Can the Food and Drug Administration Commission Assure the Safety of the Nation's Food Supply?'' What have we learned so far? At a hearing on July 17, 2007, on this very topic, former FDA Associate Commissioner William Hubbard testified that in 1999 the FDA drafted a legislative proposal which would have given the Food and Drug Administration authority to require foreign countries to take more responsibility for the foods that they send to the United States. The agency's proposal would have allowed the Food and Drug Administration to embargo a given food from a given country if there were repeated instances of that food being found contaminated when it arrived in the United States. Countries that send safe food would have no reason to be concerned because they would be unaffected. But countries that demonstrated a pattern of disregard of United States safety standards would have to increase their oversight of food exported from their country. They would have to do it. Unfortunately, Congress did not accept this recommendation in 1999, and the situation with imported foods has gone from bad to worse to truly awful. Now, Congress had a chance to examine the problem and consider recommendations on how to solve the problem, and that was back in 1999. The world was a different place, and it was perhaps difficult to anticipate the acceleration of foreign products that are coming into our country that occurred over the last decade or decade and a few years more. Was the safety of food products from foreign countries not a priority for Congress back in 1999? And the answer to that question is not as much as it should have been. Why we have allowed this problem to persist when they know how much harm these unsafe products have potential to cause, I can't answer. We may never know the answer to that question. But as I stand here tonight, I will absolutely, absolutely assure you this is a priority of mine and I intend to do something about it. Now, October 11 of this year, the Energy and Commerce Subcommittee on Oversight and Investigations had the third of a five-part series of hearings on the Food and Drug Administration's ability to ensure the safety and security of our Nation's food supply. According to testimony given by Mr. David Nelson, the senior investigator for the Energy and Commerce Committee, currently the Food and Drug Administration does not go over and see if the food products that are produced in China are done under the same standards as here in the United States of America. These are the products that are produced in China and sent over here for our consumption. These are the products that Americans will be consuming, and they are not being produced under American standards. When we had that hearing, Ranking Member Whitfield on the subcommittee asked Mr. Nelson if you were speaking to a group and a member of the audience asked how safe it is to consume products produced in China, he answered, You would be taking your chances on any imported food. Mr. Speaker, that is a chance we simply can't afford to take. America has to have the authority to prohibit these foods from coming into our country if they are not safe. We have to have the ability to determine if they are produced according to our standards. We have to be able to stop foods that we would, according to Mr. Nelson, be taking our chances on. Now, Chairman Dingell asked Mr. Nelson whether or not the Food and Drug Administration can protect the United States' citizens from unsafe imports with the resources the Food and Drug Administration currently has. Mr. Nelson's answer was, That would be an emphatic no. Just not just no, but an emphatic, underlined, bolded no. When I got a chance to ask a question, I asked Mr. Nelson what did they do about food to eat while in China. He sort of laughed and sort of didn't laugh and said, Well, we ate what everyone else ate. And I asked how he was feeling, and he said, Just fine. But actually, some of the members of our committee staff did become ill when they were traveling in China. Now, I was very interested in the protocol that they follow in China after discovering a contaminated supply of food, and the hearing we were having that day really concentrated on poultry and poultry products. During my questioning of Mr. James Rice, the vice president and country manager of Tyson Foods in China, I asked what I thought was a fairly simple question. I said, When you find a problem, do you communicate that to, say, the United States authorities so they can be on the lookout for similar products in other facilities? This was a little bit disturbing, Mr. Speaker. He said, No, we don't. He explained to me, because Tyson was using local Chinese suppliers and the products are mostly for the Chinese market, they didn't feel that was necessary. So, in essence, there is no dialogue whatsoever. Mr. Rice told me if persistent problems from one supplier were identified, no one would alert others as to the presence of this problematic supplier. There is no system in place, no early warning system, no system of surveillance, not even any honor among thieves, it appears, to let people know about a bad supplier in their midst. Mr. Speaker, that is a serious, serious problem. And it is so important, so important that I introduced legislation that relates to this 1999 proposal, H.R. 3967, the so-called Imported Food Safety Improvement Act of 2007, because I firmly believe the Food and Drug Administration needs the ability and the explicit authority to immediately stop dangerous foods and products from coming into this country. And it is a pretty simple concept. Goods are coming into this country. If goods are coming into this country on a long conveyer belt and you find a bad apple on the belt, the Food and Drug Administration needs to be able to push a big red button that says ``stop'' and immediately stop that contaminated product from continuing on downstream into our stream of commerce. My legislation would give the Food and Drug Administration that big red button to push. The idea is simple. If enacted, the Food and Drug Administration would have the authority to embargo a specific food from a specific country if there were repeated instances that that type of food or product had been contaminated. It seems so simple. We have got to be able to stop countries from sending harmful food products into the United States. My bill, H.R. 3967, will allow us to finally take control of the food being sent to America. And this is important as well, Mr. Speaker. It sends a strong message to countries that in the past have played fast and loose with our regulations, that in the past have not seen a problem with continuing to send contaminated products into our country. Well, we are going to tell them it is a new day and it is a different set of rules. You solve the problem on your end or we will end the problem over here. After summer of recall upon recall upon recall, it is time to take matters into our own hands, and I will no longer tolerate hearing a different news story every day of the week about a new and dangerous product coming into the United States of America from the People's Republic of China. China is sending these products to America and then they are being recalled. We can do a little better than that. The Health Subcommittee of Energy and Commerce, of which I am also a member, had a legislative hearing on September 26 regarding Chairman Dingell's bill, H.R. 3610, the Food and Drug Import Safety Act of 2007. Having reviewed this legislation, I think the chairman's intentions are good, and obviously I look forward to working with the chairman on this issue. I cannot support every single provision in the bill, but I do support the spirit of the proposed law. I believe we need to look toward how other Federal agencies have dealt with this issue and whether it would be appropriate to give the Food and Drug Administration similar authority or authorities. According to the Government Accountability Office, 15 Federal agencies collectively administer 30 laws related to food safety. Do you think we are suffering a little bit from too much division of labor? The Food and Drug Administration, which is part of the United States Department of Health and Human Services, and the Food Safety and Inspection Service, which is part of the United States Department of Agriculture, together comprise the majority of both the total funding and the total staffing for the government's food, safety and regulatory system. However, food safety laws and regulations vary greatly from one agency to the other and not all foods are treated equally. For instance, the United States Department of Agriculture has jurisdiction over meat, poultry and eggs, and has established equivalency determination standards for those specified foods. On October 11 at the third Oversight and Investigation hearing on the FDA's ability to assure the safety and security of our Nation's food supply, the Under Secretary for Food Safety at the United States Department of Agriculture, Dr. Richard Raymond, gave the following testimony and provided a definition for equivalency: ``Equivalency is the foundation of our system of imports. It recognizes that an exporting country can provide an appropriate level of food safety even if those measures are different from those applied here at home. ``The Food Safety and Inspection Service has always required an assessment of foreign inspection systems before those nations can export into the United States of America. This prior review was mandated by our laws, which originally required that a foreign system be equal to our system before that foreign product can be admitted.'' He further went on to state: ``An exporting country has the burden of proving that its system is equivalent to our own if that country wishes to export to the United States.'' Well, Mr. Speaker, I understand in applying a system of equivalency to the Food and Drug Administration, which, in fairness, has an 80 percent jurisdiction over all food imported, as compared to 20 percent for the United States Department of Agriculture, I recognize that that system of equivalency for the Food and Drug Administration is going to be difficult. It's going to be onerous. Currently, only 33 countries are eligible to ship meat or poultry into the United States because of those very high standards established by that equivalency protocol. If the exact standard that the United States Department of Agriculture employs was used by the Food and Drug Administration, it would drastically change. Some people would even say it would cripple the food import system if there were not enough resources to support it. Again, remember, the United States Department of Agriculture which has a system of equivalency, oversees 20 percent of the imports. The Food and Drug Administration, which does not have a system in place for inspecting sites in other countries, has jurisdiction over 80 percent of the food imports. You can begin to see some of the discrepancy there and the magnitude of the problem that faces us. Mr. Speaker, the former Speaker of our House, Speaker Newt Gingrich, is famous for quoting in his second principle of transformation: ``Real change requires real change.'' This is just such a situation. This system needs to be drastically changed. Consider this, Mr. Speaker: in 2005, nearly 15 percent of the overall United States food consumption was imported. Between 1996 and 2006, the amount of United States imports of agriculture and sea food products from all countries increased 42 percent. Furthermore, in the last decade the volume of Food and Drug Administration-regulated imports has tripled. Chinese imports to the United States of America have increased more rapidly than the global average. And between the years 1996 to 2006, the volume of imports of Chinese agriculture and sea food products increased by 346 percent. China is now the third largest exporter of agricultural and sea food products to the United States of America, only surpassed by our neighbors to the north and south. So perhaps our food import safety system should change. It needs to change drastically. The Food and Drug Administration was created at a time where we were still domestically growing and producing the majority of our own foods. And we've got some real issues here at home to deal with regarding our food regulatory system. But at least we have a regulatory system with which to deal with the problem. This is not the case for all countries from which we receive food. It seems that it would be common sense that we would only import food from a country if they can prove that their system is just as good as ours. And yet only the United States Department of Agriculture can require this, which, once again, controls only 20 percent of the imported food. The Food and Drug Administration, which cannot control that issue of equivalency, is responsible for 80 percent of the food imports. It seems to be very arbitrary that the system that the United States Department of Agriculture can employ is so much tougher than the system employed by the Food and Drug Administration. Yet, at the end of the day, where does all that food end up? It's on your table, and it looks the same whether it's regulated by the United States Department of Agriculture or regulated by the Food and Drug Administration. Americans don't discriminate from which agency had the regulatory control over the food that was imported from other countries. And it's kind of curious that in Congress we make that distinction. Congress is responsible for these dual standards and Congress must have a candid discussion on whether or not we need to make these systems more comparable, if we need to establish the same system of safety for the Food and Drug Administration that we already have in place for the United States Department of Agriculture. It is my goal to encourage this frank discussion at the committee level and here on the floor of the House, Members on both sides of the aisle. And we've both got to continue to have input on this important issue. As we all know, the system works best and we have the most effective legislative product if bills are allowed to go through the regular process. And I implore leadership to allow this important piece of legislation to go through that regular legislative process. We've seen two instances this year on our Committee on Energy and Commerce with H.R. 4040, the bill that we're going to mark up on Thursday, being the second one. The first was when we reauthorized the prescription drug user fee and the medical device user fee for the Food and Drug Administration. That bill came through regular process. And I didn't like everything in the bill at the end of the process, but you know what? It was a good bill. And it passed the House and it passed the Senate and the President signed it into law at the end of September. And for the first time we've got a robust, data-gathering capability within the Food and Drug Administration which the country has needed and has lacked for 40 years. We did this. This Congress did this, accomplished this by working together in a bipartisan fashion through regular order. We've got the same opportunity here on the Consumer Products Safety bill that's before the full committee on Thursday. And the other side of the equation is, look what we've done with reauthorizing the State Children's Health Insurance Plan. Here's a bill that every one of us, when we stood in this Congress and we raised our right hand and we swore the oath and were sworn into Congress, every single one of us, man and woman, knew that the State Children's Health Insurance Program had an expiration date of September 30 of 2007. And what did we do? We languished; we didn't have hearings. We didn't have a markup in subcommittee. We crammed some great big obnoxious bill through the full committee, came to the House floor without even being discharged by our committee. The bill was so bad that the Senate wouldn't even touch it. Now that's a bad bill. And then we got this process from the Senate; and instead of taking the Senate bill back to our committee and working on it and trying to improve it, we treated it as if it was a conference report, but everyone in Congress knew it wasn't a conference report. But it was brought to the floor like a conference report so you couldn't amend it, you couldn't change it, you couldn't try to make it better and it was rammed down our throats; and it was passed and the President vetoed it; and we sustained the veto, and then we're going to go through the same gyration again here this week. And that's not necessary. We have a way of doing things right. We have a way of producing for the American people, if we'll just do it and put the politics aside for a little while. Well, let's not allow the issue of protecting our families from harmful and dangerous goods coming from other countries also become the debate of Republican versus Democrat. That is something that I am certain holds residence in the minds of all of us working together to find the most efficient and the most effective method of solving this crisis now, making it a priority for everyone and getting the problem solved now and then moving on to other things. Now, I would be remiss if I didn't also mention that last month the President's working group on import safety presented their proposal to both the President and to Congress. While I wish that the working group had been able to present their proposal somewhat earlier than they did, I do believe that they have presented many sound policies and that we should incorporate this while formulating our legislation. I, myself, am still reviewing the group's findings. It is pretty voluminous, but I was pleased to read that they would also like to see a legislative proposal that would give the Food and Drug Administration additional authority for preventive controls for high-risk foods. If you'd like to read their proposal, it is available on the Internet at www.importsafety.gov. Import safety is all one word, all lower case. Now, I know many people watching this are asking themselves, you know, is there a down side to all of this that we should consider. The answer is, yes. We've always got to be cautious about jumping over the line and encroaching the, increasing the ever expanding grasp of the Federal Government. There's no doubt that the Federal Government has an important duty to the safety and welfare of all Americans, but the last thing you want is for the Federal Government to control absolutely every aspect of every little item that you buy. There is a balancing test and I, for one, am going to continue to be cognizant of that fact. But there is also a very clear and present public safety danger that has to be dealt with. We must be vigilant in our plight in restoring safety and trust back to the foods we eat and the products that we use. I believe that H.R. 3967, the Food Import Safety Improvement Act, will further this goal, as will amendments that I'm going to make in H.R. 4040 later this week. Compromising the safety of foods that we put on our tables is not an option. Compromising the consumer products that we buy for our families is not an option. Compromising the security of Americans will not be an option. Compromising cannot be an option that we turn to because we lack the power. H.R. 3967 and my amendments to H.R. 4040 will restore some of that power to Americans. Mr. Speaker, again I started off this talk with the notion that when people are out shopping this Christmas season and they pick up something and they look at the underside of it and it says ``made in China,'' maybe that translates into ``use at your own risk.'' I do encourage consumers to beware, be aware of where the products are made, be careful about the products that you bring into your home. Mr. Speaker, we can no longer sit back and allow these harmful products to reach our homes. All Americans, myself included, have a choice to take a stance individually and to not buy products if we don't think they're safe. And if you see ``made in China,'' remember, that's a warning label. But we can go a little further than that. Stricter rules are necessary. Funding, increased funding, increased personnel are necessary. And now it's up to Congress. It's up to Congress to create and enact those rules. Mr. Speaker, you've been very indulgent, and I'm going to yield back the balance of my time.

Mr. BURGESS

Mr. BURGESS. Madam Speaker, I rise today to congratulate the L.D. Bell High School Blue Raider Marching Band of Hurst, Texas, on being named the 2007 Bands of America Grand National Champion on November 17, 2007 in Indianapolis, Indiana. The L.D. Bell Blue Raider Marching Band has participated in the Bands of America Grand Nationals five times since 2001, placing 4th, 5th, 3rd, 2nd, and now 1st. They also received the highest achievement awards in the areas of Outstanding Music Performance and Outstanding General Effect. In the semi-finals round, the band received the highest score given in Bands of America history: an astounding 97.8. The Band is capably led by Director of Bands Jeremy Earnhart, Assistant Director of Bands Jolette Wine, and Associate Band Directors Nick Thomas and Brandon Holt. I sincerely commend the L.D. Bell High School Blue Raider Marching Band, their directors, and Drum Majors, for winning 1st place at the University Interscholastic League Bands of America Grand Nationals. Their hard work, dedication, desire to excel, and success in promoting and performing music deserves the highest recognition and congratulations. I'm very proud to represent these students and teachers in the U.S. House of Representatives.

Mr. BURGESS

Mr. BURGESS. Madam Speaker, I rise today to congratulate Erica French, a teacher at Lowery Road Elementary School in Fort Worth, Texas. Ms. French was chosen as one of fourteen recipients of the 2007- 2008 Chairs for Teaching Excellence award. The Fort Worth School District recognizes the teachers, and to be chosen, you must be nominated by a principal, parent, or colleague. The selection process also entails an interview and an evaluated teaching demonstration. The teachers were presented with their awards at the Petroleum Club of Fort Worth. It is my honor to represent a teacher such as Ms. French in the 26th District of Texas. Her dedication to education, her school, and her students and families of Fort Worth, Texas should be viewed as an example for all.

Mr. BURGESS

Mr. BURGESS. Madam Speaker, I rise today to congratulate four members of the Denton County Correctional Health Team for being accredited ``Certified Correctional Health Providers'' by the National Commission on Correctional Health Care. The four health care providers are Medical Lt. John Kissinger, Medical Sgt. Shannon Sprabary, Standards and Quality Assurance Provider Dr. Randall Kesseler, and Juvenile Health Supervisor Caren Curtis. The National Commission on Correctional Health Care certification is the highest level of certification for correctional health providers. This is a great honor as there are only 2,000 certified health care providers in all of the correctional facilities in the United States. The Health Department runs a full medical facility in the Denton County facility, and provides emergency, routine and chronic care for over 1,000 inmates. The individual and team accomplishments of these members contribute greatly to the safety and security of all inmates of the facility. I am very proud of their dedication to their community and country. It is my honor to represent these men and women, and I wish them continued successes in the future. Their persistence and commitment should serve as an inspiration to us all.

Mr. BURGESS

Mr. BURGESS. Madam Speaker, I rise today to congratulate Riley Bell, of Trinity Christian Academy, on qualifying for induction into the Spring 2007 National Honor Roll. Riley resides in The Colony, TX and is in her third year of high school at Trinity Christian. The National Honor Roll offers several benefits that can contribute to the success of its student members. The National Honor Roll chooses students based upon their academic performance. Each student that qualifies for induction must have a B average or better, and show ambition in areas such as grade point average, interests, activities, and future goals. I extend my sincere congratulations to Ms. Riley Bell for her remarkable dedication to education and exemplary learning. Her commitment to her studies, her school, and her future should serve as an inspiration to all. I am honored to represent her in the 26th District of Texas.

Mr. BURGESS

Mr. BURGESS. Madam Speaker, I rise today to congratulate Mr. Rice M. Tilley, Jr., practicing attorney with Haynes and Boone, LLP, as the recipient of the 2007 ``Distinguished Citizens Award'' from the Longhorn Council, Boy Scouts of America. Mr. Tilley practices law in the Northern District Court of Texas, as well as the U.S. Court of Appeals, Fifth Circuit. He has over 40 years of experience in the fields of taxation, estate planning, and business formation, among others. Mr. Tilley is very active in his community and holds positions on the Fort Worth Chamber of Commerce, Leadership Fort Worth, and The University of North Texas' Board of Regents, as well as other organizations. The leadership skills Mr. Tilley possesses are evident through not only his profession, but his charitable and community work as well. I extend my sincere congratulations to Mr. Rice M. Tilley, Jr., on receiving this award, and I praise his dedication, commitment, and desire to help his community and country. I am honored to represent him in the 26th District of Texas.

Mr. BURGESS

Mr. BURGESS. Madam Speaker, I rise today to recognize the superior community service and dedication of the 5th grade students from Pecan Creek Elementary School in Denton, Texas. These students volunteered many hours to illustrate a children's book, More Than Just a Mvule Tree, which raised money to plant trees in Uganda. The students' teacher, Ms. Natalie Mead, helped with the project, which sold 600 copies of the 24-page first edition book. The sales of those books, along with sponsorships, filled the village of Wonkonge in Uganda with 170 Mvule trees. Madam Speaker, it is with great honor that I stand here today to recognize these students and their teacher. The students of Pecan Creek Elementary School's 5th Grade class have shown commitment to their local and international community. I am honored to represent them in the 26th District of Texas.

Mr. BURGESS

Mr. BURGESS. Madam Speaker, I rise today to congratulate Reyna Trevino of Little Elm High School in Little Elm, TX, on qualifying for induction into the Spring 2007 National Honor Roll. The National Honor Roll offers several benefits that can contribute to the success of its student members. The National Honor Roll chooses students based upon their academic performance. Each student that qualifies for induction must have a B average or better, and show ambition in areas such as grade point average, interests, activities, and future goals. I extend my sincere congratulations to Ms. Reyna Trevino for her remarkable dedication to education and exemplary learning. Her commitment to her studies, her school, and her future should serve as an inspiration to all. I am honored to represent her in the 26th District of Texas.

Mr. BURGESS

Mr. BURGESS. Madam Speaker, I rise today to congratulate the Flower Mound High School Drumline in Flower Mound, Texas. The Flower Mound High School Drumline has been named ``Best Drumline in the Nation'' by the Percussive Arts Society International Marching Festival competition in Columbus, Ohio, and for the first time, was awarded the nationally acknowledged Fred Sanford Award. The Flower Mound High School Drumline's show, entitled ``Primary Focus,'' is centered on the idea that music is the main part of the number. Along with the ``Best Drumline'' award, individual students at Flower Mound High School also received awards for Best Snare Pit, Best Tenor Line and Best Ensemble. The forty-two member drumline competes annually in indoor and outdoor competitions, as well as marching in the half time shows during the football season. It is my honor to represent a group that shows such talent, hard work, and dedication at such a young age. I extend my sincere congratulations to The Flower Mound High School Drumline.

Mr. BURGESS

Mr. BURGESS. I thank the Speaker. The hour is late, the time is short. I do want to talk a little bit about health care this evening. Maybe, Mr. Speaker, in order to clear the air from the last 40 minutes, let's start off with a Bible verse. Let's start off reading from the Old Testament from the book of Habakkuk, Chapter 2. ``I will stand upon my watch, and I will set me upon the tower, and I will watch to see what he will say to me, and what I shall answer. And the Lord answered, Write the vision, make it plain upon tables, that he may run that readeth it. For the vision is yet for an appointed time, but at the end it shall speak and not lie. Wait for it, because it will surely come. It will not tarry.'' Mr. Speaker, I think those are important words. We are going to talk a little bit about the vision for health care, the future of health care in America. Sometimes we will have to wait for it, but it will come. It's a universal problem in this country. Some people think it has a universal solution; others disagree with that. But those two philosophies of health care, that that can be solved by the government or that that is better solved by individuals, those two competing philosophies are really going to be played out front and center over the next 18 to 24 months, both in this Congress and on the national stage in Presidential elections. I may be oversimplifying the issue a little bit, but it underscores the basic arrangements. We sometimes appear to discuss health care only in the realm of insurance, government systems, third-party systems. In fact, Mr. Speaker, if you recall back in 1993, when the attempt was made with the Clinton health care plan, a lot of us who worked in health care at the time were perplexed, we were concerned because at the time the plan seemed to be less about health care and more about the transactions involving health care, that is, more about insurance than actual health care. You know, back not too terribly long ago health care meant you called your doctor, you saw your doctor, you paid your doctor on the spot. Now, we have this convoluted system of third-party payers, government payers, private employee and self-pay. It's a complicated plan. It works. Hardly can be described as efficient. But it does work. Mr. Speaker, we have got to ask ourselves: Is our goal in reforming health care, is our goal indeed in transforming health care to protect our patients or are we here to protect that third-party system of payment? Is our goal to provide Americans with a reasonable way to obtain health care, a reasonable way to communicate with their physician, with their doctor, with their nurse? We really need to proceed carefully because the consequences of any poor choices we make over these next 18 to 24 months, the consequences of those poor choices will reverberate for decades. Not just in our lifetime, but in our children's lifetimes. Mr. Speaker, I often stress that the fundamental unit of production of this great and grand American medical machine, the fundamental unit of production is the interaction that takes place between the doctor and the patient in the treatment room. It is that fundamental unit of production which we must protect, we must preserve, we must defend. Indeed, anything we do to try to transform or reform the health care system in this country, first off, we need to ask: Is it going to bring value to that fundamental unit of production of the American health care machine? The test before us is do we protect people or do we protect the special interest groups. Do we protect big government or do we protect individuals? Do we believe in the supremacy of the State or do we believe in the sanctity of the individual? An educated consumer makes for a better health care system. We need to make health care reform about patients. Let me just spend a little time talking about what are some of the predominant plans that we hear talked about, some of those placed forward by the Presidential candidates, something that we hear talked about on the other side of the aisle here in this House. It's often referred to as a single-payer system or universal health care coverage. It's got a nice ring to it. It's almost seductive. Why shouldn't the world's strongest and best economy, the world's strongest and best health care system provide free health care to all? Well, perhaps the words of P.J. O'Rourke penned back in 1993 in the Liberty Manifesto, when he stated, If you think health care is expensive now, wait and see what it costs when it's free. Mr. Speaker, the American health care system has no shortage of critics at home or abroad. But, Mr. Speaker, it is the American health care system that stands at the forefront of innovation, the forefront of new technology. These are precisely the types of systemwide changes that are going to be necessary to efficiently and effectively provide care for Americans in the future. There's no way we can pay for all the care we are going to need to buy if we rely entirely on today's systems and solutions. There have to be new systems and solutions developed for the future, and they will deliver on that promise. The price will come down, but only if we give the system the freedom to act and develop those measures. Now, the New York Times, not something that I normally read, but just a little over a year ago the New York Times, renowned for its liberal leanings, published October 5, 2006, an article by Tyler Cowan, who wrote at the time, ``When it comes to medical innovation, the United States is the world's leader.'' Continuing to quote, ``In the past 10 years, for instance, 12 Nobel prizes in medicine have gone to American- born scientists working in the United States, three have gone to foreign-born scientists working in the United States, and seven have gone to researchers outside of this country.'' He goes on to point out that five of the six most important medical innovations of the past 25 years have been developed within and because of the American system. Now, Mr. Speaker, comparisons with other countries may be useful, but it is important to remember that the American system is always reinventing itself and it's always seeking improvement. It is precisely because of the tension inherent in this hybrid public-private system that creates that tension and creates that impetus for change. A system that is completely and fully funded by a payroll tax or some other policy has no reason to seek improvement. Its funding and its funding stream is going to be reliable and predictable, occurring day after day. There's no reason to try to improve a system like that. It's always in complete balance, complete equilibrium, and faces stagnation. But if there does become a need in such a system to balance payments or control costs, where is that going to come from? We have already seen from our experience within our own Medicare system that is going to come at the expense of the provider. It always has, it always will. The difficulties faced by providers within the Medicare system on an ongoing basis are truly staggering. Mr. Speaker, the fact is the United States is not Europe. American patients are accustomed to wide choices when it comes to hospitals, physicians and pharmaceuticals. Because our experience is unique and because our experience is different from other countries, this difference should be acknowledged and embraced, maybe even celebrated. But certainly when reform, either public or private, is discussed in this country, we need to be cognizant of that difference. That is one of the many reasons why a universal health care system, or a single payer system, translate that to ``the government,'' to me seems almost inadvisable, and certainly doesn't seem sustainable over time as an option. So let's think about some of the principles that really should be involved when we talk about changes and improvements to our health care system. Three principles that I focus on, and I think really form the crux of the basis of all activities regarding health care reform or transformation of the health care system, are affordability, accountability and advancements. Three things fairly easy to remember, almost an iteration when you put them right together. Under affordability, one of the things I think we oftentimes forget is what does it really cost to deliver the care? How do we assign those costs? How do we allocate those costs? The pricing for health care services really ought to be based on what is indicated by the market. But that isn't always the case. Oftentimes it is what is assumed by administrators, and consumers and even physicians are completely insulated, completely anesthetized as to what the care costs or what it costs to deliver the care. Now, an article or an op-ed from the Wall Street Journal earlier this year by Robert Swerlick, a dermatologist from Emory University, the title of his column was ``Our Soviet Health System.'' He laments the difficulty in finding a pediatric endocrinologist, but in turn it seems so easy to find a veterinarian who specializes in orthopedics for his Labrador Retriever. So he can't find a doctor for his child, but he has no trouble finding one for his canine acquaintance. Now, the reason for that is the administrative pricing system that really is dictated by our Medicare system. And I think Dr. Swerlick really hits the nail on the head. He says, ``The roots of this problem lie in the use of an administrative pricing structure in medicine. The way prices are set in health care already distort the appropriate allocation of efforts and resources in health care today. Unfortunately,'' he goes on to say, ``many of the suggested reforms in our health care system, including various plans for universal care or universal insurance or a single-payer system that various policymakers espouse, rest on the same unsound foundations and will produce more of the same.'' He goes on to say, ``The essential problem is this: The pricing of medical care in this country is either directly or indirectly dictated by Medicare.'' We have a system of Federal price controls in medicine in this country. Again, continuing to quote, ``Rather than independently calculate prices, private insurers in this country almost universally use Medicare prices as a framework to negotiate payments, generally setting payments for services as a percentage of the Medicare fee schedule.'' This is an extremely important point, Mr. Speaker, and one that I don't think Members of this body truly grasp. It is so important, we are going to revisit it again in a minute when we talk about Medicare pricing and what is happening in the physician realm. But remember that, because that is an extremely important point. Medicare administrators set the prices. Private insurance companies in this country tend to follow suit. So when you say we have got a market-based economy in health care, really nothing could be further from the truth. ``And,'' as Dr. Swerlick goes on to say, ``unlike prices set on market conditions, the errors created are not self-correcting. Markets may not get the prices exactly correct all of the time, but they are capable of self-correction, a capacity that has yet to be demonstrated by administrative pricing.'' Again, he goes on to associate this with the system that was in place in the old Soviet Union, and in fact correctly relates some of the problems in the old Soviet economy to the reason the old Soviet Union is not with us any longer. So we really need to pay careful attention to that. Transparency, I think that is something that we talk about a lot, but we don't spend nearly the time focusing on the issue as we should. Transparency between pricing for physicians and hospitals is essential. We want to go to a system where there is more consumer-directed health care, where consumers are more informed. But in order for consumers to be informed, they have to have the ability to go and get the data. Right now, the opacity built into the pricing structure between physicians and hospitals is significant, and, as a consequence, it becomes very, very difficult for the patient, the health care consumer, to be able to make those determinations. The other aspect that enters into it, of course, is the issue of physician quality. Sometimes that is an intangible. Sometimes that is something that is difficult to know just from visiting a Web site or checking data that may be available, and that may be the word of mouth type of information that is delivered from one patient to another. A wait time, for example, in one office that is much longer than in another office, you might be willing to pay a little bit more to wait a little bit less time, or you might be willing to wait a little bit more time if the care delivered in that office is truly exemplary. Now, Texas has taken some steps to make this more of a reality. I think people would like the ability for comparison. In fact, they would like to be able to go on-line for that comparison. I think Travelocity For Health Care, wouldn't that be a powerful tool to put into people's hands. An example in Texas is what is called Texas Price Point. There is a Web site, www.txpricepoint.org, which was created to provide basic demographic quality and charge information on Texas hospitals and to promote additional or ready access to consumer and hospital information and the appropriate interaction that could occur as a result of that. The program is very new. The data sometimes is a little too sparse, but it is a program that will build on itself over time and one that will I think provide significant utility to patients in Texas. And I believe other States have other programs. I think Florida has a program that is up and running. These are going to be critical. Some insurance companies have developed their own programs, and that will provide a critical knowledge base for patients who are covered by those insurance companies. One of the things that is going to affect affordability, even accessibility as far as physicians are concerned, is what I alluded to earlier with the Medicare pricing. Mr. Speaker, we had reported to us from the Center for Medicare and Medicaid Services the first of this month, not even 2 weeks ago, that the proposed physician payment cuts for next year will be just a little bit over 10 percent for doctors across-the-board in this country. That is untenable. Doctors cannot be expected to sustain that type of reduction. There is no telling what it does to a physician's ability to plan. A physician's office, after all, is a small business, and if they are going to be facing this type of price reduction, it is very difficult to plan. Do you hire a new nurse, do you purchase a new piece of equipment, do you take on a new partner, when year over year the Medicare system visits this type of travesty upon physicians? And this Congress, through both Republican majorities and now Democratic majorities, and Democratic majorities that preceded 1994, have refused to deal with this issue in a way that corrects it once and for all and gets us past the problem. The difficulty is that year over year, the physician pricing is set by a formula called the sustainable growth rate formula, and year over year for the past 5 years and projected for 10 years into the future, every year there is a cut to physician reimbursement. Now, you might say that doctors earn enough money and it is the Medicare system, so what harm is there in that? Let's go back for just a moment to Dr. Swerlick's article about administrative pricing. ``Again,'' he said, ``the essential problem is this. The pricing of medical care in this country is either directly or indirectly dictated by Medicare, and Medicare uses an administrative formula, the sustainable growth rate formula, which calculates appropriate prices based upon imperfect estimates and fudge factors. Rather than independently calculate prices, private insurers in this country almost universally use Medicare prices as a framework to negotiate payments, generally setting payments for services as a percentage of the Medicare fee structure.'' So, let's think about that, Mr. Speaker. What happens on January 1 if this House does not take some action to prevent that 10 percent reduction in physician payments? What happens on January 1 is all of those insurance contracts that peg to Medicare reimbursement rates, all of those are going to be reduced by a factor of about 10 percent, or in some cases a little bit more. If a plan pays 120 percent of Medicare and Medicare is reduced 10 percent, that plan will reduce a concomitant amount, which will be a little bit in excess of 10 percent for their pricing on their physician services. Again, it has ripples and effects far beyond, far beyond what it would be affected just by the Medicare system. And it leads to a problem, it leads to a problem of what happens with the physician workforce. Now, just a little over 2 years ago, when Alan Greenspan, the former Chairman of the Federal Reserve Board here in Washington, DC, was retiring and sort of made a tour around the Capitol, sort of a one last victory lap around the Capitol, and came and met with a group of us one morning, the question was inevitably asked, what do we do about Medicare? What do we do about the liabilities, the future liabilities in Medicare? How are we going to meet those obligations? The chairman thought about it for a moment and then said, you know, I think when the time comes, Congress will take the action necessary and that the Medicare system will endure, will be preserved. There may be some difficult choices and trade-offs that have to be made, but Congress at the correct time will make those choices. He stopped for a moment and then went on to say, what concerns me more, is will there be anyone there to deliver the services when you require them? And that really comes to the crux of the matter here. If we have a system within our Medicare reimbursement schedule for physicians where within the whole Medicare system itself, parts A, B, C and D, if only part B is affected by this, part A, which is the hospitals, they have a cost of living adjustment, part C, which is HMOs, they have a cost of living adjustment, part D, which is prescription drugs, they have a cost of living adjustment, if the only ones living under this onerous formula are the physicians, what happens over time? Well, what happens is people will retire early, people will restrict their practices so they no longer see Medicare patients, physicians will restrict the procedures that they offer Medicare patients, perhaps preferring office procedures to surgical procedures that tend to be more labor intensive and time intensive. It certainly has an effect on the law of supply and demand, if you will, as far as physician services are concerned within the Medicare system itself. For that reason, for that reason, it has a significantly pernicious effect on the physician workforce. Remember, I started out this talk and I said we always want to focus on are we delivering value to that doctor-patient interaction in the treatment room? Well, I will submit if you don't have a doctor there for that doctor-patient interaction in the treatment room, it is impossible to deliver value of any sort, if you don't have the physician there in the first place. So that is a critical part. A critical part of establishing and creating value for the patient is ensuring that there is indeed a capable and trained and caring physician there for that patient in the treatment room. And I worry that what we are providing for physician compensation within the Medicare system, which has ramifications throughout the entire private pay structure through the health care system, I do worry if that is a condition that can indeed be sustained. Now, one of the other things that I think we oftentime lose sight of when we talk about affordability, we always talk about the number of uninsured that exist in this country. Sure enough, it is too big a number. The number varies, depending upon who you read. But if we talk about the number today, we are probably going to talk about a number of around 47 million uninsured. And we always stop there and say, well, we have to do something about the 47 million who are uninsured, as if that was one homogenous population and one solution would work for everyone who is caught up in that category. But the reality is, one of the large insurance companies in this country did a little investigating to see who makes up, who is involved in this population, this universe of people who are uninsured. It turns out 10 percent are university students. If you say we have 47 or 48 million people uninsured, 10 percent of that is 4.8 million, nearly 5 million, are university students. Students who may arguably have health coverage available through their university or college. But even if they don't, this is a group of people that is pretty easy to insure. It is pretty inexpensive to insure. So a solution for that group would be vastly different than some of the other groups identified. Twenty percent of that population is already eligible for Medicaid or the State Children's Health Insurance Program. Why States with outreach efforts have not identified those individuals, I don't know. Perhaps we ought to make it incumbent for States to do that work. If we are providing Federal funds at all sorts of levels, maybe we ought to make it incumbent on States to do that outreach work so those individuals are enrolled in Federal programs to provide that. Again, think about it: 20 percent of 47 or 48 million people, that is almost 10 million people that could be taken off the rolls of the uninsured tomorrow because the programs already exist to take care of them. You don't need to create a new program or do something different from what you are doing right now. Current Medicaid, current SCHIP will cover 20 percent of that population. And 20 percent earn almost $80,000 a year. That is not a huge sum of money, but certainly a group of people that might be considered to be able to provide something toward their own health care. I am not a fan of mandates. I don't think you get anywhere by telling people what they have to do. But if we allow insurance companies some freedom to create the types of programs that would be of value to that segment of the population, that would be affordable to that segment of the population, if we would perhaps remove some restrictions, maybe remove some mandates, or decide what are those things that are going to comprise a basic package of benefits so we can make it affordable and marketable to that group of individuals who arguably have some disposable income that they could use towards their health care rather than creating a huge, new Federal structure to bring them in. Maybe that is a tactic that could be taken. Mr. Speaker, we don't like to focus a lot of time and energy on this, but we have to talk about it, and that is 20 percent of the people who fall into the category of the universe of uninsured people in this country are individuals who are in the country without the benefit of a Social Security number. Again, that is something that we as a country and we as a Congress do need to deal with. Whether that is increased efforts at controlling who is coming into our country and increased efforts at controlling our borders, but this is part of the problem that we as a Congress have yet to really face and deal with. We made some efforts, to be sure, in the current State Children's Health Insurance Program. One of the recent legislative proposals that came through Congress and was passed by Congress that is still tied up in negotiations wanted to relax the verification required for someone being able to document or verify that they are in this country legally. I don't know. I think this body needs to decide what direction it wants to go on this. I don't know that is a terribly useful activity from my perspective. It might engender more people wanting to come into this country to get benefits, but that is something that this Congress has to take up and face no matter how difficult it is. Mr. Speaker, we have talked about 10 percent university students, 20 percent already eligible for Medicaid or SCHIP, 20 percent who earn nearly $80,000 a year and 20 percent who are noncitizens. If we add those all together, that is approximately, 10, 20, 30, plus 5, so 35 million out of 47 million uninsured. We may have some solutions that are really just at our fingertips if we would expend a little bit of effort. And this is very frustrating to me. We never seem to want to do the effort to break down who is included in the population. We are all too content to take the number 47 million uninsured and use it as a political bludgeon to beat each other over the head, but we are never willing to do the work that a private insurance company did in a relatively short period of time. We never seem to be willing to do the work. With all of our Federal agencies and bureaus that count numbers and people, we never seem to be able or willing to do the work to get this number, break it down into the smaller subsets, the smaller populations where, in fact, we may be able to provide some significant benefit. Now, one of the things that I think we do need to talk about is on the aspect of accountability. First off, in any system that we talk about devising or implementing, we surely have to keep freedom of choice. We want to see the doctors we want to see when we want to see them. When hospitalization is required, freedom of choice has to remain central. One of the things that oftentimes gets lost in the discussion when you look at the breakdown of how health care expenditures occurs in this country, approximately half is paid for by the Federal Government. When you look at the Medicare and Medicaid programs, we heard some discussion of the HHS appropriations bill, $680 billion, almost $700 billion spent by this country every year by Medicaid and Medicare. Add to that the money spent in the veterans health service and add to that the money spent in the Indian health service and add to that the money spent in the Federal prison system, and you come pretty close to 50 cents out of every health care dollar that is spent in this country has its origin here on the floor of this Congress. So that is a pretty big chunk that comes from the Federal Government already. The other half is not entirely private insurance, but certainly there is a large portion accounted by private or commercial insurance in this country. A portion, a portion is paid for by the patient out of their pocket. I would include the growing number of people who are covered by health savings accounts in this group. Health savings accounts being a high-deductible insurance policy where a person is able to accumulate dollars, pre-tax dollars in a savings account dedicated to their health care. Those dollars are owned by the individual. They are dollars that would, if something happened to the individual, they would stay in the family. They don't go back to the Federal Government like Social Security. These are dollars that would stay around and be there to help your family. They would be there to help someone when they transition into the Medicare system. Mr. Speaker, I had a medical savings account back in the 1990s when I was in the private practice of medicine back in Texas. I thought it was a great thing, not so much because of the money I was accumulating in this medical IRA. I thought it was a great thing because that was the time when HMOs were making big inroads into our medical practice in north Texas, and I liked the idea of being in charge of my health care decisions because I owned my own health insurance policy. As an individual policy, I felt I had much more power over what decisions were made for my health care and my family's health care. So the whole concept of ownership, owning that medical IRA and being allowed to accumulate those savings to offset future medical expenses, that is a fundamental desire of many Americans. And I think that is a desire that should be encouraged and embellished. Why not be able to accumulate a few dollars dedicated toward your future health care needs? That is a pretty powerful tool to put into people's hands. Again, for me the issue was being able to be in charge of my own health care, that individual freedom that comes with increased sovereignty. That was critical for me when I went out and looked for a medical savings account when they were first offered back in 1996 or 1997. Certainly, Mr. Speaker, whenever we talk about accountability within the health care system, independence of the patient, the patient as an independent agent is something that must be preserved. That preservation of autonomy for the patient or the patient's designee if a medical power of attorney is exercised, but that is who should be responsible for the care, to be able to accept care, to be able to decline care if a particular medical intervention is either sought or someone wishes to not participate in the medical intervention that is offered. That is a fundamental right that we really should not take away from people. Advancements within the system. Again, the science of our medicine here in the United States is superior to that anywhere else in the world. You might say that our system of allocation or delivery system needs work, but no one can argue about the science that is present in the medical system in this country. So, high standards. We want to keep those high standards. The underpinnings of the American medical system has always been that we have high standards and we enforce standards of excellence, and nothing in the future should change that or undermine that. In fact, pathways to facilitate future growth in excellence should be encouraged. When you talk about expanding the role of the Federal Government in health care, you look at some other places where the Federal Government has a really big footprint, like our Social Security system, or the IRS. Are those systems administered with the highest standard? Or is it lowest common denominator? That is certainly a question worth asking before we increase that segment that is taken over by the Federal Government. As far as innovative approaches, American medicine has always been characterized by embracing innovation, developing new technologies and treatments. The transformational times we have had in medicine in the last century, development of anesthesia and blood banking in the 1910- 1920 time frame, development of large-scale production of antibiotics and anti-inflammatory agents in the 1940s, the development of antipsychotic and antidepressant medications in the 1960s, development of newer hypertensive agents in the 1960s, the beginning of the development of medicines or the recognition that elevated cholesterol levels could lead to disease, and the beginning of medicines that would begin to impact that in the 1960s, all of those transformational events. And during those same times, in the 1910 to 1920 time frame, you had a congressional investigation or commission to investigate the vast discrepancy between curricula in medical schools in one part of the country versus another, and the standardization of medical school curricula which was so critical for establishing that knowledge base of science that was going to carry us forward through the last century. In the 1940s, you are the introduction of employer-based insurance because of a reaction to wage and price controls that were in existence in the 1940s. And finally in the 1960s, you had the interjection of Medicare and Medicaid, for the first time the Federal Government having a big footprint in paying for health care. So all of those transformational times were where the science changed rapidly and the public policy changed rapidly. I think we are on the cusp of such a time right now. Things are going to be changing in the realm of the whole arena of personalized medicine. The threshold of that stretches just before us. The whole concept of far earlier prevention than anyone has thought possible. We have all heard that an ounce of prevention is worth a pound of cure. Well, we are going to get to use those ounces of prevention because of the studies and work that has gone on with studying the human genome and the whole phenomenon of genomic medicine. We are going to be able to get that ounce of prevention administered so much earlier. So we will get the equity from that pound of cure in so many ways that really we can't even fathom them at this point. What is critical is that this Congress not get caught up in the transactional, not always get caught up in the insurance and the Medicaid and the Medicare. Don't be so caught up in the transactional that you block the transformational because that is the real tragedy. That is the real difficulty. That is the real danger to the generations for a decade from now, two decades from now, three decades from now. That is why this Congress needs to be so focused on this issue. That is why all of us on both sides of the aisle need to make ourselves students of health care policy. We need to find out as much as we possibly can about it. We need to come to this floor every day and every night prepared to debate this on the merits and science. Leave the politics on the side. This is one of those issues that is too important to leave to politics.

Mr. BURGESS

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

Mr. BURGESS

Mr. BURGESS. This evening I come to the floor to talk about a growing and disturbing trend of food and consumer product safety recalls, and this danger is very real. The danger has been widely documented and discussed in the media. It's been widely documented and discussed in committee hearings, in our committee, the Committee on Energy and Commerce, discussed around the water cooler at work, kitchen tables around the country, and almost nightly on the ``Lou Dobbs Show.'' And what does this mean, recall after recall after recall all summer long? What does this mean for average Americans? It means that parents are afraid that their children are playing with lead-contaminated train sets. It means that parents are afraid that magnets or toys and charms may cause internal damage if their child accidentally swallows them. It means that families are afraid that the food they feed their pets may actually have plastic in it. It means that people are afraid that their toothpaste may contain antifreeze. It means that people are afraid that the fish they serve to their families may contain dangerous levels of antibiotics. It is seemingly without end, and people are afraid about the source of their products and the dangers, and rightfully so. People are afraid. They're afraid of the defective products being imported into our country. And, Mr. Speaker, it seems like almost all of the trouble focuses around a single country, the People's Republic of China. Consumer health and well-being are endangered on two fronts: the food we eat, the goods we use. I want to use some of my time to discuss both fronts and what we in Congress are doing and should be doing to protect American families from harmful products. First, considering the issue of consumer product safety recalls, it seems like the Nation has turned its attention on to this issue. Every time you turn on the TV, you open a newspaper, you learn about yet another consumer product safety recall. People are generally concerned about the issue of recalls; and many people, myself included, are concerned about the source of the recalls since it appears that the majority of the recalls are coming from the People's Republic of China. Just last night, nine new recalls alone were announced, including recalled products that had lead-contaminated paint on their toys. As a parent, as a physician, one recall was extremely disturbing. According to the U.S. Consumer Product Safety Commission, an e-mail notification that I received last night read: ``Spin Master Recalls Aqua Dots-- Children Became Unconscious After Swallowing the Beads.'' It's a pretty innocent looking toy, and if my kids were little, I'm sure they would have loved this toy. It looks innocent. But this product is truly a wolf in sheep's clothing. And the recall notification, I encourage everyone to sign up for the notification at www.cpsc.gov, the Web site listed the injuries caused by these beads. And I quote: ``The Consumer Product Safety Commission has received two reports over the last several days of children swallowing Aqua Dots. A 20-month-old child swallowed several dozen beads, he became dizzy, vomited several times before slipping into a comatose state for a period of time, was hospitalized, and has since recovered. A second child also vomited and slipped into a comatose state and was hospitalized for 5 days.'' This morning it was reported in the Dallas Morning News, my local newspaper, and other news outlets, that Aqua Dots were linked to rohypnol. Now, you may have heard of rohypnol in the past. Rohypnol gained some notoriety as the ``date rape'' drug. And according to ABC news, scientists say a chemical coating on the beads, when ingested, metabolizes rohypnol, the so-called date rape drug, gamma hydroxy butyrate, GHB. When eaten, the compound made from common and easily available ingredients can induce unconsciousness, seizures, drowsiness, coma and death. While it is not yet clear how this chemical wound up in a child's product, it is clear where it was made: in the People's Republic of China. In fact, eight out of the nine recalled products announced just last night were from China. The other recalled product was from Mexico. Mr. Speaker, Christmas is coming. Christmas lights, Christmas sounds, Christmas music, Christmas shopping. I cannot help but think there would be a huge market for a ``Made in America'' label on the toys and goods parents and consumers are out looking for this Christmas season. I encourage retailers to stock as many ``Made in America'' products as they can. You might even make it in Texas and put a little Texas flag on there. I bet that would be a big seller. The majority of the products that are being recalled this year were made in China. And, Mr. Speaker, quite honestly, I've made a decision. I'm treating that ``Made in China'' label as a warning label, and I've made a personal decision to try not to buy anything made in China, although it's extremely hard given the penetration that Chinese goods have in our consumer markets. Given all the circumstances, it seems like the right thing to do, the safe thing to do for my family. I feel certain that other American families have made similar decisions. In fact, Mr. Speaker, I bet the Lou Dobbs family is one of those families. Now, this concern about imported products is real and has been substantiated with real data. The United States Consumer Product Safety Commission, which is tasked with the job of trying to safeguard our society from unreasonable risk of injury and death associated with consumer products, informed me that in fiscal year 2007, a record- breaking 472 consumer products were recalled for safety reasons. Of the 472 recalls, 60 percent were manufactured in the People's Republic of China. Mr. Speaker, 60 percent of all recalled products this past year were imported from China. Furthermore, of the 472 total consumer product recalls, 61 of those recalls affected our children, our most innocent and vulnerable members of society. Sixty-one consumer products were toys. And how many of those products were manufactured in the Republic of China, you might ask? Well, I'm glad you asked, Mr. Speaker, because that figure is even more staggering. The United States Consumer Product Safety Commission estimated that over 90 percent of the toy recalls were made in China. So I guess we really shouldn't have been too surprised last night when eight out of the nine listed recalls were manufactured in China. This is now clearly becoming a common business practice, part of the business model for Chinese toys. Now, Mr. Speaker, I'm just a simple country doctor, and I don't pretend to understand everything that goes on up here in Washington; but I am asking what we in Washington can do to help Americans protect themselves and their families. Let's look at just a few of the product recalls from the month of October. For the safety of our families, we've got to get to the bottom of the cause behind all of these recalls. I am on the Commerce Trade and Consumer Protection Subcommittee, which has jurisdiction over this issue; and our committee is investigating and working on the problem. And over the next several weeks, we're going to be working on additional legislation on the issue. We have passed several bills recently dealing with specific issues of consumer product safety. We passed a bill dealing with the safety of swimming pools, and a bill that I was actually able to amend to include ornamental pools, since an ornamental pool had claimed four lives in one of my home cities in Fort Worth, Texas. The House Energy and Commerce Committee introduced bipartisan legislation last week that will strengthen the consumer product safety system in this country, H.R. 4040. For those keeping score at home, H.R. 4040, the Consumer Product Safety Modernization Act, along with 50 Members, original cosponsors of this legislation. The legislation was introduced in the Commerce Trade and Consumer Protection Subcommittee, and we had a hearing on the bill. And we have been promised that it will go through regular order, and all Members will have an opportunity to actually comment and amend the bill as it goes through subcommittee process and the full committee process. This is the way, Mr. Speaker, it should always be, the way that we formulate and work on legislation. I certainly thank the leadership of the House Energy and Commerce Committee for being committed to the legislative process. How refreshing after the donnybrook we saw with the State Children's Health Insurance Program this summer. The House version is a bipartisan effort, and I commend Chairman Dingell and I commend Ranking Member Barton for their leadership in getting this bill through the committee. I would also like to commend the U.S. Consumer Product Safety Commission Commissioner, Chairwoman Nancy Nord, for her honest assistance for the bill. We asked for technical assistance and constructive criticism, and it was provided to us. The other Chamber asked for the same assistance with their bill, and she provided the same honesty. And for going to the trouble of providing that same honesty, she was, I think, unjustly criticized. The difference was that some of the Members of that Chamber and of our own Chamber didn't like her answers, so they called for her resignation. Unlike those Members, I appreciate and I welcome the candor of the chairwoman. Because Chairwoman Nord wasn't afraid to speak the truth about her own agency's needs, the House has been able to do what the Senate was not, craft legislation that will give the commissioner real tools needed to keep Americans safe from unreasonable dangers and consumer products. Now, a week ago, the Speaker of the House held a press conference and called for the resignation of Chairwoman Nord simply for speaking her mind, exercising her free speech rights. In my opinion, this criticism was a disgrace to this body and an embarrassment to the legislative process. I often feel that an imperial speakership that likes to govern by edict really has no place in this House. But Chairwoman Nord withstood the criticism and stood in the eye of the storm. Former Prime Minister Tony Blair once said the art of leadership is sometimes saying no. It's easy to say yes, and sometimes you just have to say no. Chairwoman Nord was a true leader and was able to say no to legislation that she knew would be harmful to the country. There are times we need leaders like that. Now, turning back to H.R. 4040, the Consumer Product Safety Modernization Act, there are a lot of topics, there are a lot of issues on the table, including enhancing the commissioner's recall authority. And I firmly believe we've got to improve the U.S. Product Safety Commission's ability to notify consumers about dangerous products more quickly and on a broader scope. I'm concerned that there is a large universe of people and associations that are not receiving the information about product recalls in a timely manner. As we all know, products are recalled because they have been found to have an element of danger, otherwise the recall wouldn't take place. The danger is to the consumer, and they need to be immediately discarded. Now, nonprofits, like Salvation Army, Good Will, Christian Community Action, located in my home county of Denton County, they provide invaluable resources to the communities that they serve. And often these nonprofits run secondhand retail shops to additionally help some of the neediest members of society. But I have been informed, when I've questioned the nonprofits in my area, that, through no fault of their own, they're unaware of many of the recalls when they occur. Therefore, the fear is that they may inadvertently sell recalled products to families and individuals. So I'm currently working with the Consumer Product Safety Commission to try to close that gap. I'm also working with the Consumer Product Safety Commission on another idea, and we'll talk in more detail in just a little bit, but I introduced legislation dealing with food imports that will give the Food and Drug Administration a big red button to push to be able to stop dangerous foods from entering the country. At our hearing this week, I asked Chairwoman Nord if she had the same authority that my bill would give the FDA, did she have the same authority for the Consumer Product Safety Commission, and the answer was no. So over the next couple of weeks I'm going to be working with the commission and the commissioner to incorporate that idea into the bill as it goes through the regular committee process. While we continue to try to close the gap through legislation, I strongly encourage Members of Congress to sign up for product recall alerts. Mr. Speaker, I know we don't address the C Span audience directly in their living rooms but if I could address the C Span audience in their living room I would encourage them to go to the Consumer Product Safety Commission website and sign up for the product recall alerts. It is free. It is easy. And it can save lives. If you have access to an e- mail account and to the Internet, all you have to do is simply go to the website, go to the U.S. Consumer Product Safety Commission's home page, which is www.cpsc.gov, Consumer Product Safety Commission, go to their website and they will direct you how to sign up for free recall and safety news. The website again, www.cpsc.gov. The Consumer Product Safety Commission also has a Neighborhood Safety Network which is for organizations, civic-minded individuals, to help disseminate information about recalls and posters to members of society who may not be aware of the recalls. Mr. Speaker, do you know what? This type of education can save lives. Unfortunately, though, certain groups of Americans, the elderly, urban and rural low-income families, some minority groups often don't hear about the safety messages from the government. So some additional outreach is needed. And it is critical, because when people go to yard sales, when people go to garage sales, when people go to Internet resellers, they need the ability to have this information and discern whether or not a product is on the recall list and is in fact unsafe for them to bring in their homes. So, Mr. Speaker, although rules of the House do not permit me to address people directly, but if I could, I would ask that they help make their community safer by getting the word out, getting the word out about recalls. I am a member of the Neighborhood Safety Network, and we will disseminate information about the recalls vie my website, www.house.gov/burgess. Let's talk a little bit, in the time remaining, about food safety because that is an issue that is critical. And again it is in the news. Has there been any attention at all paid by the United States Congress to the food we eat? Well, again, I am glad you asked because there has been a lot of attention paid in Congress regarding the safety of the food we eat. On the Energy and Commerce Committee, we are pursuing an aggressive investigation, and then we will move on to subsequent legislation, to try to correct this problem. As a member of the Oversight and Investigation Subcommittee, we have taken an active role in investigating the safety of our Nation's food supply. In August, a bipartisan team of investigators was sent by our committee to China to see, first-hand if they could delineate some of the causes of the problem. In the committee staff report, the investigators came to the following conclusions about their trip and their investigation thus far. Quoting directly from the staff report, ``Number one, it would appear that the Chinese food supply chain does not meet international safety standards. In fact, it is responsible for very serious domestic Chinese food poisoning outbreaks. ``Number 2, the Chinese Government appears determined to avoid embarrassing food safety outbreaks in exports markets due to the damaging and potentially lasting effect this would have upon their `Made in China' branding.'' It seems like that has happened any way. ``Number 3, the lack of meaningful internal regulation of farming and food processing in China, the advanced development of the document counterfeiting industry, and the willingness of some entrepreneurs in both China and the United States to smuggle foodstuffs that do not meet quality standards, necessitates a much more vigorous program of inspection and laboratory testing in China and in this country and at the U.S. ports of entry than the Food and Drug Administration has been able or willing to pursue to date.'' Now, Mr. Speaker, these are important conclusions, and yes we must not simply watch the problem worsen. We must be willing to handle the problem head on and transform the Food and Drug Administration into an agency that can fully cope with the importation problems of the 21st century. The Energy and Commerce Committee is doing their part to do just that. In addition to the staff trips to China, we are in the middle of a series of five hearings to discuss the topic, can the FDA, can the Food and Drug Administration assure the safety and security of our Nation's food supply? What have we learned so far? Well, let's recapitulate. At the hearing on July 17, 2007, on this very topic, former FDA Associate Commissioner William Hubbard testified that in 1999, the Food and Drug Administration drafted a legislative proposal which would have given the Food and Drug Administration the authority to require foreign countries to take more responsibility for the food that they send to the United States. The agency's proposal would have allowed the Food and Drug Administration to embargo a given food from a given country if there were repeated instances of food being found contaminated when it arrived in the United States. Well, that seems pretty simple, to embargo a given food from a given country if there were repeated instances of that food being found contaminated when it arrived in our country, when it arrived in the United States. Countries that sent safe food have no reason to be concerned. They would be unaffected. But countries that demonstrated a pattern of disregard for United States law and safety standards are going to have to increase their oversight of food exported from their country. Now, unfortunately, Congress did not accept this recommendation in 1999. And the situation with imported foods has gone from bad to worse to simply awful. Congress now has a chance to examine the problem and consider recommendations on how to solve the problem. Mr. Speaker, the world was a different place in 1999. It was difficult to anticipate the acceleration of foreign products, how rapidly the acceleration of foreign products coming into our country would occur. Was the safety of food products from foreign countries not a priority for Congress back in 1999? Well, I am sure it was but not nearly as much as it should have been. Why we have allowed this problem to persist when we know how much harm these unsafe products have the potential to cause? We may not be able to answer that question, but as I stand here tonight, I will tell you, it is absolutely a priority of mine, and I hope a priority of my committees that we intend to do something about it. On October 11, the Energy and Committee Subcommittee on Oversight and Investigations held the third part of a five-part series of hearings on the Food and Drug Administration's ability to assure the safety and security of our Nation's food supply. According to testimony given by Mr. David Nelson, the senior investigator for the Energy and Commerce Committee, currently the Food and Drug Administration does not go over and see if the products that are produced in China are done so under the same standards that we expect those products to be produced in the United States. These are the products that are produced in China and then sent over here for consumption, the products that Americans will be consuming, and they're not produced under American standards. The ranking member of our subcommittee, Ed Whitfield from Kentucky, asked Mr. Nelson that, if he were speaking to a group and a member of the audience raised their hand and asked how safe is it for consumers to consume the products produced in China, he said, ``Well, you're taking your chances on any imported food from China.'' Well, we can't act like that. America has to have the authority to prohibit these foods from coming into our country if they're not safe. We have to be able to stop those foods on which our consumers would be taking a chance. It's not worth it. Chairman Dingell, the full committee chairman, asked Mr. Nelson whether or not the Food and Drug Administration can protect the United States citizen from unsafe imports with the resources that they currently have. His answer: ``That would be an emphatic no.'' Not just ``no'' but an emphatic ``no.'' When I got my chance to question, I asked him while they were over in China, they were there for several days, perhaps a couple of weeks, did they have occasion to eat anything. And he smiled and said, yes, they did. I said, Were you worried at all? And he said, yes, he was. Fortunately our committee staff weathered that, put themselves in harm's way and they weathered that trip okay, although I think some of them did get a little ill, no one got severely ill, which is actually fortunate. We had a witness come before the committee and during my questioning of Mr. James Rice, the Vice President and Country Manager of Tyson Food in China, he was just talking about the problem, I said, Do you look for problems? In your policies and procedures while you're in country in China, does it cause you to look for problems from Chinese suppliers? And he said, of course it does. And I said, Do you ever find a problem with a Chinese supplier? He said, oh, yeah, we sure do. So when you find a problem with a Chinese supplier, do you get on the phone and do you call other companies that are over there working in businesses like yours? Do you kind of send out a little e-mail alert, hey, watch out for this supplier, he has some really bad chicken wings coming your way? And the answer was, no, we don't do that. He explained to me that because Tyson was using local Chinese suppliers and the products were mostly for the Chinese market, they didn't feel that it was necessary to do that. So in essence there would be no dialogue whatsoever. Mr. Rice told me that if there were persistent problems from one supplier, no one would alert the others to this problematic supplier and, probably more frighteningly, they wouldn't pick up the phone and call the local Food and Drug Administration inspectors that were in country and were responsible for assuring the safety of products that are going to be shipped into this country. There is no system in place to let other suppliers or, indeed, the Food and Drug Administration itself know that someone is significantly misbehaving, that someone is behaving in a criminal manner. That's a serious, serious problem. Mr. Speaker, it was important that I introduce legislation that relates to this 1999 proposal and H.R. 3967, the Imported Food Safety Act, was introduced a few weeks ago. And I firmly believe, firmly believe that the FDA needs the ability and the explicit authority to immediately stop dangerous foods and products from coming into this country. It's a pretty simple concept. Think of it like this. You got all this stuff, all this food coming into this country on a big giant conveyor belt. And when the FDA finds a bad apple on that belt, they need to be able to push a big red button that says Stop on it and immediately stop that bad apple from continuing into the line of commerce in this country. The legislation that I introduced would give the Food and Drug Administration a big red button to push that would stop the food from coming into this country. The idea is so simple that I don't understand why it hasn't been enacted previously. If this is enacted, the Food and Drug Administration would have the authority to embargo a specific food from a specific country if there were episodes of repetitive violation of United States food safety standards or if the food was found to be contaminated. Quite frankly, we've got to be able to stop countries from sending harmful food products into the United States. So H.R. 3967 will allow us to finally take control of the food that is being sent to America. And, Mr. Speaker, it would send a pretty strong message to countries that in the past have sent harmful products to the United States: Solve the problem on your end because we mean business on our end. After a summer of recall upon recall upon recall, it is time. It is time that Congress take this matter into its own hands. I for one am no longer going to tolerate hearing a different news story every night about a new and dangerous product coming into our country from the People's Republic of China. The Health Subcommittee of which I am also a member had a legislative hearing on September 26 regarding Chairman Dingell's bill, H.R. 3610. Having reviewed this legislation, I think the intentions are good and I look forward to working with the chairman on this issue. Clearly I don't support every provision but I do support the spirit of the proposed legislation. I believe we need to look toward how other Federal agencies have dealt with this issue and whether or not it would be appropriate to give the Food and Drug Administration similar authorities. According to the Government Accountability Office, 15 Federal agencies collectively administer 30 different laws related to food safety. The Food and Drug Administration, which is part of the United States Department of Health and Human Services, and the Food Safety and Inspection Service, which is part of the United States Department of Agriculture, together comprise the majority of both the total funding and the total staffing of the government's food safety regulatory system. However, food safety laws vary greatly from agency to agency and not all foods are treated equally. For instance, the United States Department of Agriculture, which has jurisdiction over meat, poultry and eggs, has an established equivalency determination standard for those foods. What is equivalency, you might ask? I'm glad you did ask. On October 11 at the third Oversight and Investigation hearing on the FDA's ability to assure the safety and security of our Nation's food supply, the Undersecretary for Food Safety at the United States Department of Agriculture, Dr. Richard Raymond, gave the following definition: ``Equivalency is the foundation of our system of imports. It recognizes that an exporting country can provide an appropriate level of food safety, even if those measures are different from those applied here at home. The Food Safety and Inspection Service has always required an assessment of foreign inspection systems before those nations can export their products to the United States. This prior review is mandated by our laws, which originally required that a foreign system be `equal to' our system before the foreign product can be admitted.'' He further went on to state, ``An exporting country has the burden of proving that its system is equivalent to our system if that country wishes to export that product to the United States.'' Now I understand, I understand that applying this system of equivalency that is currently employed by the United States Department of Agriculture, implying that more stringent requirement to the Food and Drug Administration, which, in fairness, has about an 80 percent jurisdiction of all food compared to the roughly 20 percent of the United States Department of Agriculture, that is going to be hard. That is going to be difficult. Currently, only 33 countries are eligible to ship meat and/or poultry products to the United States. If the exact standard that the United States Department of Agriculture employs was used by the Food and Drug Administration, it would drastically change and some people would even say it would cripple the food import system if, if there were not enough resources to support it. That's why the resource aspect, the staffing aspect becomes so critical. Mr. Speaker, former Speaker Newt Gingrich in his book on Transformation lists as his second principle of transformation: Real change requires real change. This is a time for real change. This system should be drastically altered. Consider this: In 2005, 15 percent of the overall volume of U.S. food consumption was imported. Between 1996 and 2006, the amount of U.S. imports of agriculture and seafood products from all countries increased by 42 percent. In the last decade, the volume of FDA regulated imports has tripled. Chinese imports to the United States have increased more rapidly than the global average, and between the years of 1996 to 2006 the volume of import of Chinese agriculture and seafood products increased by 346 percent. China is now the third largest exporter of agriculture and seafood products to the United States, only behind our neighbor to the north and our neighbor to the south. So perhaps our food import system should, should undergo real change. It should undergo significant change. The Food and Drug Administration was created in a time when we were still domestically growing the majority of our foods here in this country. We have got real issues here at home to deal with regarding our food regulatory system, but at least we have a regulatory system here in this country to deal with the problem. This is not the case for all the countries from which we receive food. It seems that it would be common sense that we would only import food from a country if they can prove that their products are as safe as ours. Yet, only the United States Department of Agriculture can require this. Let's think about this for a minute: USDA, 20 percent; FDA, 80 percent stringent controls on the 20 percent far less stringent controls on the 80 percent. Kind of seems like an imbalance, Mr. Speaker. Now it seems to me to be very arbitrary that the system the United States Department of Agriculture can employ is so much tougher than what the Food and Drug Administration can employ. At the end of the day the American consumer doesn't know whether that food has been checked and regulated by USDA or FDA. The final common pathway, the end target is the kitchen table. When it goes from farm to fork, people don't consider what regulatory agency has had jurisdiction over that food, especially if it came from another country. We don't discriminate as Americans about the food, where it comes from and which agency has the regulatory control over that food. You know, it's almost a little curious that Congress does. Congress set forth dual standards and Congress must have a candid conversation and discussion with itself on whether or not we need to make these two systems, the United States Department of Agriculture 20 percent, Food and Drug Administration, 80 percent, whether or not we need to make those two jurisdictions perhaps more comparable. Now Chairman Dingell's food safety bill is tentatively scheduled to be marked up at both the subcommittee level and the full committee level later this month. I don't know if we will have time. I hope we are able to do it before the end of the year, but the legislative year is rapidly passing us by with each successive day and I hope that we can get that work done because I think it is critically important. It's my goal to encourage this frank conversation at the committee level, and hopefully Members on both sides of the dais will continue to have input on this critically important issue. As we all know, this system, our system works best, and we have the most effective legislation if our bills are allowed to go through the normal process, if they are allowed to go through regular order. I implore the leadership, implore the leadership to allow this important piece of legislation to go through the normal process. Don't rush it through, don't jam it through. We saw what happened to the State Children's Health Insurance Program when that process was circumvented. Did we save any time delivering a State Children's Health Insurance Program to the children of America by jamming it through at the end of July and jamming it through in September and trying to jam it through in the early part of October? No. We didn't save any time. We are now 2 months passed the time that we should have reauthorized that legislation and, quite frankly, no resolution is in sight. That is no way to run an airline, that is no way to run the United States Congress. I implore the leadership, let's stick to the regular legislative process and let this legislation work its way through the committee. Let it be improved by the committee. There's some of the best and brightest minds in the United States Congress that sit on both sides of the dais on the Energy and Commerce Committee. Some of the biggest brain firepower in this Congress sits on that committee. Don't circumvent the committee process, don't cut them out of the process. You don't serve the American peoples' interests when you do that, you don't serve congressional interests when you do that. Quite frankly, leadership does itself a huge disservice when it continues to do that. You're not scoring points politically and certainly not scoring points with the American people. So let's not allow the issue of protecting our families from harmful and dangerous goods coming in from other countries to become a debate of one political party versus the other. It's something that I am certain holds resonance in the minds of us all. Realistically, we do our best work when we work together, and that is that the American people realistically sent us here to do. We need to work together effectively, solve this crisis now. It ought to be a priority for everyone in this body, regardless of their political party. Just this week the President's working group on Import Safety presented their proposal to both the President and Congress. I wish the working group had been able to get their proposal together at a little bit earlier date, but better late than never. I do believe they have presented many sound policies, many sound ideas, and we should incorporate some of these ideas when we are formulating our own legislation. I am still reviewing that group's findings. They are certainly voluminous, and have recently come to us. I was pleased to read that they would also like to see a legislative proposal that could give the Food and Drug Administration additional authority for preventive controls for high risk foods from high risk countries. If you would like to read their proposal for yourself, I encourage you to visit their website at www.importsafety.gov. Mr. Speaker, you might ask, is there a dark side, is there a downside to all of this that we have been talking about tonight? Of course, the answer to that is yes. We always, we always in this Congress, have to be cautious about crossing the line and approaching or pushing that ever-expanding reach and grasp of the Federal Government in places it doesn't belong. But, you know, that is one of the basic activities that Americans expect out of their Federal Government, and that is to ensure the safety of the food supply and ensure the safety of the products that come into this country from other countries. The last thing we want is for the Federal Government to control every little aspect of things that we pick up off our grocers' and stores' shelves, but it is a balancing act, as always, and we have to be always vigilant and be always cognizant of that fact. We also must be vigilant in restoring safety and trust back into the foods we eat and the products we use. I believe that H.R. 3967, the Food Import and Safety Improvement Act of 2007, will further that goal, will further that purpose, as will the enhanced recall authority for the United States Consumer Product Safety Commission that we talked about a little earlier tonight. Compromising the safety of the foods that we put on our tables must not ever be an option for this Congress. Compromising the consumer products that we buy for our families must never be an option, must never be an optional activity, for this Congress. Compromising the security of Americans cannot be an option. Compromising cannot be an option because we simply lack the power or lack the political will to exercise that power. Remember the big red stop button. H.R. 3967 gives us the power to protect Americans by stopping things before they get into this country. We can no longer sit back and continue to allow harmful products to reach our homes. All Americans, all Americans, and I include myself, have the choice to take a stance individually and simply not buy products that come from a country that serially violates our safety standards. And we have talked about that country several times tonight, the People's Republic of China, because they have not proven that their products are safe, and, over and over again, we hear and see the news reports that their products are not safe. But we have got to go further than that. Stricter rules are necessary. It is up to this Congress, it is up to this Congress, to step up, take the necessary legislative activities under their control, and do what is right for the American people. Mr. Speaker, you have been very indulgent, and I yield back the balance of my time.

Mr. BURGESS

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

Mr. BURGESS

Mr. BURGESS. Madam Speaker, I rise today to honor one of the churches in my district, Trietsch Memorial United Methodist Church in Flower Mound, Texas, which will hold a Veterans Memorial Plaza Dedication on Sunday, November 11, 2007. A group of members from the church once envisioned a place to honor friends and family members that have served their country in the armed services as well as veterans from their community. Now, thanks to their hard work and commitment, that vision will soon become a reality. The design of the Memorial is a lasting tribute to veterans' achievements and sacrifices on behalf of their grateful communities. The beautiful centerpiece is an obelisk surrounded by flags representing the United States, the State of Texas, and the Armed Forces. The Memorial serves as a place of prayer for peace, and as a symbol of eternal hope for all of the men and women who continue to serve and sacrifice. It recognizes the innumerable accomplishments of our military and forever commemorates their endeavors as servants of our great nation and also the State of Texas. The Veterans Memorial Plaza is an accomplishment that I and everyone in the 26th District of Texas can look upon with pride. I offer my congratulations to Reverends Jim Ozier, John Allen and the members of Trietsch Memorial United Methodist Church. It is my honor to represent them in Congress.

Mr. BURGESS

Mr. BURGESS. Mr. Speaker, I come to the floor tonight to talk a little bit about health care. Of course, we are enmeshed in the great State Children's Health Insurance Program debate here this week, that load having been taken by the Senate at the end of last week, the bill being sent off to the President, we expect a veto, and probably sometime before this week is over, we will, one more time, test whether or not that veto will be overridden or sustained. I suspect the numbers will not have changed from the last time when the veto was sustained. So we are going to continue to have this debate in front of us for some time. I do want to talk about the State Children's Health Insurance Program in some detail. But I want to put it in context. I want to put it in the context of what is happening in American medicine today, the transformational process that is going on in American medicine today and how those rapid advances in science are being affected by the policies that we craft here in this body and indeed how that has happened several times during the last hundred years, and we may expect it to happen in the future, but why the decisions we make today in this body are so critical for the future of health care in this country not just for next November, not just for a year from now, but for decades into the future. Mr. Speaker, it is so critical, so critical that we develop a near- term, a mid-term and a long-term plan or strategy when it comes to crafting our health care policy. Sadly, I don't think this House has really been engaged in that process. We have been more fascinated by the political aspects of the fight. Mr. Speaker, indeed, medicine is at a critical crossroads. This is a time of great transformation within the science. Down one of these pathways is a whole new genre of personalized care, changes in information technology, changes in the study of the human genome, changes in protein science, changes in imaging, the speed of information transfer; and indeed a time of rapid learning all serve to increase value for the patient. Late last week at a conference downtown, Dr. Elias A. Zerhouni, the head of the National Institutes of Health put it in terms of the four Ps. He described a type of medicine in the future which will be predictive, personalized, preemptive, and participatory. Now, Mr. Speaker, down the other path leads to the continued expansion of the reach and grasp of the Federal Government. Could this path equate to increased value for the patient? Well, the answer might be yes, but history has not been kind to that experience so far for this type of trajectory. The trend tends to become process driven, intensely process driven to a greater and greater degree rather than creating a true patient-centered environment. Medical care, in fact, could be rationed in some of the most insidious ways that medical care can be rationed, and that is in the treatment room itself. That is by not paying for the care, not paying for the imaging, not paying for the physician services, having the physician not be there for the patient in the treatment room. That is the type of rationing that we may be talking about. It becomes all about the transaction, very little attention being paid to delivering value for the patient. And, Mr. Speaker, no secret about it, I am a physician. I practiced for 25 years back in my home State of Texas. I will tell you, this is also injurious to providers. It is injurious to doctors. And that, in turn, increases an already existing problem with the physician workforce and aggravates an already existing supply-and-demand inequity. This, in turn, creates a further imbalance between workforce required versus workforce produced. Prices are then set administratively rather than by the marketplace, and this disconnect heightens the insensitivity to market demands, and indeed, we end up with a system much as we see today where physicians are anesthetized as to the true cost of delivering the care that they deliver, and, in turn, the patient is unaware of the cost of the care that they receive. And this becomes a true hindrance to the transformational process itself. Again, the process becomes entirely transactional, and this hinders, or reverses, the transformational process. Now, Mr. Speaker, I would like for us to consider three events, or three epics in the last hundred years where health care policy and changes in science kind of came together to alter, fundamentally alter, the way medicine is practiced and alter it forever into the future. The first time would be early in the last century, 1910 to 1920, where significant advances in medicine including new discoveries related to immunizations, advances in public hygiene, discoveries of anesthesia and modern blood banking weren't too far removed from that era, but they did occur a little bit earlier. That was such a far cry from the way medicine had been practiced up even into the late part of the 19th century. Back then, the order of the day was burning, bleeding, and blistering; and those were accepted as scientifically proven ways to deliver value or to deliver care for the patient. So there was a rapid change in the science that was going on, and there also occurred that intersection of a sudden change in public policy that, again, altered the direction of medical care forever after then. In fact, now the policy that was developed we pretty much regard as a State function. And it is ultimately a change in State policy. It did originate at the Federal level with the commissioning of what became known as the Flexner Commission, which subsequently delivered the Flexner Report. This report, delivered to Congress in 1910, characterized the uneven structure of medical schools across the country. Indeed, the variability of medical schools was truly startling. As a consequence of the Flexner Report, there was a standardization of medical school curricula at a time when the science was, indeed, rapidly advancing. This set the stage for the transformation of medicine literally out of the Dark Ages into the illumination of the 21st century. Then let's skip forward several decades, Mr. Speaker, to the 1940s. And again we see vast changes occurring. Penicillin had been discovered a little bit before that. Back in 1928, Sir Alexander Fleming, we all know Sir Alexander Fleming, there is a big statue erected to him by the bullfighters because he obviously changed the way bullfighting injuries could be treated, but penicillin was discovered in 1928. It was really little more than a laboratory curiosity at first, this substance produced by a mold that would inhibit the growth of bacteria on an agar plate in a Petri dish, but only small amounts could be produced, and it was fairly labor intensive and extremely expensive. So it is a compound that showed great promise, but there really was no way amenable for treating large numbers of patients so its social impact was really quite, quite muted. But then came the discovery of new fermentation techniques in this country in the 1940s. Suddenly, penicillin moved from a laboratory curiosity to a compound that was readily available, readily available in the clinics and dispensaries across the country, readily available and the price subsequently came down significantly. This new life- saving antibiotic was even available to treat our soldiers who were wounded during the invasion and the landing in Normandy in 1944. For the first time battlefield medicine had a way of combating infected wounds which obviously had a significant impact on saving life and limb. Now, a similar story could be told about cortisone. It had been discovered prior to the 1940s, but the production of cortisone was very labor intensive. In fact, you had to derive it from the adrenal glands of oxen so it required someone going down to the slaughterhouse and collecting these glands and then doing whatever extractive process that was required to pull the cortisone out. So you can imagine that there just wasn't a lot of cortisone available and what was available was pretty expensive to produce. But a bright young scientist name Percy Julian, and parenthetically, Mr. Speaker, we honored Dr. Julian here in this House in the last Congress, an African American scientist of great renown and turned out to be responsible for a great number of discoveries in the 1940s, 1950s and 1960s. And it was appropriate that this House honored his memory. But Percy Julian discovered a way of producing cortisone in large amounts using precursors that he derived from a plant product, from soybeans. Thus, again, a medicine which had heretofore been only a laboratory curiosity or a research oddity became readily available, became readily available in large supply, and the price fell to within reach of the average patient. So in the 1940s, we see the near-simultaneous introduction of large- scale quantities of an anti-infective agent, penicillin, and an anti- inflammatory agent, cortisone; and that was to forever alter the landscape of medicine. But, at the same time, we saw the intersection, again, of a major policy change and how that policy change has affected and has impacted the practice of medicine now for decades into the future. In some ways, in many ways, Mr. Speaker, that change in policy, that social change that occurred in medicine at that time had just as profound an effect as the scientific advances of the 1940s. Of course, during the 1940s we were a country at war. The Second World War was raging. Because a lot of the workforce was tied up in fighting that war, there weren't many people left to do the manufacturing work in this country, but it was work that was required because, after all, they were producing for the war effort. So, employers wanted to keep their employees working, they wanted to keep them happy, they wanted to keep them healthy, but the President issued wage and price controls so employers were not able to pay higher and higher wages. The President did this with all good reasons, to prevent an inflationary spiral from getting out of control. With wage and price controls on, employers looked around: Well, how are we going to improve things for our employees so they will want to stay here working for us and won't go off looking for work in some other location? They hit upon the idea of providing benefits to their employees, both health insurance benefits and retirement benefits. Well, there was a lot of controversy over whether or not that violated the spirit and the context of the wage and price controls. So they did what all good people do; they went to court and eventually it worked its way up to the Supreme Court. In 1944, the Supreme Court ruled that indeed these health benefits that were being provided to employees could be provided without violating the spirit and the intent of the wage and price controls. Moreover, that these benefits could be supplied to the patient with pre-tax dollars; that is, they were not a taxed benefit given to the employee. So, simultaneously, we had the era of employer-derived health insurance ushered in, which has proved to be exceedingly popular and endures to the present time. Although it has experienced some problems recently, it is still a very popular way for people to obtain their health insurance coverage. Also, near simultaneously, we began the time of the uneven tax treatment between employer-provided insurance as opposed to individually owned or individually provided insurance, which is paid for with after-tax dollars. So then, Mr. Speaker, we fast-forward to 1965. Again, there were vast changes occurring in the science and medicine. At that time, new antipsychotic medicines were introduced, and for the first time the mentally ill could be treated with medication as opposed to simply restraining someone or holding someone in an incarcerated environment. So it truly changed the landscape of medicine in the mid-1960s. Also, at that time you had the introduction of antidepressant medications. Although the antidepressants have undergone many, many changes since that time, for the first time medication was available to treat a condition of depression, and this opened up whole new worlds for treatment of patients in the 1960s. Newer antibiotics were introduced to fight more aggressive infections. There was the beginning of the understanding that biochemistry played in the development of coronary artery disease, why high cholesterol had an impact and was important in the subsequent development of coronary artery disease. And, Mr. Speaker, conditions like malignant hypertension, which had claimed President Franklin Roosevelt the generation before, now saw newer medications that were available to treat this malady, medications that had not been previously available. But, Mr. Speaker, again, there was that intersection of public policy which combined with rapid changes in the scientific arena to forever alter the landscape of the practice of medicine. In 1965 we saw the introduction of a program that we now know as Medicare, and then subsequently the Medicaid system was introduced in the years that followed. Now, for the first time, for the first time the Federal Government had an established role in paying for health care. Again, the medical world was forever altered. Mr. Speaker, now in the present time we find ourselves in a highly political year. Health care is foremost in a lot of people's minds, particularly those that seek to lead the country via the office of the Presidency. The next administration is likely to be under significant pressure for the expansion of the Federal role in delivery of health care. Indeed, we see evidence of that now with the debate that is occurring over the State Children's Health Insurance Program. Before we get to the State Children's Health Insurance Program, Mr. Speaker, history tells us that policy makers will, we will put the emphasis on the transactional and the administrative aspects of health care reform and we'll ignore the transformational process as it is occurring all around us. Mr. Speaker, I think it is helpful to consider what is the unit of production of this vast American medical machine that is all around us. In its simplest terms, the unit of production is the interaction that occurs between the doctor and the patient in the treatment room. That is the widget. That is what the American medical system produces. So all of our focus, all of our focus should be directed at driving up or delivering value at the level of the doctor-patient interaction. But all too often, all too often, our attention is diverted into other things. This, in turn, degrades the doctor-patient interaction. Now, at the health fair's 25th anniversary symposium downtown last Thursday, Dr. Mark McClelland, former Director of the Food and Drug Administration, former Director of the Center for Medicare and Medicaid Services, started off his talk with: We want to know what works best at the lowest cost for each patient. In a nutshell, that is what personalized medicine is all about. Right now we don't know. We don't know. But that concept defines a whole new era of the type of medicine that will be practiced in the latter part of our lifetimes, and indeed in our children's lifetimes and certainly in our children's children's lifetimes. That's the type of medicine that we will be practicing. Short-term gains in affordability, unfortunately, could lead to long-term stifling of patient access and interfering with the supply-demand relationship that occurs and exists in the medical marketplace. Certainly accountability may suffer with the subsequent reduction in quality because, quite frankly, the best and the brightest may self-exclude themselves from the medical workforce. Thus, we could have a situation where care is delivered by those who do not represent the best and brightest physicians or perhaps physician extenders or other paramedical personnel, and the overall quality of medical care to what, arguably, is the most challenging group of patients, our seniors, that might be further eroded. Advancements in medicine might be placed in peril. Indeed, it is some of the tension in the current system, that hybrid system that is part public and part private. It is partly the tension that exists in that system that is a dynamic for change. Not all the change is good, but generally, generally it moves in the right direction. Mr. Speaker, I'd ask us to consider for a moment the dilemma of health information technology. When I first came to Congress in 2003, the Department of Health and Human Services said it's going to develop a platform for the establishment of a national information technology effort. In fact, please, Congress, don't do anything right now because we are going to do this. We are going to establish this platform. We are going to get it right, and industry will follow what we do. Unfortunately, that reality has yet to be delivered. Now, there are some bright spots. There is advanced informational technology within the Veterans Administration, but it lacks the interoperability with the system used by the Department of Defense, and this lack of interoperability may well have been the root cause for some of the problems encountered by our soldiers on medical hold at Walter Reed Hospital. Let me just give you an example of that, Mr. Speaker. Mr. Speaker, of course The Washington Post broke the story, I believe, in January of this year about some of the treatment being received by some of our soldiers at Walter Reed Hospital. So, like many Members of Congress, within a week I took a trip out to Walter Reed Hospital, and indeed the physical characteristics of Building 18, the building in question, were deplorable, and the building was appropriately decommissioned and those soldiers were moved into more reasonable accommodations actually inside the campus of the Walter Reed Medical Center. Building 18 was outside the garrison, it was outside the actual confines of the campus of the Medical Center, and, as a consequence, that made it desirable for some individuals. But the reality was the building itself was just not up to standards, not up to code, and realistically our soldiers on medical hold should not have been there. What happens too, Mr. Speaker, is soldiers on medical hold, they are trying to decide if the injuries that they are there for which they are being treated are serious enough that they will now be discharged from the military and their care will transition over to the Veterans Administration system so it will be more of a disability-type of assessment that they undergo, or are their injuries such that they can in fact rejoin their unit. The individuals in that situation are placed on what is called medical hold, and there were facilities outside the garrison at Walter Reed Hospital to house those individuals on medical hold. Now, here is a picture of Master Sergeant Blades, who took me around and showed me the rooms in Building 18 that were the point of some contention. But Master Sergeant Blades told me when I was there that the real problem he and his men were encountering, yes, the accommodations were crummy, but the real tragedy was the work that went into preparation of this medical record, the Department of Defense medical record, in getting it ready to send over to the Veterans Administration to perhaps make the case for the disability, make the case for what the disability allowances should be, what the disability payments should be, what care could be available at the VA hospital. He said that he would spend hours and hours and hours preparing his medical chart, highlighting things with a yellow highlighter. This large chart in front of him, it looks about the size of the Washington, DC phone book, would then go sit on a desk for 2 weeks and then be lost and he would have to start all over again. I said, well, wait a minute. I thought the VA system had this new fancy computer equipment and that this should no longer be a speaker. But as it turns out, Mr. Speaker, the Department of Defense can't speak to the computers in the VA system, and, as a consequence, it depends entirely on a hand-prepared record, and you see Master Sergeant Blades there preparing it as we visited that day at Walter Reed Hospital. Here in Congress, the legislative process dealing with health information technology is completely stalled. We had a chance to act last year in the last Congress. The bills we were considering were to provide either grants or buying equipment outright for medical practices. But in the end, we couldn't get our work done, and the current legislative attempts that we see this year seem even more desperate and futile from those of last year. We have gone from bad to worse. Considerable expense could be borne by individuals in private practice, physicians in private practice, trying to purchase or upgrade equipment. These informational systems and costs and learning of the operating of these new systems are significant barriers to entry. Relaxation or moderation of what are known as the Stark laws could allow for hospitals and doctors to be cooperative and involve themselves in the investment in this type of technology. But barriers to entry for physicians are that the equipment is expensive. And in addition to the initial cost and the cost of maintenance and the cost of software and the cost of software upgrades, there is a problem: If there is no established criteria for interoperability, how is a guy out in private practice or a lady out in private practice who goes and buys a computer system from a vendor, how are they to know that they are making the correct purchase at all? Now, that is the public sector. That is the government working on this. Remember one of the things I first said, the change of the speed of delivery of information is one of the things that is going to transform medicine. We are kind of stuck here and have been stuck here for 4 or 5 years. What is happening on the private sector? Consider the experience of Aetna Insurance Company. A single company employing 34,000 individuals and has 15 percent of its workforce involved with information administration and maintenance. In fact, according to their CEO, if the Aetna Information and Technology Department was a standalone company, it would be one of the largest software development firms in the United States of America. They have developed a Web-based electronic health record, not an electronic medical record controlled by the doctor, but a Web-based electronic health record that is controlled by the patient, the access is controlled by the patient, and that is available then to a patient anywhere in the country where they have computer access. So, if they are traveling and they have got a medical condition that is under pretty tight control and good control at home and they have a problem, that information can be handed over to the treating physician in an emergency room at a distant location, because all that information is going to be available to them up on the Web. And when that patient returns home and returns to their doctor at home, the information derived, the testing done by that doctor in the different location, will be available to the patient when they return to their home for care. Mr. Speaker, I have to tell you, I haven't always been a big believer in things like computerized medical records. Sometimes they are hard to learn. There is a learning curve associated with them. It takes some time to get up to speed with them. No one is interested in paying for the time it takes to get up to speed. But in January 2006, taking my second trip down to the City of New Orleans after Hurricane Katrina came through there, all of the water came in, this is the basement of Charity Hospital. The water has been removed. You can't see in the picture, but there was still water about ankle deep. This is just one of hundreds of rows of charts as you might imagine a hospital of that size might contain. This black here, they haven't been burned, this is mold growing on the medical records. This vault now is a hazmat site. Someone wanting to review a record for a patient would have to take extraordinary precautions not to inhale the spores from the mold when they opened the record. These records are unusable and unavailable and no one knows what has been lost here. There might be someone's leukemia, childhood asthma; those records are lost forever. This changed my mind on the concept of having an electronic medical record or, as Aetna has developed, an electronic health record that is owned and controlled by the patient and is Web-based. Mr. Speaker, I ask which system now, remember my fundamental criteria: Do we deliver value to the doctor-patient interaction in the treatment room? Which system is delivering value to the doctor-patient interaction in the treatment room right now? Is that what we are doing at Health and Human Services, where we are trying to get things up and running, develop a national platform and one of these days we are going to roll this out? Or in the Halls of Congress, we are going to craft legislation if we can get the pieces right. But watch out, the unintended consequences of that legislation may turn around and bite you when you try to practice medicine a few years in the future. Or the experience at Aetna U.S. Health Care. You have one system that is mired in entrenched bureaucratic wrangling, and the other one providing real data for real patients and advancing their health. Which system is making the maximum capital investment at the same time demanding accountability to deliver value for its covered individuals? Which system continues to hamper the growth and development of the technology that everyone acknowledges is necessary to bring medicine into the next generation? I talked about a short-term, mid-term and long-term strategy. That long-term strategy is the explosion in health infomatics that is going to bring us the type of personalized care we want in the future. Now, Mr. Speaker, the American medical system takes a fair amount of criticism from around the world. I want to bring to the attention of this House the Washington Post and the Wall Street Journal today, two stories in two different newspapers today talking about some things that are happening when you export American medicine, American know- how, American technology half the way around the world. From the ``World in Brief'' section under the heading of Afghanistan: ``Six years after the Taliban's ouster, medical care in Afghanistan has improved such that nearly 90,000 children who would have died before the age of 5 in 2001 will survive this year.'' That's thanks to the efforts of the United States Agency for International Development that has brought modern American medical technology to the country of Afghanistan. They still have a long ways to go, but I thought I would share that with the House. Another story from the Wall Street Journal about how we export American technical medical know-how to other countries. This is actually in the ``Marketplace'' section of today's Wall Street Journal. The title is: ``Health care building booms in the Persian Gulf.'' It says that the region's families are recruiting brand-name U.S. medical institutions and private investors with plans over the next 20 years to more than quadruple the estimated $12 billion spent annually on health care. They are essentially trying to duplicate Harvard Medical School and its residency programs at the Massachusetts General Hospital in the City of Dubai. As I stated previously, we are at a transformational time in medicine. There are changes occurring on many fronts. At the same time, we have the intersection of changes in public policy which can vastly affect the practice of medicine for years, decades into the future. Mr. Speaker, there is a risk here. If health care policies are based on political expediency, and if they are not patient-centered, there is a risk of continuing to be beholden to the special interests and not empowering patients. There is a risk of delivering for the status quo and not delivering for the future. Indeed, the transactional could triumph over the transformational. Prevention of this scenario will require development of, certainly with physician leaders within the house of medicine, they have to be engaged for their patients and not for the enduring bureaucracies or special interests. We do have some relatively new products that have emerged on the scene in the last several years. Health savings accounts and their precursors, medical savings accounts, are just a little over 10 years old, and they show some significant promise by putting purchasing power back in the hands of the patient and rekindling that doctor-patient relationship that has been so many times stifled by the current system. Improvements to the health savings accounts could include methods for paying for preventive care and adding new coverage to include disease management for chronic conditions. In other words, move health savings accounts from the type of patient that is only going to purchase one because they don't think they will get ever get sick, to the type of patient who knows they have a medical condition but they want the power over their medical condition, and a medical savings account is a way to do that in an affordability fashion and still retain power over their illness. Mr. Speaker, we should encourage new thinking by third-party payers. At some companies that is going on already. It could help move borders for affordability. A business that provides a premium reduction for individuals who engage in preventive practices and periodic screenings would represent a reasonable way to deliver increased affordability. It is a way of delivering value for the patient. If the legislators and Federal agency personnel have the vision and discipline to focus on the long term, we may yet see delivery on the promise of the pending transformation in American medicine. Mr. Speaker, former Speaker of this House, Newt Gingrich, in his book on transformation, I think his second principle of transformation where he asserts real change requires real change. What does he mean by that? He means in order to affect real change, you have to walk the talk. There has to be a culture and leadership not just embracing of the concept of change, but they have to act on it. They have to live it and breathe it and work it every single day. That is a valid concept, and I think the Speaker is right on the money when he brings that concept up. But look at it another way. Real change requires real change. There is real change occurring in medicine, whether Congress knows it or not, whether Congress likes it or not, and whether Congress helps it or not. Real change is occurring in American medicine right now. Because of that real change that is occurring in the science part of medicine, real change is required here in this Congress, in the other body as to how we approach our health care policy so, again, we don't let the transactional become the enemy of the transformational. Mr. Speaker, a short-term, a mid-term and a long-term strategy are essential, and we must avoid sacrificing this concept and giving it all up for short-term political gain, which brings us back to the subject of the State Children's Health Insurance Program. When I think of health care policy, I try to put it in the context of what is delivering value for that doctor-patient interaction in the treatment room, not the cost, but what delivers value to that interaction. What diminishes value? What happens if we have a significant negative effect on the physicians who are providing the care for our pediatric patients? Is there a cost to providers for shifting populations from commercial insurance onto public insurance? Well, I believe there is. Mr. Speaker, I don't really know why and where insurance companies get the idea it is okay to only partially cover the cost of providing care, but I have a suspicion they get that because that's the way the Federal reimbursement structure works. That is the way it works in Medicare and Medicaid; and if we expand the reach and grasp of the Federal Government in the SCHIP program, I think we will find to the detriment that process is alive and well and subsequently we have the negative effect on the physician workforce. Mr. Speaker, before I yield to other speakers, let me bring up this slide from the American Enterprise Institute. This points out at successive income levels, and these are rated at the percentage of the Federal poverty level, so here is between 100 and 200 percent of the Federal poverty level. This is about $41,000 to $42,000 a year. Here is between 200 to 300 percent of the Federal poverty level, so that is up to just over $60,000 a year. And 400 percent of poverty would represent a figure of over $80,000 a year. So in the group between 100 and 200 percent of poverty, and this is the group that SCHIP was originally designed to cover, about half of those children have private coverage. If you move into the 300 percent of Federal poverty limit, they earn up to $60,000 a year, three- quarters of those kids already have health insurance. And nine out of 10 and 95 percent have health insurance. Why do we want to go and take these children who are already covered and bring them back into the SCHIP program? Are we delivering value to the patient? Are we furthering the concept of good patient care? Mr. Speaker, I would point out that on the floor of this House 2 weeks ago when we had the debate on the new State Children's Health Insurance Program bill that we passed which was exactly like the one that the President vetoed and we sustained, when we were debating the new bill, I asked the chairman of the Committee on Energy and Commerce to enter into a colloquy with me, and he graciously did. We talked about State income set-asides. If the bill said that the maximum amount available for coverage under the program was 300 percent of the Federal poverty limit, so a little over $60,000, where again three-quarters of those children already have insurance, if that is our upward limit of coverage, were there income exclusions available to the State that could take that upper income level even higher, and I asked specifically about the cost of housing. And indeed within the bill was the language that States could exclude $20,000 of annual income involved in housing. And States could exclude $10,000 of annual income that is there for clothing. And States could exclude $10,000 of annual income that is available for transportation. Mr. Speaker, we are already over $100,000 in annual earnings for a family of four when we talk about this bill that was introduced and passed by this House. Mr. Speaker, I am just a simple country doctor and there is so much about the budgeting process that I don't understand that I am so grateful that I have been joined by the gentleman from New Jersey (Mr. Garrett) who sits on both our Budget Committee and our Committee on Financial Services. I think he is going to provide us all with some valuable insight as to some of the numbers involved in this process. So I do now want to yield the floor to the gentleman from New Jersey (Mr. Garrett).

Mr. BURGESS. One of the things before the time completely leaves us, I just want to draw attention to a recent poll put out by U.S.A. Today that does show that the plurality of Americans, a majority of American citizens, believe that the benefits in the SCHIP program should go to poor children first, and that's not to the children at the upper-income levels that we were showing on the other slide. That is the group of children for which this program was originally intended, that is children whose parents make too much money to qualify for Medicaid, yet not enough money to reliably afford their health insurance. When this program was first enacted in 1997, by a Republican Congress with a Democratic President when this program was first enacted, that was a group of children that the Congress was trying to help. The concept of poor children first is one that the American people embraced. In fact, I introduced legislation earlier this year, H.R. 1013, that would have put the children back in SCHIP and removed adults from the program. Now, I am grateful, very grateful that the Democratic majority has now embraced that concept and at least their latest iteration of the SCHIP reauthorization bill said that there will be no adults on the program within one year of the enactment of the bill. It's a bittersweet victory because there are so many other aspects of the bill that are flawed that Mr. Garrett has just alluded to. The funding mechanism absolutely disappears in the fourth year of the program. The funding mechanism itself is based on a belief that there will be an increasing number of smokers in this country, and public policies that I support to decrease the number of smokers and decrease the number of young people who begin this habit. It makes no sense to be saying we are going to fund this entire program based upon that type of tax and, on the other hand, try to put our maximal effort behind trying to reduce the number of smokers in this country. It is certainly a conflicted mindset that the Democratic majority seems to be propounding here. One of the other things that I do want to bring up just before we close, another poll from U.S.A. Today that the American people are concerned, are concerned that the program as proposed would pull those children off of private health insurance and put them onto a government plan. Then as Mr. Garrett so eloquently pointed out, then the funding dries up, and where are you then? At the same time, if you have driven pediatricians out of practice because of lower reimbursement rates, you have now the trifecta, the triple whammy, where health care for children may be seriously jeopardized in the mid-term or the long-term because of the fact that we are sacrificing for political expediency today.

Mr. BURGESS. One of the points that I probably did not make eloquently enough tonight is that the practicing pediatrician, not the pediatrician in an academic setting, not the pediatrician in a federally qualified health center, but the pediatrician is out there with a mix of different payer groups in his practice or her practice. The average reimbursement for a child on the SCHIP program is about 30 percent less in my State of Texas than it is for one of the commercial insurances. If we take those children off of commercial insurance and move them to an SCHIP program, we are negatively impacting the bottom line of the pediatrician who is providing the care. We can only do that for so long before they will decide that they have got something else that they might do.

Mr. BURGESS

Mr. BURGESS. Madam Speaker, I rise today to congratulate the City of North Richland Hills' North Hills Hospital. North Hills Hospital is opening a new Heart Center that specializes in fast and efficient heart attack care. North Hills Hospital has been leading the medical world in heart care. It is the first hospital in the United States to accomplish Cycle 2 Accreditation for its Chest Pain Center. The hospital is opening a Heart Center for its patients and will continue to lead the way in top- of-the-line cardiac care. The Heart Center has been in construction for two years and consists of two operating rooms, 13 cardiac progressive care beds and eight cardiac intensive care beds. All of these rooms are on the same unit, which is helpful for transferring patients, and also for visiting families. The new model of the Heart Center is considered ground breaking in the medical field. I extend my sincerest congratulations to the City of North Richland Hills and the North Hills Hospital. It is my hope that they will continue to serve patients of the 26th District of Texas with the same care and spirit of service that they have shown throughout the years.