Michael Burgess

Mr. BURGESS

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

Mr. BURGESS

Mr. BURGESS. Mr. Speaker, I want to come to the floor of the House tonight and add my voice to a lot of my colleagues in opposition to the dangerous resolution condemning Turkey for reported atrocities against the Armenian people. Everyone regrets what happened at the end of the First World War; but, Mr. Speaker, we are in the midst of a very complicated war, a complicated war in which every ally is valuable to our war effort. This resolution, Mr. Speaker, this resolution has the potential to inflict damage on the United States-Turkish relationship such that it would be very difficult to repair it, and this should be at the forefront of our minds as we consider bringing to the floor for a vote. I am concerned about this resolution, and I urge the Speaker not to allow these actions. I am asking us to consider the long-lasting negative effects that this resolution could have on our foreign policy interests. The last thing we need is for an American ally to stray from the path of victory in Iraq, and with President Abdullah Gul threatening to withdraw Turkey's support of the Iraq war should we vote on and pass this risky resolution, this possibility unfortunately is moving ever closer to reality. Mr. Speaker, Turkey continues to be a consistent U.S. partner in developing some of the crucial defense equipment we're going to need to protect our country into the future. Currently, Turkey is aiding in the development of Lockheed Martin's F-35 Lightning fighter. I can testify to the significant importance of sustaining positive relations with Turkey, because the final assemblage of the aforementioned aircraft will, in fact, take place at Lockheed Martin's Ft. Worth plant which is very near my district in North Texas. These are important developments in the war on terror and now is not the time to compromise these efforts. But more importantly, Mr. Speaker, this resolution, this resolution is ill timed and ill suited for a country at war. What will happen to the transport of goods, fuel, food, fiber through Turkey into northern Iraq? And if those shipments, if those shipments of food, fuel and fiber are delayed or ended by the Turks, who wins and who loses? Mr. Speaker, I will submit that the average American probably doesn't know the answer to that question. It's not that they're indifferent, but they just don't know if there's going to be a winner or a loser. The average Turk, while he may care, is really just pretty mad about it all. But, Mr. Speaker, I would submit it is the Iraqi citizen who is on our side who will lose. They will be denied sustenance. They will be denied food for their family. They will be denied fuel to heat their homes in the coming winter in the northern part of Iraq, in a country that has been ravaged by war. Well, if Iraqis who are friendly to us are likely to be hurt, what about the enemy in Iraq? Well, Mr. Speaker, they may be the indirect winner because after all, we know they love chaos; and anything that increases disorder in Iraq's fragile social system benefits our enemy. Mr. Speaker, I am not connecting dots that have not already been connected. Right as we left before the August recess the majority whip was quoted as saying if things go well in Iraq, it's bad for us; it's bad for our majority party. Mr. Speaker, sadly, then we've seen several times during the month of September where it does seem like sometimes they're invested in defeat. But who really bears the brunt is the United States soldier. And, Mr. Speaker, this is not just a theoretical concern. October 2000, same bill, conflicts are a little bit different. Northern watch, keeping the Iraqis from attacking the Kurds. Those planes in northern Iraq to enforce the no-fly zone and keep Saddam from attacking the Kurds, those F-16s flew out of Turkey and they kept watch every day of every week during what we now know as Northern Watch. They kept the Iraqi Republican Guard in a box and kept them from attacking Kurds. Mr. Speaker, I was not in Congress in October of 2000. But I will tell you that a young man who is now a constituent, actually stationed in Clovis, New Mexico, but was moved to Incurlik, Turkey, and was on duty then, he talked to me back in October of 2000. He said, we were away from home in a place that really was awfully strange for a 21- year-old. And then we picked up our newspapers one morning and there's a big hole in the side of a United States ship, the USS Cole which was bombed in October of 2000. The tension was mounting daily. Other attacks were a possibility. And then all hell broke loose outside the base. There was protests, there was shouting, there were people yelling at us at the gate. None of us were allowed off the base. And why? Because the House of Representatives was going to take up the Armenian genocide resolution. Mr. Speaker, this constituent was my son. He asked me then, Dad, why is Congress making things tougher for us over here? I didn't have an answer for him now and I don't have an answer for him now. President Clinton did not support this bill in 2000. Majority Leader Armey refused to allow it to come to the floor. Don't make life tougher for our soldiers. We're a country at war. Let's act like it for once.

Mr. BURGESS

Mr. BURGESS. Madam Speaker, I rise today to congratulate Miss Kirstie E. Wade of Argyle High School in Argyle, Texas, for being chosen as a semifinalist in the 44th Annual National Achievement Scholarship Program. It is an honor to have such a qualified student in the 26th District of Texas. The National Achievement Scholarship Program began in 1964 as a way to provide scholarships to promising black students. Since 1964, almost 28,000 students have been provided with scholarships totaling more than $88 million. Miss Wade was one of 114 semifinalists from the State of Texas. She was chosen based on her Preliminary SAT scores. Finalists will be chosen based on abilities, achievements, and potential for success. The scholarship winners will be announced in April of 2008. I extend my sincere congratulations to Miss Kirstie E. Wade and her family for her academic achievements at Argyle High School. Her dedication and commitment to her education will lead her to great things. I wish her the best of luck with the remainder of the National Achievement Scholarship Program.

Mr. BURGESS

Mr. BURGESS. Madam Speaker, I rise today to congratulate the city of Highland Village, Texas for being named the safest city in Texas. Highland Village has been named the safest community in north Texas for the past 5 years straight and is now also the safest city in the entire State of Texas. A report by the Federal Bureau of Investigation Uniform Crime Reports shows that Highland Village has the lowest index crime rate and the lowest violent and property crime rate for 2006. Mayor Dianne Costa attributes this award to the outstanding work of the Highland Village police officers and the citizens of Highland Village and their efforts to keep the city safe. The police department utilizes a community-policing model, which focuses on a proactive approach through crime prevention and education. I extend my sincere congratulations to the city of Highland Village, Texas for their great achievement. I thank Mayor Costa and the Highland Village police officers in their continued effort to keep the community of Highland Village as safe as possible. It is an honor to have such a great city in the 26th district of Texas.

Mr. BURGESS

Mr. BURGESS. Madam Speaker, I appreciate you letting me come to the floor tonight to talk, as I often do, about health care, the state of health care in our country. This is a unique time in our Nation's history. We are kind of coming up on the 2008 Presidential campaign, and the reality of unfettered election-year politics intersects harshly with the perennial challenge, the perennial challenge we face in this House, how do we refine, transform, transform this Nation's health care system. The history of health care in America over the last century and the very beginning of this century, it's a fascinating, fascinating subject. Medicine is a very highly structured, highly ordered, scientific-oriented, disciplined, scientific process, the scientific method. And then coupled with a number of governmental policies, we would like to think that they are science driven, we would like to think that they are fact based, but oftentimes they are more emotionally based, and how those policies interact with the scientific basis of the fundamental world of medicine and how, when we enact those policies and what seems like with every good noble intention in the world, how those policies then affect things decades into the future in ways that most people who enacted the policies would have had no idea what became of them. Now, last century, in the 1940s, really a pivotal year in health care, medical care in America, both from a scientific aspect and from the policy aspect. From the scientific aspect, it was a time of great discovery and great excitement. Mr. Alexander Fleming, the famed British scientist, isolated penicillin in 1928 in his laboratory, didn't quite know what he had or what to do with it. Certainly the substance produced by this mold in a petri dish inhibited the growth of the microorganism staphylococcus, a known cause of infection. For the first time, mankind had an agent to battle these unseen microscopic entities that plagued mankind for centuries. Now, 1928 is not exactly 1940, and I referenced 1940. What happened in 1940 was American scientists, American scientists in this country, recognizing the value of this discovery, elucidated a method for mass production of penicillin. Penicillin, which had been a miracle drug before but available in very small quantities only for a very select few was now suddenly available for everyone, and available cheaply. This affected our soldiers, who landed at Normandy on D-Day in 1944, the wounds that they suffered, which otherwise may have become infected and caused serious disability or even death were now even amenable to therapy with an antibiotic. Therapy with an antibiotic is something we now just take as almost second nature, just for granted. We get sick, we go to the doctor, they write a prescription for an antibiotic, we take it, we get well. In the 1940s, this was almost unheard of. So this was truly a breakthrough in the 1940s in the scientific realm in medicine. Another discovery, that had actually occurred earlier, the discovery of cortisone. A very potent anti-inflammatory, cortisone was actually taken from the adrenal glands of oxen who were slaughtered. It was a very laborious, labor-intensive process to get small amounts of cortisone, so it really wasn't something that was amenable to treatment. Then in the 1940s, a scientist that we, in fact, honored in this House during the last Congress, an African American gentleman, Percy Julian, who was a biochemist, not even a physician, a biochemist who worked heavily with soybeans and soybean products elucidated a method to mass produce cortisone, cortisol, which had not been able to be produced other than in very small quantities before, and now suddenly, again, it's available to very large numbers of people at a very reasonable price. These two entities, antibiotics, anti-inflammatory, introduced in the 1940s changed forever the practice of medicine not just in America, but worldwide. What else happened in the 1940s? Obviously, World War II. The Supreme Court made a decision in the 1940s that affects us to this day. During the Second World War, President Franklin Roosevelt, in an effort to keep down problems with inflation, it was a wartime economy, and he was worried about inflation taking hold and taking off, said we are going to have to have wage and price controls. There was a lot of demand for labor in this country. We were producing materiel, things that were needed on the frontlines in the war. Yet the workforce were all off fighting the war, so employers who were lucky enough to have employees to work wanted to keep them and keep them happy. How do you do that? You pay them more money. But the President said we better not do that or we are going to have trouble with the inflation. Well, employers, being enterprising and ingenuous sorts, said, let's then offer benefits. Let's offer health care benefits, let's offer retirement benefits. A decision by the Supreme Court in the 1940s said, yes, you can do this. It does not violate the spirit of the wage and price controls. Not only that, you can pay these with pretax dollars. So the era of employer-derived, employer-based health insurance was born, turned out to be enormously popular. People liked the idea, and, for decades into the future, that was the model that was followed in this country. Then, fast-forward another 20 years and we are in the mid-1960s. What other health care policy happened at that time? Well, it was the institution of the Medicare program by President Lyndon Johnson. The Congress at that time who said, You know what? We are going to provide protection for our seniors. Now, at that time, they provided protection for the doctors in the hospitals. Prescription drugs came 40 years later in the 108th Congress when we enacted the prescription drug benefit, but think how the interposition of the Medicare policies changed the fundamentals of how health care is paid for in this country. The Medicare and Medicaid programs of the mid-1960s meant all of a sudden the government is in a position to finance a large portion of health care provided in the United States. Now, prior to the Second World War, most health care was paid for at the time of service and was a cash exchange. With the advent of employer-derived health insurance and the position of a large governmental program, most health care now is administered through some type of third-party arrangement. That's useful in that it protects the individual who is covered by insurance from large cash outlays, but there is a trade-off. The covered individual is generally unaware of the cost of the care that he or she receives, as well as the provider, who remains insensitive to the cost of the care that that provider orders. This arrangement has created an environment that permits really rapid growth in almost all sectors of health care and the cost of health care. America's challenge in the early part of the 21st century, America's challenge becomes evident. How do we improve the model of the current hybrid system that involves public and private payment for health care but at the same time anesthetizes most of us as to the true cost of that care? It's also perhaps wise to consider that any truly useful attempt to modernize the system, the primary goal really has to be, first off, you protect the patient. You protect the person, not the status quo. And we also need to ask ourselves if the goal is to protect the system of third party payment or to provide Americans with a reasonable way to obtain health care and allow physicians a reasonable way to provide health care for their patients. Sometimes, with some of the legislation that I see come before my committee, Energy and Commerce, I wonder if we don't forget that fundamental rule. In health care, the basic fundamental unit of production is the interaction that takes place between the medical professional, the doctor and the patient in the treatment room. That fundamental interaction, Madam Speaker, if you will, is the widget. That's what this large health care machine produces. And sometimes that concept also gets lost in the process when we talk about how do we reform health care. The current situation subsidizes, makes payments to those indirectly involved with the delivery of that widget and, ultimately, that drives up the cost. Now, currently in the United States, about half of every health care dollar that's spent originates here in the United States Congress. The United States gross domestic product, we spend about 15 percent of that on health care, and half of that expenditure is generated from the Congress. The gross domestic product currently is about $1.6 trillion. Medicare and Medicaid systems pay for or cost about $600 billion in aggregate. You've got the Federal prison system, the Indian Health Service, the VA system, all of the other interactions that the Federal Government has with paying for health care amount to about half. What's the other half? Is it all private insurance? No, of course it's not. There are a certain number of people who are uninsured. Private insurance, to be sure, occupies a significant percentage of that half that's not paid for by the government. Some is paid for by the individual. Some of it is self-pay, and I would include health savings accounts, medical savings account in that self-pay group because I think that's an important concept that sometimes gets lost in the discussion. And finally, let's be honest. There is a good deal of care that is delivered that is simply a charitable offering by doctors, nurses, hospitals, a charitable offering that is given to patients who lack the ability to pay. Again, the test before us, protect the people, not the special interests. Madam Speaker, we ought to define that which ought to be determined by market principles and that which, of necessity, must be left in the realm of the public provider, the government realm, and how, in all of this process, we preserve individual self-direction instead of establishing supremacy of the state. Additionally, we must challenge those things that result in distortion of market forces, especially those market forces in health care, and acknowledge that some of that distortion is, in fact, endemic. We'll never be able to subtract it out of the system. Some of it is hidden. We'll never even know that it's there, and since it's hidden, or we can't subtract it out of the system, it's not readily changed. So recognize that and acknowledge that we're not going to change that part, but also recognize that there's part of it that is actually easily amenable to change. And the key here is how to maximize the value at the production level. Again, I go back to that fundamental unit of production, the doctor- patient interaction in the treatment room. Yes, I know it may be the emergency room, the operating room, but that fundamental unit of interaction, how do we maximize value at the production level? How do we place a patient who exists on a continuum between health and disease, how do we move that patient more in the direction of health and slow that movement in the direction of disease? How do we allow physicians an appropriate return on their investment, their investment of time, their skill, their intellectual property? And that opens up a host of questions relating to future physician work force issues. How do we keep the employer, if the employer is indeed still involved in providing health insurance for an employee, how do we keep the employer to continue to see value in the system? They get a quicker return to work for their injured or ill employee. Perhaps there's increased productivity, better maintenance of a healthy and more satisfied work force. All of these things are of value to the employer, and that ought to be recognized. In regards to health insurance, how to provide a predictable and managed risk environment, remembering that insurance companies themselves, of necessity, they tend to seek a state of monopoly, and if left unchecked, that's the direction in which they're going to move. If that is a good thing, okay. If that needs to be monitored or regulated, we need to be willing to provide that regulatory expertise as well. And finally, how do we balance the needs of hospitals, ambulatory surgery centers, long-term care facilities and the needs of the community, as well as the needs of doctors, nurses and administrators? Now, Madam Speaker, individual legislation, H.R. 2583, H.R. 2584, H.R. 2585 deal specifically with medical work force issues. And as some of the hubbub around the current health care debate dies down, I hope we get a chance to actually articulate and debate those issues. Another bill, H.R. 2203, that was introduced in the 109th Congress would provide low-income Americans with a direct subsidy to help pay for their health care and many others that would chart a path to true reform in our health care system. But let's keep in mind some principles when we talk about legislation. And I would say the first principle that Americans, at least in my estimation from 25 years of practicing medicine, what do Americans value in their health care system? They value that freedom of choice. They want to go see the doctor they want to see. They want to see them when they want to see them, not when the system says they can come in. When hospitalization is required, you know, no one objects to incentives, but freedom of choice must remain central. Another principle that certainly a number of people talk to me about is a principle of ownership. Madam Speaker, I had a medical savings account before I came to Congress. The whole concept of having what we now call a health savings account or a medical IRA and being allowed to accumulate savings, a nest egg, dollars to offset future medical expenses, is a fundamental desire of many Americans, and I think we should encourage that. These dollars that are then dedicated to health care should be properly owned by the individual. And guess what? When this individual leaves this life, those dollars stay in that individual's estate and they don't go back to any governmental body upon the death of the individual. Another principle would be independence, the preservation of autonomy. The patient or the patient's designee should ultimately be responsible for their care or the ability to decline medical intervention. Another principle that I think we need to keep foremost in our minds is that of high standards. One of the underpinnings of the American medical system has always been high standards of excellence and nothing, in any future change, should undermine that. And, in fact, the pathways to facilitate future growth in excellence should always be encouraged. Again, it gets back to delivering value for the dollar. Innovative approaches. We Americans pride ourselves on innovative approaches. American medicine has always been characterized as embracing innovation and developing new technologies and treatments. Clearly, this must be preserved. Madam Speaker, we just came through the FDA reauthorization bill earlier this year. The whole purpose, years ago, with the development of the Prescription Drug User Fee and the Medical Device User Fee Act was to provide additional funding so that inventions and discoveries and intellectual property that was developed, whether it be a pharmaceutical or a medical device, would not sit so long in the approval phase and could be brought, not just to market, but to be able to help patients more quickly. The difference between practicing medicine in the 1980s, when we had the old system, and the 1990s, under the new system, was phenomenal, and the ability to deliver drugs and devices to the patient public was, in fact, vastly increased. I was grateful to play a small role in the reauthorization of the FDA process when we did that earlier this year. In fact, Madam Speaker, we heard a lot of talk just a few minutes ago about the SCHIP bill. I would hold out the FDA legislative process as a model which this Congress should follow because that was truly a bipartisan process. The SCHIP bill that came through this House that everyone is now holding their breath waiting to see whether or not the other side has the votes to override a veto, but the reality is that bill came through this Congress in what I consider a very pernicious way that is likely to poison any future attempts at bipartisan cooperation because here was a bill that was simply thrown across the transom, rammed through committee, rammed through the House on a party- line vote. Then we go back to the Senate. Well, we can't really do a conference committee. So what do we do? We take up a brand new bill. But we don't bring it back through the committee. We don't bring it back through the subcommittee. No. We come right to the floor and take it or leave it. That's not the way America wants to see this Congress operate. America wants to see this Congress operate as it is supposed to operate. They want to see my committee, the Committee on Energy and Commerce, have a subcommittee markup on the bill. There might be a good idea out there on the Republican side. There might not, but there might be. And what reason could anyone in this body give for saying, we're just not going to do that? They say it was in the interest of time. Madam Speaker, every single Member of this body who stood in this House in January of 2007, raised their right hand and swore an oath to defend the Constitution, knew that at the end of September, what's going to happen? SCHIP expires. It was a 10-year authorization. It started in 1997. Time's up at the end of September. The fiscal year is over. So we all knew this was coming. Why did we leave it till the last minute? And then why did we bring such an imperfect product through and then ram it through at the last minute, without any of the usual consultative advise and consent that goes on at the subcommittee level and the committee level. I frankly don't understand. If people are watching this process, if people are able to dig beneath the political rhetoric, they ought to be outraged at the way this was handled. But I'm getting off message. When we talk about principles for health care reform, one of the things that we really have to focus on is timeliness. Madam Speaker, we always hear about American comparisons to other health care systems around the world. But consider this: Access to a waiting list does not equal access to care. This was the message delivered by the Canadian Supreme Court to its medical system in 2005. We must diligently seek not to duplicate the most sinister type of rationing than that that exists in a system of nationalized health care which prevents citizens from getting care because it just simply takes so long to get to the doctor or get that needed procedure or get that needed hospitalization. Another principle that really, I think, we ought to spend some time discussing and debating, not everyone agrees with this, but really this ought to be a market-based solution and not an administrative solution. The pricing should be based on what is actually indicated by market conditions, and not that that is assumed by an administrator, either an administrator at a private insurance company or an administrator at a Department of Health and Human Services or Center for Medicare and Medicaid Services. Madam Speaker, we hear a lot of talk about mandates. Mandates, in general, in my opinion, lead to a restriction of services. State mandates cause more harm than good and impede competition and choice and drive up the cost and limit the availability of health insurance. Employer mandates. We've heard various reform schemes that have been talked about that deal with employer mandates. That was the crux of the Clinton plan in 1993. Individual mandates, some of the things that have been talked about at some of the State levels. But employer mandates and individual mandates are likewise restrictive. A discussion of mandates should include an accounting of cost and whether those mandates limit the availability of insurance for those who may operate a small business, those who may be self-employed or self-insured. Remember, Medicare part D, the prescription drug program from 2 or 3 years ago, achieved a 90 percent enrollment rate with education, incentives, competition, and not a single mandate. We must not forget that lesson because that's been a highly successful program and one that, in fact, enjoys very high popularity in the population that it serves. The concept of premium support. Premium support is kind of like a tax credit, kind of like a voucher, but not quite. Let's be honest. Our Tax Code is complicated enough as it is. We don't need to layer more complexity on the Tax Code. I know that's a topic for a different discussion, but when we're talking about health care reform, I'm not such a big fan of tax credits. But if there is the ability for, whether it be the SCHIP program or the Medicaid program, to help someone buy down the cost of that health insurance premium so they can, in fact, afford an insurance policy, I think the concept of premium support is one that this Congress really ought to investigate. In fact, that was an amendment that I had for the SCHIP process, but, again, we weren't allowed to amend that bill in subcommittee, full committee or here on the House floor. You know, on the concept of the premium support, one thing that we could think about doing is some individuals receive some additional help to the earned income tax credit. Well, what if we made it not just a good idea but a requirement that people who receive money on the earned income tax credit that some of those dollars are actually earmarked for their health insurance? Maybe an idea worth exploring. Another principle is that of antitrust enforcement. It has to be balanced. If the Federal Government picks winners and losers, we're going to further distort and make the playing field unlevel, and as a consequence, we are going to thwart our best efforts for health care reform. Creating winners and losers via the antitrust law actually erodes the viability of the American health care system. Well, what about talking about some of the policies that actually may affect some change? For health care within the public sector model, the transformation after the experience with Medicare part D has been instructive. Six protected classes of medication, which were required of all companies who wish to compete and participate in the system, allowed for greater acceptance by the covered population and greater medical flexibility when treating patients. At the same time, the competitive influences brought to bear in that part of the program, indeed, have managed to control costs. In fact, the projection of the cost of the Medicare part D program is $130 billion less over that moving target we call the 10-year budgetary window. It's solely the result of competition. It is likely we will get some additional benefit, some additional cost relief by more timely treatment of disease and delivering more value for the health care dollar. But those concepts, those savings are going to necessarily appear later in the timeline of that process. But just from competition alone, a substantial amount of dollars savings were achieved under the part D program. Madam Speaker, one of the most important lessons learned in the Medicare part D program is that coverage can be significant without the use of mandates. Ninety percent of seniors now have some type of prescription drug coverage, and this was achieved how? By mandates? No. But by creating plans that people actually wanted. What a concept. You don't mandate you have to do it. You build something that people want, and they come to it. We ought to follow that model more often when we are talking about health care reform in this country. Ninety percent of seniors have prescription drug coverage, and providing that coverage means that incentives to sign up in a timely fashion had to be provided. And, indeed, that worked. It emphasized that the personal involvement responsibility was there to maintain some type of credible coverage if it already existed or to buy into credible coverage during the open enrollment period. And, in fact, people accepted that and behaved accordingly. Employer-derived health insurance I think will be a significant player in the American health care scene. A lot of writers who write about health care insurance say the employer-based model is passe. It's dead and gone, never to return. I don't know that I agree with that. Certainly it is still a very viable presence, a very robust presence in the insurance market today. And while again there are some problems, it is hard for me to see that the day is coming where that will completely fall by the wayside. I think that's because it adds value. It adds value to the contract between the employer and employee. It rewards loyal employees and builds commitments within the organization. Businesses can spread risk and help drive down cost. Now, one of the features that is inherent in that model is the proposed associated health plans that the previous Congress and the Congress before that have voted on on several occasions. We have never been able to get that concept to pass in the Senate, but maybe it's time to look at that again. Associated health plans are allowing small businesses of a similar business model to pool together to get the purchasing power of a larger organization. It gives, say, a group of Realtors or a group of doctors' offices the ability to go out and perhaps achieve some of the same kind of discounts that Verizon or AT&T or Wal-Mart get because they are such big employers. This is a very powerful concept to put in the hands of employers. In fact, it was a concept that was so good it was actually first proposed on the floor of this House by Bill Clinton in 1993 in his September speech to this body when he outlined his proposals for health care reform. Associated health plans were part of that reform package. I don't know what happened to them on the way to the end of the legislative process, but somewhere along the way, people stopped talking about them. But they are a good idea. Again, the concept has passed this House twice, in the 108th Congress and 109th Congress. It's a mystery to me why we don't take it up again. I think that is something the American people would be interested in our doing, and, goodness knows, they would like to see us work on something meaningful when it comes to health care. Now, regardless of whether the system is public or private, what have we seen in the way that information is transferred and handled? Have there been any changes in the last 100 years? Yes, I think so. Are there going to be changes in the next 25 years? I think you can bet on that. Vast changes in information technology are going to occur whether doctors want them to, whether hospitals want them to, whether insurance companies want them to. Those changes in how information is handled are going to occur, and they need to be facilitated. We are coming up to a time of rapid learning, and because of improvements in health care technology, the ability to manage databases, retrieve data in a timely fashion are going to be critical for the delivery of health care and protection of patients in the future. Madam Speaker, if I could, let me just share with my colleagues in the House a picture. When I was first elected to Congress in 2002, I have got to say I wasn't a big believer in electronic medical records. They are kind of cumbersome. When you are first learning them, they really slow you down. Your productivity suffers because you have got to learn this system. But 2 years ago at Charity Hospital in New Orleans, one of the venerable, venerable health care institutions of this country, the whole city of New Orleans was hit with Hurricane Katrina and then the flooding to follow the hurricane. Well, here is a picture from January 2006. So 5 months after the hurricane, the water has been pulled out of the city. Here is the medical records room at Charity Hospital. These records haven't been burned. This black stuff here, that is black mold. You could not send anyone in there to retrieve data off of one of these charts without imposing a significant health risk. I don't know what's contained within there, maybe a bone marrow transplant, childbirth, kidney transplant, heart attack. All of that information lost to the ages because they were contained on paper records. Again, I wasn't a big believer in electronic medical records, but walking through the records room at Charity Hospital that day, how many hours have I spent in the records room doing my medical records when I was on staff at various hospitals. It looked a lot like our records room at Parkland Hospital back in the 1970s. These records are lost. This patient's data are now forever irretrievable. And at some point we are going to have to come up with a system that allows that data to be stored in an area where it is not vulnerable to this type of degradation and that it is readily retrievable. And then guess what. If a patient is being seen in New Orleans and treated for a condition but they happen to travel to Fort Worth, Texas, and their medical records are needed, they are accessible online and immediately available to the treating doctors in the destination city. Another issue that I think we will have to pay some attention to is quality reporting. In my opinion, quality reporting should be voluntary, but it is important. Programs need to be generally available. They have got to be accessible to the medical personnel who desire to participate. Currently, I think in all 50 States, we have got quality improvement organizations, and they currently do a good job. They provide information, timely information, information back to the provider as to how the care was delivered. Was it delivered in a timely fashion? Was it delivered in a fashion that was utilizable? There are other ways of establishing quality. Legislation that passed in this House last time to establish a medical home also will result in the accumulation of some quality and some utilization data. I think that data needs to be available to the treating physician. It doesn't have to be widely disseminated publicly, but you make that data available to the physician, and physicians being naturally competitive sorts are going to ask the question, Well, that's interesting. I wonder if I could do better or how have I done in comparison to the people around me? And that will be useful information to provide to physicians and hospitals. Any of the quality reporting methods that are out there have to be generally available and accessible to all of the physicians practicing in a community. Yes, I would like for it to be voluntary, but if it is not generally available, ultimately it is not going to be useful. Now, this approach was a component of the Medicare physician update proposal by, at that time, Chairman Joe Barton of the Energy and Commerce Committee. He offered that late in 2006. I think it is a concept that should be revisited. Within the individual market, and, again, within the individual market I would include self-pay and also that individual who is the owner of a health savings account, within that portion of the market, transparency of information is critical, and that is another area where we are going to see rapid evolution and rapid change. It is going to require that there is adequacy of the reports that detail the information about cost, price, and quality, and they are not all the same. This information has to be linked to data detailing things like complications and infection rates. Web-based programs. We have got a good one in my home State of Texas. Web-based programs will begin to build databases and actually build familiarity with the consuming public so that these will become useful in the future. And www.txpricepoint.org is a Web-based program that is up and functioning in Texas. It's just beginning. Some people will look at it and say, well, that information is really pretty rudimentary, but currently it allows patients, say, in my home county of Denton County where there are four hospitals, to compare the costs of treating a fractured femur, episode of childbirth. How do those four hospitals compare in the area? Is there one that is significantly cheaper or one that is significantly more expensive than its counterparts? Maybe if that information is present, then to begin to ask the questions why and for the consumer to begin digging a little deeper and finding out more information about the hospital, whether or not they want to choose that hospital for their care. Again, not for people who have Medicare, Medicaid, SCHIP, or private insurance, but for the individual who is paying out of pocket or the individual who has a health savings account with a high deductible so, again, is probably paying out of pocket for a portion of their care. This is a useful exercise, and, again, I encourage people, particularly people in my home State of Texas, www.txpricepoint.org. Now, crafting a readily affordable basic package of insurance benefits perhaps modeled after what we already do in the Federally Qualified Health Center program is another important opportunity for reform that this body could look into. Currently, Federally Qualified Health Centers are required to provide a basic level of primary care. They also provide dental and mental health services. Providing a basic package of benefits along this line that is affordable and available with the option of adding on additional benefits at additional costs, that could be a powerful option for many Americans. This could remove some of the influence of some of the special interest groups, which I talked about earlier, and, again, allows us to focus on the patient and certainly allows a functioning business model to replace some of the draconian institutional standards that are now required. Providing a truly affordable basic package of benefits, that coverage which insurance companies then would want to market to segments of the uninsured population, you've got to believe that companies like Aetna, United look at 47 million people who are uninsured and say that's a potential market share. If we only had an affordable product that we could deliver to that population, we actually could perhaps provide a good deal of coverage for that population. Madam Speaker, let's not forget that care that is truly charitable: Organizing and providing a tax credit for donated services by doctors, nurses, even hospitals, I think that is something that is fundamental to the American psyche and something to be readily embraced by the American people. We could provide additional protection under the Federal Tort Claims Act, perhaps a legal safe harbor from lawsuits where, in good faith, charitable care is provided and, in effect, allow providers who are retired or semiretired to return and fill some of the vacuum for indigent care. I had an acquaintance whose father is a physician. Hurricane Katrina hit, obviously, the next-door neighbor State of Louisiana, but a lot of people left Louisiana and came to Texas. There were a lot of areas that were strained in their availability to deliver health care in that time 2 years ago. This acquaintance's dad was a physician. He was a retired physician, no longer carried insurance, and said, well, I'm going to go down to the shelter where these people are being received and offer my services. And my friend was quite concerned about his dad and said, you don't have insurance. If you go down there and something bad happens and you get sued, you have no coverage for that. Maybe we ought to provide a mechanism for providing that coverage for someone who truly, out of the goodness of their heart, wants to respond to a national emergency, wants to respond to their country in a time of need, allow them the opportunity of doing that. And along those lines, we ought to have a system of emergency credentialing so that when people just show up on a scene of a disaster, whoever is in charge, the first responders in charge will have a way of quickly and rapidly assessing whether this individual, indeed, possesses the credentials that they purport to have. And that would go a long way towards alleviating, frankly, some of the confusion that occurred on the ground in various health care sites, not just in Texas, but back in Louisiana as well. Madam Speaker, the late President Ronald Reagan used to say, ``trust, but verify.'' Trust the market to make correct decisions, and to the extent that distortions can be removed, remove those distortions, but remember that some guidance from market principles will always be required, whether the system is completely public or completely private. Finally, as part of this discussion, there must be a rational breakdown of the numbers of the uninsured. We want to talk about, how do we cover the uninsured? We don't have accurate numbers, not for the total number of the uninsured, but who comprises that population? We just say 47 million uninsured. And we're happy to talk about that in a political sense, but we need the data on the breakdown of those numbers so we know how to better craft policies that will provide coverage that's needed for those individuals. Is it just that some people aren't bothering to buy insurance? Maybe we craft a policy that would encourage them to do that. I don't like mandates. I prefer incentives. Other people may like mandates. But let's have that discussion. But if we don't know how big the population is who just choose not to have health insurance but has the means to pay for it, we will never be able to enter into that discussion because we don't know. We just say 47 million uninsured. We hit each other over the head with it. We go home at the end of the day and feel like we've done a good job, the American people say not so much. Finally, just a point of contrast. And we've heard it a lot because of our health care discussions this week. My good friends on the other side of the aisle want to expand a culture of dependence on the state, while on my side of the aisle we want to expand the number of individuals who actually own and direct their own care. Which system would you choose? Which system gives you the greater liberty, the greater freedom that we all treasure and cherish as Americans? The answer for me is obvious. Finally, Madam Speaker, we talked about this a little bit at the beginning of this discussion, but the concept of American exceptionalism. The American health care system has no shortage of critics, critics throughout this body, critics throughout the city, critics throughout the world, but it is the American system that stands at the forefront of innovation and new technology, precisely the types of system-wide changes that are going to be necessary to efficiently and effectively provide care for Americans today and on into the future. Now, Madam Speaker, I would rather this information not be widely disseminated, but from time to time I pick up and read the New York Times. An article in the New York Times from October 5, 2006, a year ago, by an individual named Tyler Cowlan, he writes, ``When it comes to medical innovation, the United States is the world's leader. In the past 10 years, 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 went to researchers outside this country; 15-7, America, the rest of the world.'' 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, comparisons with other countries may be useful, it may be information that we want to go out and seek and consider when crafting health care policy, but it is important to remember that it's the American system that's always reinventing itself and always seeking to improve itself. It is precisely because of the tension inherent in our hybrid system that creates the impetus for change. A system that's fully funded by a payroll tax, well, that's what they've got in Sweden. I think it's 7.1 percent that they pay on their payroll tax, and it funds their health care system. But quite honestly, Madam Speaker, there is no reason for them ever to seek improvement; and as a consequence, a system like that faces stagnation. And indeed, if such a system, if it becomes necessary to control costs, guess where they look? Doctor, they look at you. They look at the provider. You know this. It's happening in the Medicare system, cuts projected for as far as the eye can see. Make no mistake about it, if the Democrats are successful with this SCHIP system that they are proposing to vastly expand, it's going to drive kids off of private health insurance onto an SCHIP program. The difficulties faced by providers within the Medicare system on an ongoing basis are certainly witness to this. The fact is, Madam Speaker, 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 it's different from other countries, this difference should be acknowledged and embraced when it comes time to talk about reform or transformation, whether it's contemplated in a purely public or private health insurance model within this country. One final point that's illustrated in a recent news story that was covered by a national Canadian television broadcaster about a Canadian Member of Parliament who sought treatment for cancer within the United States. The story itself is not particularly unique, but the online comments that followed the story I thought were pretty instructive. To be sure, a number of the respondents felt that it was unfair to draw any conclusion because this was, after all, an individual who was ill and was seeking treatment. No argument with that concept. I hope she got the treatment that she sought, and I certainly pray that she got better. No one could argue this point. But one writer summed it up, ``She joins a lengthy list of Canadians who go to the United States to get treated. Unfortunately, the mythology that the state-run medicine is superior to that of the private sector takes precedent over the health of individual Canadians.'' A further comment from another individual: ``The story here isn't about those who get treatment in the United States. It's about a liberal politician who is part of a political party that espouses the Canadian public system and vows to ensure that no private health care is going to usurp the current system. She is a Member of Parliament for the party that relentlessly attacked conservatives for their ``hidden agenda'' to privatize health care. The irony and the hypocrisy in that position supports the notion that the rich get health care and the rest of us wait in line. All because liberals' fear-mongering that does not allow for a real debate on the state of the health care system in Canada.'' One final note from the online postings, ``It's been sort of alluded to, but I hope everyone who is reading this story realizes that, in fact, we do have a two-tiered system in Canada. We have public care in Canada. And for those who have lots of cash, we've got private care in the United States, which is quicker and better.'' Well, Madam Speaker, a little over a year ago, maybe now a year and a half ago, Alan Greenspan came and talked to a group of us one morning before he left Capitol Hill. And as it often happens with Chairman Greenspan, the talk came around to entitlements and entitlement spending. And the question got around to Medicare, how are we going to pay for Medicare. And the chairman acknowledged this is going to be a tough problem. But after he thought about it, he also said, ``When it comes time, I think that the Congress is going to end up doing the right thing and it will find a way to pay for Medicare.'' He said, ``What concerns me more is, will there be anyone there to actually deliver the services that you want?'' That's a pretty profound statement, and one that certainly has stuck with me for the past year and a half or more. Now, in March of this year, back in my home State of Texas, the official magazine of the Texas Medical Association, Texas Medicine, put out a story. In fact, their cover story that month was, ``Running Out of Doctors.'' I think that's something we need to pay some attention to in this body. With all of our discussion about health care reform, all of our talk about changing the system this way or that way, more public, less public, more private, less private, if we ain't got the docs on the front line, it doesn't matter what we do because the care won't be there for the patients. We see this in the Medicare system. There is probably no other issue that I deal with with more frequency than the program cuts that are going to happen to Medicare physicians, again, literally, as far as the eye can see; 5 percent cut this year, 5 percent cut next year, oh, by the way, we've got to make up that 10 percent cut from last year. The problem is, the formula by which we pay physicians is different from the formula by which we reimburse hospitals, HMOs, drug companies and nursing homes. Bear with me for just a moment because, wouldn't you know it, I have a poster that illustrates that. And I apologize, this one has gotten a little bit dated. The 2007 number has an asterisk beside it because that was projected, and now we're well into 2007. This didn't happen because we held it back at zero. So it looks like there is no recording here for physician reimbursement under 2006; in fact, it was held at zero. Again, by a last-minute maneuver last year, we held it at zero for 2007 as well. 2002, pretty big cut. We did some last-minute changes in 2003, 2004 and 2005, which prevented the program cuts. We were unable to come up with any additional money in 2006 and 2007. Now, for 2008 and 2009, move this bar graph over a notch for those 2 years because that, after all, is what we're looking at, Medicare Advantage, hospitals, nursing homes, they're basically reimbursed on a cost of living adjustment, it's called the Medicare Economic Index. Physicians ought to be reimbursed on the Medicare Economic Index, but they're not, and we need to fix that. It's not easy to fix it. It's going to cost some money. The Congressional Budget Office puts a very big number up there. Deep down in my heart I don't believe it's a real number, but nevertheless, we do need to be sensitive to that fact and we do need to fix it. I would encourage Members to look at H.R. 2585. It is a way to sanely repeal the sustainable growth rate. It doesn't do it next year, waits a couple of years to do it, but because of some adjustments to the baseline, physicians won't, in fact, take a cut for 2008 and 2009. We need to keep them involved. And then in 2010, the SGR is repealed, with savings that are going to occur over the next 2 years. And we know savings are going to occur in the Medicare program over the next 2 years because that's the history that we've seen in the last several years. The trustees' report that came out just this past June had some good news and some bad news. The bad news was, we're still going broke; but the good news is we're going to go broke a year later than what we told you last year. The reason is because 600,000 hospital beds weren't filled in 2005 that they thought would be filled in 2005. And why weren't they filled? Because the doctors were doing a better job. They were keeping people out of the hospital. Maybe the prescription drug benefit was allowing them for more timely treatment of disease, to treat disease earlier. So we didn't push them on that health disease continuum in the arena of disease, we kept them on the side of health. Things that are done in ambulatory surgery centers that are billed to part B, the physicians' part of Medicare, are actually savings that accrue in part A. Let's take those savings, sequester them, wall them off, a lock box, like we used to talk about back in 2000. Remember that? Put those savings in a lock box and use them to offset the cost of repealing the SGR in 2010. That is the type of innovative thinking that is going to be required to get us out of this conundrum. And why is it important? Again, Alan Greenspan said, ``What worries me more is not how you pay for it, but is there going to be anyone there at the bedside to provide the service?'' I don't want to make light of what is a very serious situation. Yeah, there will always be someone there at the bedside, but I don't know that you want to look up and find it is Dr. Nick who is delivering your care, Dr. Nick, the famous physician from Springfield, Somewhere, U.S.A. who can do any operation for $199.95. That may be the physician of the future. We don't want to leave that legacy for our children. We need to correct this situation now. We can do it in this Congress if we just have the political will to work together to get this done. Now, my time is almost up. This discussion on health care is likely to consume the better part of the next 2 years of both dialogue here on the floor of the House, dialogue on the Presidential campaign trail, and indeed dialogue in the general public. The United States is, indeed, at a crossroads. It is incumbent on every one of us here who believes, who believes in the American system of providing health care, that we be educated and we stay involved and we be committed to being at the top of our game every single day, whether we agree on every principle or not. We have to be on the top of our game every single day. This is one of those rare instances where it is necessary, certainly on my side, to be prepared to win the debate because we don't have the votes to win much of anything in subcommittee, committee or the House floor. But it is an important topic. It is one of that the American people believe that we should be involved in. If we adhere to the principles that I have outlined here this evening, I think that ultimately we are going to post a win for the health of the American people and for generations yet to come. That is the central task in front of us.

Mr. BURGESS

Mr. BURGESS. Mr. Speaker, I thank the gentleman for yielding. I thank our committee chairman for bringing this bill to the floor and all the people who have worked so hard on this legislation over the years. Mr. Speaker, I am going to rise in support today of H.R. 1721, the Virginia Graeme Baker Pool and Spa Safety Act. During the Commerce, Trade and Consumer Protection Subcommittee markup, it occurred to me because of some things that had happened back in my district that there was an additional danger that was not being addressed in the hearings we had leading up to this legislation. So during the subcommittee process, I introduced an amendment that was inspired by the tragic accident that occurred in an ornamental pool back in my district back in Fort Worth, Texas. In June of 2004, three children and one adult drowned at the Fort Worth Water Gardens: Myron Dukes, age 39; his daughter, Lauren, age 8; his son, Christopher, 13; and a family friend, Juanitrice Deadmon, age 11. On that tragic day, one child accidentally fell into the ornamental pool and the other three jumped in trying to save the child. Compounding the tragedy, the water was unusually deep due to a recirculating pump malfunction and recent heavy rains. Mr. Speaker, let me quote to you and the House from the Fort Worth Star Telegram about that event. Fort Worth Star Telegram June 17, 2004: ``The victims were among the thousands of visitors attending the National Baptist Congress at the Fort Worth Convention Center. ``The pastor, Gerald Dew, said he was told that the children went to the Water Gardens to play because the swimming pool at the Fort Worth Plaza Hotel where they were staying was closed for maintenance. ``One of the children slipped, which started a chain reaction. ``Bike patrol officer Tony Maldonado, who was one of the first officers to arrive at the swimming pool, said he jumped in and the force `literally sucked the socks off of my feet.' '' From the Fort Worth Star Telegram 2004. While this tragedy happened in Fort Worth, the visitors were from Chicago and were constituents of my subcommittee chairman and friend, Congressman Rush. I know that both of our cities, Fort Worth, Texas, and Chicago, Illinois, grieved about this loss. Mr. Speaker, let me quote to you from an online report from the CBS affiliate in Chicago, Chicago.com, on the reopening of the Water Gardens last spring. This is from March 20, 2007: ``The park of artistic pools and fountains closed following the June 2004 drownings of the four from Chicago, who were in Fort Worth for a religious convention. Since then, more than $3 million in modifications to improve the park's safety have been made. ` ``The renovations from the past month don't take away from the mystique,' Mayor Michael Moncrief said during the ceremonies. ``Now, the depth of the Active Pool, where the drownings occurred, has been restricted to less than 2 feet. Other renovations include new pumps and pump system, switches, electrical work, lights and additional handrails, as well as a larger and easier- to-clean drain system around the park's perimeter.'' Mr. Speaker, as with many things in life, awareness and education can save lives. And this disaster, this disaster that happened in my district in Fort Worth, must not be repeated. More education regarding the unseen dangers hidden in ornamental pools is necessary. Mr. Speaker, almost every single community in this country has an ornamental pool. We have quite a few here at the Capitol. While 36 States have pool safety programs, not all of these States have an ornamental pool safety program, and therefore they likely do not educate their constituency on the dangers that ornamental pools can represent. Ornamental pools often greatly enhance communities, but they can also pose a great threat to communities if the owners and operators are not educated as to the potential danger. Through my amendment in this bill, there will be a wider public education campaign to alert consumers to the safety hazards associated and the requirements for proper maintenance of ornamental pools. The bill, which requires the use of proper anti-entrapment drain covers and drainage systems, establishes a swimming pool safety grant program to be administered by the Consumer Product Safety Commission. This legislation also encourages States to strengthen pool and spa safety laws and increase public education and outreach to consumers. I believe the inclusions of ornamental pools in this bill is an important component of this legislation. Mr. Speaker, I urge my colleagues to support the bill.

Mr. BURGESS

Mr. BURGESS. Madam Speaker, I rise today to honor Dr. James T. Willerson for his work as President at the University of Texas Health Science Center at Houston. Dr. Willerson will be stepping down from his position to become the next President at the Texas Heart Institute. Dr. Willerson graduated with honors in 1965 from Baylor College of Medicine and in 1972 joined the faculty at UT Southwestern Medical School in Dallas. In 1989, Dr. Willerson became chair of the Department of Internal Medicine at the UT Medical School where he served until 2001, when he became President of the UT Health Science Center at Houston. During his time as President at the UT Health Science Center, the school has utilized over $700 million for the building of seven new research buildings, educational programs and clinical services, and recruiting some of the world's best scientists and educators. Class sizes have also been increased at each of the university's six schools. Thanks to the efforts of Dr. Willerson, the University of Texas Health Science Center at Houston is poised for greatness. It is with pride today that I honor Dr. Willerson for the outstanding works he has done at the University of Texas Health Science Center at Houston during his rein as President. I also wish him the best of luck at his future position as President of the Texas Heart Institute.

Mr. BURGESS

Mr. BURGESS. Madam Speaker, I rise today to congratulate Burton and Nellie Searles for receiving the ``Foster Parents of the Year'' award. This award is given to one family each year by the Texas Council of Child Welfare Board. On September 20, 2007, the Searles received the award at the 29th Annual Cheerleaders for Texas Children ceremony. Mr. and Mrs. Searles have been fostering children for 18 years. The couple, who will be married 49 years in February of 2008, have fostered a total of 77 children in their home. In addition to three children of their own, they have also adopted a child. Mr. and Mrs. Searles began taking care of basic children but then changed their foster care licenses to take care of special needs children. The Searles say that they love taking care of special needs children because of the challenge. The Searles also plan on continuing care for foster children for many years to come. I extend my sincerest congratulations to Mr. and Mrs. Searles for their award. I thank them for their devotion and dedication to helping foster children. I am very proud and honored to represent them in the 26th District of Texas.

Mr. BURGESS

Mr. BURGESS. Mr. Speaker, I yield myself the balance of my time. Mr. Speaker, I do want to thank my friends who have come to the floor to help us today honor Dr. Michael DeBakey. I do want to thank Al Green for his persistence in getting this bill to the floor. It has been a long time in the making. And obviously I want to thank our senior Senator from Texas, Kay Bailey Hutchison, and certainly thank Chairman Frank for allowing the Senate bill to come through the floor procedure so that we may hasten this floor process for Dr. DeBakey. As has been mentioned here several times this morning, Dr. DeBakey is 99 years old and certainly deserving of this honor, and we need to get it to him with all haste. Dr. DeBakey is the father of cardiovascular surgery in our country. And I do encourage my colleagues to vote in favor of S. 474, a bill to designate the Congressional Gold Medal for the famed Houston heart surgeon. This bill has been very important to me, as one of the physicians in the House of Representatives, to be able today to come to the floor and talk about how Dr. DeBakey changed the face of medicine so significantly forever in this country. As a fellow physician, Dr. DeBakey's work on medical advancements is legendary. His dedication to healing those around him came not only from his talents as a physician but his ongoing commitment to the larger medical community. His motto, as we heard others mention it today, was ``strive for nothing less than excellence.'' Boy, every Member of this House could adopt that as one of our mottos and do better by the country for it. Mr. Speaker, I would be remiss if I didn't mention the education and entrepreneurial spirit that made him worthy of the Nation's highest expression of appreciation for distinguished achievements and contributions. Dr. DeBakey received his bachelor's and M.D. degree from Tulane University in New Orleans, as we have already heard mentioned. He delivered Al Green in medical school. But probably more importantly, while in medical school, he developed the roller pump, later to become the major component in the heart-lung machine that is used in open heart surgery routinely today. This was a groundbreaking achievement, Mr. Speaker. Every pump to pump the heart, to take over the work of the heart artificially, prior to that time, had worked on a mechanical piston-type arrangement. Dr. DeBakey envisioned the roller pump which preserved the structure of red blood cells as they took their course through the pump and allowed this pump to, in fact, become part and parcel with something that we now just all accept as part of cardiovascular surgery. It was truly a visionary change. Again, he popularized that while he was in medical school in the 1930s. Now, Dr. DeBakey completed his internship at Charity Hospital, one of the venerable institutions of learning in this country. Many of my professors at Parkman Hospital trained at Charity Hospital. Charity Hospital is no longer with us because of the ravages of Hurricane Katrina 2 years ago. After Dr. DeBakey completed his internship at Charity, he went on to the University of Strasbourg in France and the University of Heidelberg in Germany. He volunteered for service in World War II and was subsequently named director of the surgical consultants division of the U.S. Surgeon General's Office. His work during that war led to the development of what we have already heard described today as the Mobile Army Surgical Hospital, the so-called MASH unit. Mr. Green has already eloquently pointed out that we wouldn't have the MASH units today. More importantly, we wouldn't have those forward surgical teams that go into the combat areas and provide vital care to our soldiers in that first golden hour after injury, all of that pioneered by Dr. DeBakey well over two generations ago. He helped establish the specialized medical and surgical center system for treating military personnel returning home from war, which we now know as the Veterans Administration Medical Center. But it was at Methodist Hospital in Houston where Dr. DeBakey performed many of his groundbreaking surgeries, including the first removal of a carotid artery blockage in 1950, interestingly the year that I was born, the first coronary artery bypass graft in 1964, the first use of a ventricle assist device to pump blood and support a diseased heart in 1966; and then on to some of the first heart transplants in this country in 1968 and 1969. He developed a self-contained miniaturized left ventricular assist device to pump blood for a diseased heart, something that is in use to this day. The techniques used to miniaturize the device's inner workings were developed by engineers working on the Nation's space program at nearby NASA. He has served as adviser to every President of the United States for the last 50 years. Think of that, Mr. Speaker: every President for the last 50 years has depended upon Dr. Michael DeBakey for medical advice. He has given advice to heads of state throughout the world and traveled famously to Russia in 1996 to consult on heart surgery for the ailing Boris Yeltsin. I have to believe, Mr. Speaker, that he did a lot more than consult in that operating room that day 10 years ago. During his professional surgical career, he performed more than 60,000 cardiovascular procedures and trained thousands of surgeons who practice around the world. Today, his name is affixed to any number of organizations, centers for learning and projects devoted to medical education and health education for the general public. But think of this, Mr. Speaker: Dr. DeBakey also underwent an operation that was named for him. I picked up a copy of the New York Times last December and read a story about how Dr. DeBakey had undergone the surgery that he himself had described many years before. In fact, Dr. DeBakey admitted that at the time, although he knew he was ill, he never called his own doctor, he never called 911. ``If it becomes intense enough you are perfectly willing to accept cardiac arrest as a possible way of getting rid of the pain.'' This is what he told the New York Times last year. What a unique, what a pragmatic individual. He helped establish the National Library of Medicine which is now the world's largest and most prestigious repository of medical archives. The National Library of Medicine is something I look at several times a week as I prepare for committee hearings on our Committee on Energy and Commerce, developed and established by Dr. Michael DeBakey. Mr. Speaker, as we talk in this Congress about the need for improving computer technology for medical records and medical information, Dr. DeBakey was on the forefront of that while most of us were still in grammar school. In 1969 he received the highest honor a United States citizen can receive, the Presidential Medal of Freedom with Distinction. In 1976, his students founded the Michael E. DeBakey International Surgical Society. His contributions to medicine and his breakthrough surgeries and innovative devices have completely transformed our view of the human body and our view of longevity on this planet. He has been designated as a living legend by the United States Library of Congress; and, today, we take another step in honoring him with the Congressional Gold Medal. Mr. Speaker, it has been a high honor for me to be associated with this endeavor. And I certainly do thank Mr. Green and thank him for allowing me to be on the telephone when we gave the news to Dr. DeBakey several weeks ago on his 99th birthday. It is imperative that we get this legislation accomplished quickly. I appreciate Mr. Green's willingness to work with the other body in getting this legislation to the floor so swiftly. Mr. Speaker, I yield back the balance of my time.

Mr. BURGESS. Mr. Speaker, at this time I would like to yield such time as he may consume to the gentleman from Texas, one of the original cosponsors of this bill, Mr. Culberson.

Mr. BURGESS. Mr. Speaker, I am now pleased to yield such time as he may consume to the gentleman from Texas (Mr. Poe).

Mr. BURGESS

Mr. BURGESS. Mr. Speaker, I am coming to the floor tonight to talk, as I often do, about health care, the state of health care in America, some of the things that we face as a country, as a Congress. And, Mr. Speaker, we have reached a point where it is kind of a unique time, and it occurs from time to time in our Nation's history in political cycles that we have the political reality of unfettered election-year politics meeting head on with the perennial challenge of redefining or reforming America's health care system. Mr. Speaker, the history of health care in America over, say, the past 60-plus years going back to the 1940s is that of a very highly structured, highly ordered scientific process coupled with a variety of governmental policies, policies each aimed at achieving a specific objective; but rarely do we get the opportunity to reexamine the policies and what follows on from those policies and how they continue to affect things years and decades into the future. Mr. Speaker, if we go back to that time in the middle 1940s, the time of the Second World War, some significant scientific advances occurred. In 1928, for example, Sir Alexander Fleming rediscovered penicillin. It actually had been discovered in the late 1800s, but Sir Alexander Fleming in England discovered that the growth of a bacteria called staphylococcus could be inhibited by the growth of a certain type of mold on the auger plate. Well, it took some additional research. It took some additional input from other scientists who actually came to this country and developed the process of fermentation that allowed for the large-scale production of that compound that we now know as penicillin, a compound that when it was first discovered was priceless. You couldn't get it at any cost and by 1946 had come down to about 55 cents a dose, all because of American ingenuity coming into play in the mid-1940s. In fact, soldiers injured during the invasion of Normandy on D-Day were oftentimes treated for their wartime-acquired wounds that became infected with penicillin. Another individual, an individual we have honored on the floor of this House during the last Congress, Dr. Percy Julian, an African American scientist or, actually, an organic chemist, who didn't discover cortisone. Cortisone had been discovered earlier. But the extraction of cortisone from the adrenal glands of oxen was a laborious time-intensive process, and as a consequence, cortisone was only available as a curiosity, as an oddity. But Dr. Julian perfected a methodology for building cortisone out of precursor molecules that were present in soybeans and, as a consequence, ushered in the age of the commercial production of cortisone. So there in the 1940s, we had the development of two processes that allowed for the commercial application of an antibiotic, an anti- infective agent, that previously was unavailable on the scale that it was made available after the Second World War, and an anti- inflammatory, cortisone, for treating things like rheumatoid arthritis, Addison's disease. Cortisone now on a commercially available basis. These changes profoundly affected the practice of American medicine starting at about the time of the Second World War. But what about on the policy arena? Did anything significant happen during the Second World War? Well, you bet it did. What happened during the Second World War is President Roosevelt said in order to keep down trouble from inflation, he was going to enact some very strict wage and price controls on American workers. And he felt it was necessary to do that because, after all, the country was at war. Well, employers were looking for ways to keep their workers involved and keep them on the job, and they came up with the idea, well, maybe we could offer benefits. Maybe we could offer health insurance, retirement plans. It was somewhat controversial as to whether or not these could, in fact, be offered at a time of such strict wage and price controls, controversial as to whether or not these added-on benefits would be taxed at regular earnings rates. Well, the Supreme Court ruled that they could, indeed, be offered; that they did not violate the spirit of the wage and price controls, and, in fact, they could be awarded as a pretax expense. Fast forward another 20 years to the mid-1960s, and now the administration and the Congress are locked in the discussion and the debates that ultimately led to the passage of the amendment to the Social Security Act that we now know as the Medicare program. Suddenly we have a situation where the body of scientific evidence, the body of scientific knowledge is expanding at an ever-increasing rate. We have got some fundamentally different ways of paying for health care, some in the private sector and now some in the public sector, all leading to what is happening currently at the present time. Now, again, going back to the Second World War, most health care was paid for at the time of service, and that was a cash exchange between the patient and the physician or the patient and the hospital. Now, with the advent of employer-derived health insurance and with the interposition of now this large government program, most health care is now administered through some type of third-party arrangement. Now, this is useful. It protects the individual who is covered from large cash outlays. But there is a trade-off, and this covered individual is generally unaware of the cost of the care that is rendered, as well as the provider who is quite happy to remain insensitive as to the cost of the care that is ordered. This arrangement has created an environment that permits rapid growth in all health care sector costs. We have a hybrid system. America's challenge then becomes evident. How do we improve upon the model of the current hybrid system, which involves both public and private payment for health care and which anesthetizes most parties involved as to the true cost of this care? It's also wise to consider that any truly useful attempt to modernize the system, any attempt to modernize the system, the primary goal has to be, first off, protect the people instead of protecting the status quo. Now, we must also ask ourselves if the goal is to protect a system of third-party payment or provide Americans with a reasonable way to obtain health care and allow physicians a reasonable way to provide care for their patients. Remember that the fundamental unit of production is the interaction that takes place between the medical professional, the physician, and the patient in the treatment room. That fundamental interaction is the widget that is produced by this large health care machine, and sometimes that concept gets absolutely lost in translation. Now, the current situation subsidizes and makes payment to those indirectly involved in the delivery of that widget, and ultimately that drives up the cost. Now, currently in the United States, we spend, depending upon what you read, 15, 16, and 17 percent of the gross domestic product on health care, amounting to about $1.6 trillion a year. Within that total amount of spending, the government accounts for approximately half. When you add together the expenditure of the Medicare, the Medicaid system, the Federal prison system, VA system, Indian health service, all of those things together equal about 50 cents out of every health care dollar that is spent in this country. The other half is made up by commercial insurance, self-pay, and I would include health savings accounts in that grouping of self-pay. Certainly some percentage is made up by services that are just simply donated or never reimbursed. We might call it charity care. A lot of money is spent in health care, but only a fraction on direct patient care and oftentimes too much on an inefficient system. Now, the test before us, the test before this Congress, the test before this country is to protect the people instead of providing protection to special interests. Define that which ought to be determined by market forces, market principles, and that which of necessity must being left in the realm of a government or public provider; that balance between the public and private sectors, and how in all of this process we preserve the individual self-direction instead of establishing supremacy of the State. Additionally, we must challenge those things that result in the extortion of market forces in health care and acknowledge that some of that extortion is endemic, some of it's built into the system, some of it's hidden and not readily changed, and some of it is, in fact, easily amenable to change. And we need to know the difference, and we need to know what is worthwhile to try to effect change. Now, the key here is how to maximize value at the production level; again, where that widget is produced, the doctor-patient interaction in the treatment room. How do we place a patient who exists on a continuum between health and disease, how do we shift that balance more in the favor of a state of continued health, which is obviously less expensive than paying for disease? Do we allow physicians a return on the investment, which opens up a host of questions relating to future physician workforce issues, and I am going to touch on those in more detail in just a minute. How do we keep the employer, if the employer is involved, how do we get them to see value in a system, things like a quicker return of an ill employee to work, increased productivity, better maintenance of a healthy and more satisfied workforce? In regards to health insurance, how to provide a predictable and manage risk environment, remembering that insurance companies are, of necessity, they tend to seek a state of a natural monopoly; and if left unchecked, they will, indeed, seek that condition. And finally, how do we balance the needs of hospitals, ambulatory surgery centers, long-term care facilities and the needs of the community, as well as the needs of doctors, nurses and administrators? Now, Mr. Speaker, some legislation has already been introduced to try to effect some of these changes. I want to make reference at this point to a publication that's produced by my home State organization, the Texas Medical Association. Last March, this was the cover of their publication, Texas Medicine. It referenced that the United States may, in fact, be running out of doctors. So I've introduced three pieces of legislation geared toward the physician workforce and how do we keep the workforce involved and engaged. Alan Greenspan, talking to a group of us right before he retired as chairman of the Federal Reserve, came in and talked to a group of us one morning and was asked the question: How in the world are we ever going to pay for Medicare going into the future? And he thought about it for a moment and he said, if I recall correctly he said, ``Well, I'm not sure. But I think when the time comes, you will do what is necessary to preserve the system.'' And I believe he is right. But he went on to say, ``What concerns me more is will there be anyone there to provide the services that you require.'' Well, Mr. Speaker, in an effort to be certain that there are the people there to provide the services that we require, I introduced legislation such as 2583. This establishes low-interest loans for hospitals seeking to establish residencies in high-need specialties, primary care, general surgery, OB/GYN, gerontology in medically underserved areas. It turns out one of the thrusts of this article is that doctors tend to have a lot of inertia, they tend to go into practice close to where they had trained. So if we can establish residency programs where none currently exist in communities of moderate to small size and allow those physicians to undergo their training in those community hospitals, they're very likely to settle in or very close to those communities, thereby driving the equation in favor of supplying physicians in high-need specialties in medically underserved areas. Another piece of legislation, H.R. 2584, is more geared at the medical student or perhaps even the student in college, the student who's considering a career in health professions. And this expands the old health professions scholarships, provides the availability of scholarships, provides the availability of low-interest loans, provides the availability of favorable tax treatment if an individual is willing to go into practice in a medically underserved area in a high-need specialty. And then finally, the third piece of legislation, 2585, deals with more of what I would describe as the mature physician, that physician who has been in practice. But one of the problems of our publicly financed side of health care, one of the problems in the Medicare side is that reimbursement rates for doctors are decreased year over year as an effort to control costs in the overall program, but the result is it tends to drive doctors away from practice. So this bill would have at its heart the repeal of a payment formula that is referred to as the ``sustainable growth rate,'' or SGR formula, which I believe is critical. I believe we have to repeal that formula if indeed we're going to keep physicians involved in the process. Mr. Speaker, another component of this bill, 2585, does allow for some voluntary compensation if a physician or group wishes to participate in a system to upgrade health information technology. And I put this slide up here, Mr. Speaker, because this is the records room at Charity Hospital in New Orleans taken in October of 2005. You can see that, although the records themselves were not disturbed by the wind of that particular storm, that records room is in the basement and it was completely under water for several days. And you can see there, this is 2 months after the storm, probably a month after the water was removed from the downtown area of New Orleans and removed from the basement, you can see the destruction evident on those paper records. And clearly, that's a situation that has to be addressed. If we are going to move America forward into the 21st century, that's a condition that has to be addressed. And I have attempted to do that in H.R. 2585, as it deals with the medical workforce; it also deals with some bonus payments to allow physicians who wish to voluntarily participate in an upgrade of health information technology, allows them the freedom to do that. Other legislation that is out there, H.R. 3509. H.R. 3509 is a medical liability bill. And this bill was crafted after legislation that was passed in my home State of Texas in September of 2003. This was legislation that was crafted, it was styled after the Medical Injury Compensation Reform Act of 1975 passed by the State of California and then modernized for the 21st century. And what this bill does is provide a cap on noneconomic damages. It is a cap that is shared between physicians, hospitals, a second hospital or a nursing home, if one is involved. Each entity is capped at a $250,000 payment for noneconomic damages, or an aggregate cap of $750,000. Now, the reason I bring this up, the reason I introduced this legislation that is similar to the Texas-passed legislation in the House of Representatives, is, after all, our Founding Fathers said that the States should function as laboratories for the country. So here we have the State of Texas functioning as a laboratory for meaningful liability reform in the health care sector. And the results are in and the results are clear; 4 years after this legislation was passed we have held rates down for premiums for medical liability insurance for physicians. More importantly, a State that was losing insurers at a rapid rate, we had gone from 17 insurers down to two by the end of 2002, which was my last year of active practice, and now we're back up to numbers in the twenties or thirties. And these liability insurance carriers have come back to the State without an increase in premiums. In fact, the Texas Medical Liability Trust, my old insurer of record, has lowered rates by about 22 percent at the time of my last calculation. This is critical for getting the young individual who is in high school or college interested in a career in the health profession. The crisis in medical liability that exists in many areas of the country serves as a deterrent, a repellant that keeps young people from even thinking about a career in health care. And that is, in fact, one that we do desperately need to change. Let me, just for a moment, go back to the Texas Medical Association hypothesis, ``are we running out of doctors,'' and the comments of Chairman Greenspan as he spoke to our group early that morning, now probably some 18 months ago. Will we run out of doctors? No. The answer is we probably won't. I guess we should ask ourselves: If we make the climate too inhospitable, if we make the climate too difficult, what will the doctors of the 21st century look like? Well, I don't know. But from time to time I allow myself some internal speculation as to what the medical workforce of the future might resemble, and sometimes I come across this young individual, kind of a health care entrepreneur from a famous American sitcom that is seen on the Fox Network. I don't know. But it's not worth running the risk of running out of physicians and not attracting the best and brightest into the practice of medicine. Now, that brings me to what I would describe as a set of principles that for any health care legislation that I endorse, that I embrace, that I put out there myself or that I cosponsor, what are the principles that I need to see? Well, certainly, first and foremost, you have to have freedom of choice. American patients, they want to see who they want to see, they want to see them when they want to see them, and if hospitalization is required, no one objects to an incentive. But freedom of choice must remain central to any system, whether it is private or public, in this country. Ownership. We hear a lot about the ownership society, things both good and bad. But I will tell you something, from having myself had a medical savings account starting back in 1997, when they first became available, until the time I left private practice in 2002. The whole concept of having a health savings account or, if you will, a medical individual retirement account, a medical IRA, and being allowed to accumulate savings in that account to offset future medical expenses, that's a fundamental desire of many people in this country. And many Americans in this country feel the same way, and, in fact, I'm of the opinion that that should be encouraged. The dollars accumulated in those accounts, and this is the great thing about them, even if you no longer have the account, which I no longer am insured through an HSA because when I came to Congress they weren't generally available. Now they are and I haven't switched back, but that money is still there. It still grows month by month at the regular savings rates. Right now I think it's about 4.5 percent, so a reasonable rate of return on that investment. But that money is there for me and my family to use in the future should any medical expenses arise that maybe aren't covered by other insurance. Well, what happens if I get to the end of a long and happy life and I've never had to tap into those savings, what happens to them then? They stay in my family. They're available to my heirs and assigns for the coverage of their care going into the future, and all the while continuing to grow in value, tax deferred because that's the way the law was written back in 1997 when I first opened that account. These dollars are dedicated to health care, they're owned by the individual, and they don't, by default, go to some governmental entity upon the death of the individual who's covered. Now, another principle that I think is just critical to any discussion of health care is independence. There has to be preservation of autonomy. The patient or the patient's designee should ultimately be responsible for their care and the ability to accept or decline medical intervention. High standards, one of the things that we pride ourselves on in this country, one of the underpinnings of the American medical system has always been high standards of excellence, and nothing in any future change should undermine that. And, in fact, pathways to facilitate future growth in excellence really ought to be encouraged. Mr. Speaker, we have to preserve innovative approaches. American medicine has always been characterized as embracing innovation, developing new technologies and treatments. Clearly innovation must be preserved in any process going forward. Another key is timeliness. Access to a waiting list does not equate to access to care; so spoke the Canadian Supreme Court to its medical system in 2005. We must diligently seek not to duplicate the most sinister type of rationing, which is a waiting list. And that can be, unfortunately, involved with any large health care system, whether it be a nationalized single payer system or, indeed, a very, very large private system. We have to keep it market based and not administrative. Pricing should always be based on what is actually indicated by market conditions and not what is assumed by administrators. Remember, in general, mandates lead to a restriction of services. State mandates cause more harm than good, impede competition and choice, drive up the cost of care and can actually limit the availability of health insurance. Another type of mandate, we heard a lot about it in 1993 when health care reform was discussed last decade, employer mandates and individual mandates are likewise restrictive. A discussion of mandates should include an accounting of cost and whether the mandates limit the availability of insurance for those who may operate a small business, for example, for those who may be self- employed or self-insured. Mr. Speaker, it is worth remembering that Medicare part D in its first year of existence, the year 2006, achieved a 90 percent enrollment rate. They didn't do that with mandates. How did they do it? With education, incentives, competition, but certainly not mandates. Well, what about premium support? That is something you hear about from time to time. In fact, premium support was a big part of when President Bill Clinton talked about how to modernize the Medicare system. Bill Thomas who recently was chairman of the Ways and Means Committee, Bill Frist who was Senate majority leader, Bobby Jindal who serves as a Member of this House currently, these individuals were on a task force appointed by President Clinton to try to improve the Medicare system. One of the concepts they came up with was premium support to help someone who doesn't make quite enough money to pay a health insurance premium, help them, support them in purchasing that premium or buy down the cost of that premium. A subsidy, yes, but I prefer to think of it in terms of support. Now, people also talk about tax credits. It is a similar rationale for helping an individual who can't quite afford the premiums on their health insurance. Mr. Speaker, I just submit that our Tax Code is currently complicated enough. We don't need to do anything that further complicates the Tax Code. That is why I move in the direction of premium support as opposed to tax credits or other incentives. One of the things we ought to do, though, when we do talk about mandates, and certainly that has been one of the stories coming out of Massachusetts, the plan that Governor Romney talked about when he came and addressed our House Policy Committee a couple of years ago when that program was first established, one of the mechanisms they had at their disposal was the ability to, because they have a State income tax, the ability to help someone understand the validity of buying insurance. I don't know. Maybe we ought to look at that when we provide money to individuals through the earned income tax credit. Perhaps a portion of that money ought to be earmarked for at least a catastrophic policy or a high deductible policy, those that can be had generally at lower expense. Maybe it is time to think outside the box in that regard and provide those individuals an earmark, if you will, of that tax credit so that they, in fact, do purchase health insurance if they are going to be covered under the earned income tax credit. Then finally, and this is a terribly difficult concept and a lot of people just tune me out when I talk about it, but we have to balance the way we handle our anti-trust laws. We have to balance anti-trust enforcement, and we have to prohibit overly aggressive anti-trust treatment under the law. Exemption or enhanced enforcement is only likely to further distort the market. It means the desired results are never obtained because we are always providing this market distorting influence by either protecting one side or one group and potentially punishing another side. Creating winners and losers via our anti-trust law erodes the viability of our American health care system. Again, I think we would do well to pay some attention to that and prevent that from being part of our lexicon in the future. Now, as far as the specific policies for health care within the public sector model, the transformation after the experience with Medicare part D has, in fact, been instructive. Six protected classes of medication were required of all companies who wish to compete within the system. That allowed for greater acceptance by the covered population and certainly greater medical flexibility as far as the physicians were concerned when treating patients. At the same time, the competitive influences brought to bear in that part of the program, in fact, managed to bring down cost. In fact, the projection of $130 billion over the 10-year budget window less than was originally outlined was a success story. That is solely the result of competition. I feel certain that, in the future, we are going to get benefits for more efficient treatment, timely treatment of disease. I think there are additional successes out there to be had, but certainly competition within the first year or two of the existence of part D program certainly showed where competition can pay off. Now, one of the most important points of lessons learned in the Medicare part D program is that coverage can be significant without the use of mandates. Ninety percent of seniors now have some type of prescription drug coverage. That was achieved by creating plans that people actually wanted. It was achieved by providing the means and incentives to sign up in a timely fashion. This emphasized that personal involvement and responsibility was there, was important to maintain, and it was important to maintain credible coverage. There was, in fact, a premium to pay if someone signed up after the initial enrollment cycle. Mr. Speaker, employer-derived insurance will continue to be a significant player in the American health care scene. It adds value. It adds value to the contract between the employer and the employee. It rewards loyal employees and builds commitments within the organization. Businesses can spread risk and help drive down cost. A feature of the proposed association health plans have been, in fact, proposed in this House in every Congress that I have been a Member of since the beginning of 2003. In fact, the first time I heard about the concept of association health plans, Mr. Speaker, was when it was actually delivered from the rostrum here in this House of Representatives. The concept was delivered by President William Jefferson Clinton in September of 1993. It is a concept that I believe we ought to explore. We ought to be able to discuss it rationally without impugning each other's character, because after all, it was brought to this Chamber by a Democratic President. It has been endorsed and supported by Republican Congresses in the past. Again, the concept of association health plans is one that I think going forward could provide a great deal of utility as far as preventing the inexorable increase in health insurance premiums that are faced by small businesses and individual employees. These are people who don't get the benefits of spreading out the risk through a large insurance market. Now, Mr. Speaker, regardless of whether the system is public or private, vast changes in information technology are going to occur. They are going to need to be facilitated. We are coming up to a time of rapid learning. Because of improvements in health care technology, the ability to manage databases and retrieving data in a timely fashion are going to be critical for the delivery of health care and for the protection of patients. Mr. Speaker, let me share this picture with the House of Representatives. This is Master Sergeant Blades. I met the master sergeant at building 18 at Walter Reed Hospital last January. Of course, everyone remembers The Washington Post story about building 18 and how there was great concern that some of our soldiers were not being properly cared for, individuals who were on medical hold at Walter Reed and awaiting a ruling on their request for going back in with their unit or their request to have a disability claim evaluated. Those individuals on medical hold became the subject of a good deal of discussion in the press here in Washington, D.C. Well, like many Members of Congress, I decided to go see for myself. I went out to Walter Reed. I went through building 18. The paper was right: it was crummy. But Master Sergeant Blades drew to my attention something that he said was, in fact, more significant and more important and, in fact, more of a frustration for him and his men who were there on medical hold. And that is the fact that there was no interoperability between medical records contained within the Department of Defense and that of the Veterans Administration. You see here the master sergeant is preparing his medical record. It may not show up that well, but here is a medical record that he is going through with a yellow highlighter. He is making his case for, again, either going back and joining his unit or making his case for perhaps a future disability claim. What he told me that day is that he can go through a medical record that may be the size of several stacked phonebooks on top of each other, go through and painstakingly pull out the bits of data that he thinks will be important to his case. This paper record will then go to someone's desk. It might sit there for a week, two or three, before it is opened. And then at some point it gets lost, and he has to start all over again, or his men have to start all over again. So his admonition to his men who are under his command there at the medical hold unit at Walter Reed was to prepare several copies of your medical record. Don't leave your future, whatever it might hold, don't leave your future in the hands of a single medical record and at the discretion of someone who might be cleaning off a desk one night, think they are doing everyone a great favor by moving some charts or papers off to the side or some other location, where, in fact, they become lost and not retrievable. Again, I bring this up to just point to some of the problems that are out there. We are in the 21st century. Rapid learning and rapid turnaround of data is something that is just expected. We go into an ATM in a foreign country. We swipe our card. We punch the number in. If it takes more than 12 seconds for the money to come out at the other end, we wonder what the problem is. We need to be moving to that same type of system within our medical information system because it is truly to the point where it is untenable. We saw that as, again, Master Sergeant Blade so eloquently pointed out to me that day at the Walter Reed Hospital. But we see it over and over again replicated in tests that have to be duplicated. Someone goes into a hospital emergency room late at night. They have had a CT scan earlier in the week in the physician's office, but it is not available to the emergency room doctor who then orders another test and, oh, by the way, there is another $1,000 spent by some insurance company, government or perhaps even the hospital itself if that patient is uninsured. Another thing that I think really is something that we are going to have to really concentrate on in the future is introduced legislation, H.R. 1046, to modernize some of the quality reporting systems that are present in this country. I think quality reporting is going to be part and parcel of medical care going forward. I think it should be voluntary at this point. I think while we are in the mode of gathering data, a physician or group who wishes to voluntarily associate themselves with some type of quality reporting scheme, I think that should be rewarded at this point. I don't know that we have developed enough of the systems to require that. Now, State Quality Improvement Organizations, QIOs, were actually developed back in the '80s and early '90s across the country. They were developed to primarily deal with quality issues within the Medicare program itself. But there is no need to reinvent the wheel here. These organizations are already out there. They exist. They do a credible job. If they need to be modernized for the 21st century, then so be it. But H.R. 1046 is an effort to bring those Quality Improvement Organizations into the 21st century and allow concepts like a medical home and allow concepts like the accumulation and utilization of data so it can be for the benefit of all of the physicians who attend the patient and of course the patient themselves. Now, this approach was a component of the Medicare physician payment update proposal by then-chairman Joe Barton on my Energy and Commerce Committee when he offered it right at the end of 2006. I thought it was a good proposal then. I think it is one that certainly bears further exploration. Mr. Speaker, within the individual market, and that is going to include for the purpose of my discussion both individuals who are paying their freight themselves out of pocket and those individuals who own a health savings account, introduced legislation, H.R. 1666, to provide for increased price transparency within the medical pricing system. Information is going to evolve rapidly. It's going to evolve rapidly for individuals who are paying cash for their procedures, as was certainly the majority of cases back before the 1940s. But, again, we may see a growing, increasing segment of the population who hold medical savings accounts and will be the primary dispensers of their health care dollars, so those dollars will be spent much the same as a self-pay individual would handle their medical affairs. But it's going to require that the adequacy of reports and the detail of information that is available to patients on things like cost, price and quality, and, yes, there is a difference between what a procedure costs and what its price is, and quality information is going to be increasingly important for health care consumers to make best decisions about the health care of their families and how they wisely spend their health care dollars. This information needs to also be linked to data detailing perhaps complications and other issues, like perhaps infection rates, so that families and individuals are able to make the best decisions. Now there are some Web-based programs that are out there right now. Again, in my home State of Texas on the Internet there's something called texaspricepoint.org, except it is abbreviated to txpricepoint.org. The individual who lives in the State of Texas can go to that Web site and, after the obligatory legal disclaimers that you have got to scroll through to ensure that you understand the data that you're about to call up, you can get some significant data on the difference in cost and price between hospitals in a given county, different hospitals that perhaps are offering the same procedures, something as simple as a fractured leg without complications. You can click on the appropriate button, scroll through the appropriate number of screens and get a cost comparison between all of the hospitals that exist within a given county and what the difference in cost is at each of those facilities. Now someone who is truly on a third-party payment such as Medicare, Medicaid, SCHIP, they are not going to be perhaps so interested in that, but they might be from just a quality perspective. If one hospital is a lot more expensive than the others, that may be a quality issue that is driving that increased expense. So I can see that that information would be useful to individuals who aren't in fact even the target population who's paying out-of-pocket for their own care. But certainly the individual in a family who's paying out-of-pocket, they're financing their health care out of cash flow, or the owner of a medical savings account, that individual is likely to be very interested in what that information on cost, price and quality is as it becomes available. I think we are going to see increasing utility of programs such as these going forward. As we have talked about crafting a readily affordable basic package of insurance benefits, it's something that this Congress really ought to set itself seriously to do. Now we have had discussions in the 109th Congress. Sometimes those discussions got kind of rough. Let's remember, we, Congress at one time has agreed upon what exactly is a basic package of benefits that ought to be available to an individual who subscribes to a program, and that program is the program under the Federally Qualified Health Center statute. The statute is probably about 35 years old and it details at a significant level of detail what benefits ought to be available to the individual who goes in for their care at what is known as an FQHC, or Federally Qualified Health Center. What if we were to get together and decide that same basic package of benefits ought to be available to an individual, but they wouldn't necessarily have to go into the Federally Qualified Health Center? Maybe it's embedded in a card that they take into a clinic or provider's office within their community who agrees to participate in the program. Clearly, there is some out-of-the-box thinking that can go on here in trying to provide a meaningful, affordable product for individuals who are currently lacking health insurance. One of the things, again, that drives the cost up is all of the mandates that we put on insurance companies. But maybe if we agreed on what should be the basic package of benefits, Republican and Democrat alike, sit down and agree on what should be that basic package of benefits and allow individuals to access that type of care within their own communities. One of the problems with Federally Qualified Health Centers, and I am a believer in the concept, in fact, I am trying mightily to get a second such facility in my part of Tarrant County. I'd like to see one in Denton County, another county that I represent that doesn't have such a facility available. What has happened is we have picked winners and losers across my State, across the country. Some areas are replete with Federally Qualified Health Centers; other areas are seriously lacking in that type of care. Maybe we need to take that thinking to the next level. Maybe we ought to, instead of building the bricks and mortar of a Federally Qualified Health Center, simply provide the patient with, ``Here's the card, here's the list of individuals that participate in the program in your community, and they will accept the card at any one of these facilities that you see.'' That would also have the advantage of perhaps separating out, once again, some of that special interest stuff that tends to keep things as they are, to keep things from moving forward, to keep any meaningful progress from coming into any of the arenas and delivery of health care to low-income individuals, but particularly in this particular arena. The other thing is I will tell you, as a practitioner of medicine, you look at some of the rules under which these facilities have to be set up, and it becomes very, very difficult to construct a business model that will actually be able to stay afloat, given some of the restrictions and regulations that are placed on these facilities. Again, if we would allow perhaps a little bit more of that hybrid-type system that you could have coexistence between a private facility and a government-paid program, providing each side was willing to behave by some mutually agreeable guidelines. Well, providing truly affordable basic coverage to individuals in this country I think is a concept that insurance companies, I think is something they would want. I can't believe that an insurance company doesn't look at a figure like 47 million people who are uninsured and not say, ``that is a lot of market share I could have,'' if we would only allow them the ability to construct a policy that is affordable to the individuals who fall into that group. Another concept, Mr. Speaker, and this is one that I have held for a long time, a lot of clinics, a lot of doctors, a lot of medical practices, a lot of hospitals simply donate their time and their efforts. Their actions are truly charitable. Well, maybe we could organize and provide a tax credit for those services that are truly charitable and donated. We could provide perhaps additional protection under the Federal Tort Claims Act, maybe a safe harbor from lawsuits, wherein good faith, charitable care is provided, and allow other providers to participate and fill the vacuum for indigent care. Another area where this might be extremely useful is in times of national emergency, national crisis. Maybe if we had some type of emergency credentialing facility, and I know the CDC is looking into that, but if there were a way for a practitioner to precredential if there were a national emergency in their area, or they traveled to an area where the next Katrina hits so that they could be immediately credentialed within that area and begin to help provide that care. Again, also allow them some relief from liability under the Federal Tort Claims Act. This could help fill the vacuum that exists sometimes in care. We don't want people to stay away from where actual help is needed in time of a national emergency. We don't want doctors and nurses to stay away from those areas for fear that, number one, they will be sent away because they are not credentialed, or, number two, out of fear that they might bring on some condition of liability that they would then have to defend for months, years, decades after. The admonition of Ronald Reagan, ``trust but verify.'' Trust the market to make the correct decisions, but to the extent that some distortions are there, acknowledge that they are there. Sometimes there are going to have to be some protections that can only be provided by the Federal level. Some guidance for market principles will always be required, whether the system is public, private, or is a hybrid system. Finally, as part of this discussion, there needs to be a rational breakdown. We always talk about the number of uninsured. As near as I can tell, this is a formulaic number that simply goes up by the addition of 2 million people every year. I don't know that any of us really knows what is the makeup of this number. It is pretty hard to craft public policy to deal with the number of 45, 46 or 47 million uninsured when you don't know what makes up that population. Are some of these young individuals who are simply between college and their first job and haven't yet found it a wise investment or necessary to get insurance? Are part of these individuals who have serious long-term medical conditions who find medical coverage unavailable to them at any level, at any place? Obviously, those are two very different populations. You can't craft a policy to help one that is not terribly distorted by the time it is applied to the other. We need to know what the makeup of that number is. So agencies like the Census Bureau need to do a better job for us as far as detailing and delineating what exists within the parameters of that large number that simply gets added to every year, and a lot of times you wonder if it is not just added to for political reasons. But, nevertheless, we need accurate data on who is encompassed within that population. Finally, I will just leave this segment with a point of contrast. There are some people in this House who think it is a good idea to expand the culture of dependence, dependence on the State. There are other individuals in this Chamber who want to expand the number of individuals who can actually participate, direct and own their own health care. Mr. Speaker, I don't have to tell you what side of that question I come down on. Finally, Mr. Speaker, I want to talk just a little bit about, again, I said I was going to talk about health care in America. I have talked a lot about health care. Let's talk a little bit about America. Let's talk about American exceptionalism. Mr. Speaker, the American health care system has no shortage of critics, here in this House, across the country, and certainly in foreign countries. But, Mr. Speaker, I would emphasize, it is the American system that stands at the forefront of innovation and new technology, precisely the types of systemwide changes that are going to be necessary to efficiently and effectively provide care for Americans for today and into the future. Now, Mr. Speaker, I don't normally read the New York Times, so please don't tell anyone in my district that I did. But last year, in fact just about a year ago, October 5, 2006, Tyler Cowen wrote, ``When it comes to medical innovation, the United States is the world's leader. 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 within the United States, and seven have gone to researchers outside of this country.'' Remember, Mr. Speaker, when I first started this discussion I talked about the contributions of Sir Alexander Fleming, albeit an Englishman, but it was a lab in Peoria, Illinois, that developed the ability to mass-produce penicillin, and it was that ability that allowed the clinical trials to go forward. It was that ability that allowed penicillin to become part of our modern lexicon. Percy Julian, again, an African American biochemist honored in this House during the last Congress. Remember, it was Percy Julian, he didn't invent cortisol, he wasn't the first to identify the compound, but he was the first to delineate a formula by which this compound could be mass-produced and available to much, much greater numbers of patients than would have ever been possible with the old animal extraction method that had preceded it. All developed within and because of the United States. Tyler Cowen 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. Mr. Speaker, comparisons with other countries may, from time to time, be useful. It is important to remember that the American system is always reinventing itself and seeking improvement. But it is precisely because of the tension inherent in a hybrid system that creates this impetus for change. It drives the change. A system that is fully funded by a payroll tax or some other policy has no reason to seek improvement, and, as a consequence, faces stagnation. Indeed, in such a system, if there becomes a need to control costs, that frequently is going to come at the expense of who? The provider. Precisely the person you need to stay involved in the system. Mr. Speaker, I have got one final slide, and I ask your indulgence to let me put this up here. This just shows the Medicare comparative payment updates for physicians, Medicare HMOs, hospitals and nursing homes. The years are delineated there in separate colors. The year 2007, when the slide was developed, was in fact an estimate for physicians. The reality is this number actually came back to zero because of some changes we made right at the end of last year. Under physicians, you don't see a number for 2006 again because that number in fact was zero for 2006. You stop and think about that, this reduction was planned but never happened, but physicians were held to a zero percent update for the past 2 years. Mr. Speaker, what do you suppose the cost of delivering that care in a doctor's office, what do you suppose has happened to that over the last 2 years? Well, their electricity prices probably went down because they went down all over the country. Cost for gasoline to go to the office every morning probably went down because the cost of gasoline went down everywhere across the country. I don't think so. The Medicare system is designated to reimburse at about 65 percent of cost under ideal conditions, but the reality is there has been significant erosion of that. This is important because hospitals, nursing homes, and to some degree the Medicare HMOs, their prices are adjusted every year based on essentially what is called the Medicare economic index. That is a cost-of-living formula. Only this group, the physicians, is under a separate formula that is somehow tied to changes in the gross domestic product. The sustainable growth rate formula penalizes physicians and has the perverse incentive of driving doctors out of the practice of medicine. As was detailed to us by Alan Greenspan many months ago, there is only so long that can go on before ultimately you reach a place where it is going to be very, very difficult for the people who need the care to get the care. Mr. Speaker, the United States is not Europe. American patients are accustomed to wide choices when it comes to hospitals, physicians and pharmaceuticals. It is precisely because our experience is unique and different from other countries, and this difference should be acknowledged and embraced, particularly when reform is contemplated in either the public or private health insurance programs in this country. Mr. Speaker, one final point illustrated in a recent news story covered by a Canadian television broadcaster. It was about a Canadian member of Parliament who sought treatment for cancer in the United States. The story itself is not particularly unique, but the online comments that followed the story, I thought, were instructive. To be sure, a number of respondents felt it was unfair to draw any conclusion because, after all, this was an individual who was ill and seeking treatment and therefore deserving of our compassion, and I wouldn't argue that. But one writer summed it up: ``She joins a lengthy list of Canadians who go to the United States to get treated. Unfortunately, the mythology that the state-run medicine is superior to that of the private sector takes precedent over the health of individual Canadians.'' The comments of another individual: ``The story here isn't about who gets treatment in the United States. It is about a liberal politician that is part of a political party that espouses the Canadian public system and vowed to ensure that no private health care was ever going to usurp the current system. She is a member of Parliament for the party that has relentlessly attacked the conservatives for their `hidden agenda' to privatize health care. The irony and hypocrisy is that position supports the notion that the rich get health care and the rest of us wait in line, all because of liberal fear-mongering that does not allow for any real debate on the state of health care within the country of Canada.'' One final note from the online postings: ``It has been sort of alluded to, but I hope everyone reading this story realizes we do have a two-tiered health care system. We have public care in Canada and for those with lots of cash, we have private care in the United States which is quicker and better.'' Mr. Speaker, this is a discussion that will likely consume the better part of the next two years of public dialogue, certainly through the next Presidential election. The United States is at a crossroads. It is incumbent upon every one of us who believes that the involvement of both the public and the private sector is best for the delivery of health care in the United States of America. And it is incumbent upon us to stay educated and involved and committed. Mr. Speaker, we have all got to be at the top of our game every single day. This is one of those rare instances where it is necessary to be prepared to win the debate, even though those of us on my side may lose when it is taken to a vote here in the House of Representatives. But if we adhere to principles, we may ultimately post a win for the health of the American people, and not just the American people today, but for generations to come.

Mr. BURGESS

Mr. BURGESS. Madam Speaker, I rise today to congratulate Mr. Grant Simpson, a Hidden Lakes Elementary School teacher in Keller, Texas, for being named Texas Elementary Teacher of the Year. Mr. Simpson was selected from twenty finalists by an eleven member panel of educators, principals and state officials. This is the second consecutive year that a Keller teacher has been recognized. Mr. Simpson turns his fourth-grade classroom into a comfortable learning environment for his students. He tries to attend numerous student activities such as recitals and football games, and it is not uncommon to see him eating lunch with his students. Mr. Simpson will receive $5,000 and a technology package worth $15,000 for his award. He will be honored at a luncheon November 3, 2007, in Austin, Texas. I would like to join Mr. Grant Simpson's family and friends in congratulating him on receiving this remarkable award. It is an honor to have such a prestigious teacher in the 26th district of Texas.

Mr. BURGESS

Mr. BURGESS. Madam Speaker, I rise today to congratulate Miss Alexis L. Taylor of Keller High School in Keller, Texas, for being chosen as a semifinalist in the 44th Annual National Achievement Scholarship Program. It is an honor to have such a qualified student in the 26th District of Texas. The National Achievement Scholarship Program began in 1964 as a way to provide scholarships to promising black students. Since 1964, almost 28,000 students have been provided with scholarships totaling more than $88 million. Miss Taylor was one of 114 semifinalists from the State of Texas. She was chosen based on her Preliminary SAT scores. Finalists will be chosen based on abilities, achievements, and potential for success. The scholarship winners will be announced in April of 2008. I extend my sincere congratulations to Miss Alexis L. Taylor and her family for her academic achievements at Keller High School. Her dedication and commitment to her education will lead her to great things. I wish her the best of luck with the remainder of the National Achievement Scholarship Program.

Mr. BURGESS

Mr. BURGESS. Madam Speaker, I rise today to congratulate the Liberty Christian School in Argyle, Texas for celebrating its 25th anniversary. This is a great accomplishment, and I am proud to have an establishment such as this in the 26th Congressional District of Texas. I would like to give special congratulations to Rodney and Judy Haire, Mark Bowles, Karen Watts, and Dee Quick for serving 25 years at Liberty Christian School. Thanks to teachers and staff such as these, I am confident that Liberty Christian School will continue to inspire and educate the young adults that walk its halls today. Liberty Christian School is celebrating its 25th anniversary with a jubilee celebration. It is an event where both current and former families, students, staff, faculty, and friends can get together and celebrate the heritage of Liberty Christian School. Congratulations to the Liberty Christian School on their anniversary. Twenty-five years of service is a milestone to be celebrated. It is with honor that I stand here today to honor Liberty Christian School for their continuing commitment to education in my congressional district.

Mr. BURGESS

Mr. BURGESS. Madam Speaker, I rise today to congratulate the Denton Acme Brick plant for creating what could be the world's largest brick. The 6,400-pound brick was created in honor of the company's 116th anniversary. Crews began creating a replica 3,000 times larger than an original brick on December 12, 2005. The process took 18 months from start to finish. The brick was built using 99 percent Denton-area clay and 1 percent combination of other materials. The employees have lovingly named the brick ``Baby Clay''. The brick will be transported to several Acme locations throughout the company to be on display for employees. It will then return to Denton and be put on public display. Acme Brick hopes to obtain the ``world's largest'' brick recognition from the Guinness World Records. Currently, there is no recognition for such a record. It will take 4 to 6 weeks for the Guinness employees to validate or reject Acme's claim. I extend my sincere congratulations to the Denton Acme Brick Plant and the creation of ``Baby Clay''. Also congratulations to the Acme Company in celebrating 116 years of service.

Mr. BURGESS

Mr. BURGESS. Madam Speaker, I rise today in memory of Dr. Mary Esther Gaulden Jagger from Highland Village, Texas in the 26th Congressional District of Texas. Dr. Jagger passed away September 1, 2007 from Alzheimer's disease complications. She was 86 years of age. Mary Esther Gaulden Jagger was a scholarly woman who earned a bachelor's of science degree from Winthrop College and a doctorate in biology from the University of Virginia. Dr. Jagger began working in 1949 at the Oak Ridge National Laboratory in Oak Ridge, Tennessee as a senior radiation biologist. The Jagger's relocated to Dallas from Tennessee in the mid-1960s, where Ms. Jagger took a position as professor of radiology at UT Southwestern Medical Center. She officially retired in 1992, but continued to visit her office until 2004. Mary Esther Gaulden Jagger helped found the National Organization for Women in 1966. She was president of the Association of Southeastern Biologists in 1959. She was also a member of the Committee on Toxicology and the U.S. National Research Council, as well as being involved in the Radiation Research Society and the Environmental Mutagen Society. I know from my time in residency at Parkland Hospital, that Dr. Jagger was revered as an expert. When in doubt or if any questions arose, you could always turn to the wisdom of Dr. Jagger. While this woman was an accomplished biologist and successful author of scientific literature, she always made her family a priority. Relatives will remember her most for her personality and her devotion to her family. - Dr. Jagger is survived by her husband, children, and three grandchildren. It was my honor to represent Dr. Mary Esther Gaulden Jagger, and I extend my deepest sympathies to her family and friends. She will be deeply missed.

Mr. BURGESS

Mr. BURGESS. Mr. Speaker, I want to come to the floor of the House today to talk and honor the legacy that is that of Dr. Michael DeBakey, the father of cardiovascular surgery, and to encourage my colleagues on both sides of the aisle to vote in favor of H.R. 1154, the bill to designate a Congressional Gold Medal for the famed Houston heart surgeon. This bill was introduced by my good friend from Texas, Representative Al Green. And Mr. Speaker, we've heard in great detail the number of accomplishments of this singular individual. But, Mr. Speaker, I felt it was incumbent upon me, as one of the very few physicians in the House of Representatives, to come to the floor and talk just a little bit about how Dr. DeBakey forever changed the face of the practice of medicine in this country. As a fellow physician, Dr. DeBakey's work and medical advancements are indeed legendary. His dedication to healing those around him came not only from his talent as a physician, but his ongoing commitment to medical education, the larger medical community, and indeed, the entire profession, the practice of medicine. His motto, as always, was ``Strive for nothing less than excellence.'' This motto should be adopted by every one of us in this House and indeed across the country. His education and his entrepreneurial spirit made him worthy of the Nation's highest expression of appreciation for distinguished achievements and contributions. Dr. DeBakey received his bachelor's and M.D. degree from Tulane University down in New Orleans. While in medical school, Dr. DeBakey invented what became known as the roller pump, later to become a major component in the heart-lung machine used in open heart surgery. Think of that, Mr. Speaker. He was in medical school. He was not yet an M.D. and he devised a revolutionary concept for the engineering of a pump that dealt with a roller mechanism, as opposed to the piston mechanism that resulted in the destruction of red blood cells by the very mechanism that was intended to pump those red blood cells. He had an unusual knack for looking at things in a new light and developing new ideas. He completed his internship at Charity Hospital in New Orleans. Charity Hospital. Think of that, Mr. Speaker. One of the venerable institutions of medical education in this country; an institution that was unfortunately lost to us just two short years ago to the ravages of Hurricane Katrina. Charity Hospital has turned out a number of medical icons of my generation and the generation before, now lost to us forever. But it was Dr. DeBakey at his residency in surgery or doing his internship at Charity Hospital to then go on to his residency in surgery at the University of Strasbourg, France and the University of Heidelberg in Germany. He volunteered for service in World War II and was subsequently named director of the surgical consultants division of the United States Surgeon General's Office. His work during that war led that office to the development of the mobile army surgical hospital, which we now know as a MASH unit. These units were the forerunners of our forward surgical combat teams that have saved so many lives in the present conflicts in Iraq and Afghanistan. Previous conflicts in Korea and Vietnam certainly benefited from the mobile army surgical hospitals, but those forward surgical teams, to be able to deliver the type of care in the battlefield that those critically injured patients need, many of us have traveled to Iraq and seen those hospitals at Ballad and Imbue Sinai in Baghdad, the Baghdad ER. And it's the principles put forward by Dr. DeBakey that are at work at this hour in those centers where our men and women are fighting today. He helped establish the specialized medical and surgical center system for treating military personnel returning home from war, subsequently known as the Veterans Administration medical center system. But it was at Methodist Hospital in Houston in the Texas Medical Center represented so capably by my friends from Texas Mr. Culberson and Mr. Green where Dr. DeBakey performed many of his groundbreaking surgeries, including the first removal of a carotid artery blockage. Mr. Speaker, the year was 1950. That's the year I was born. The first coronary artery bypass graft in 1964, the first use of a ventricular assist device to pump blood and to support a failing heart in 1966, and then some of the first heart transplants performed in this country in 1968 and '69. He developed a self-contained miniaturized left ventricular assist device pump, again, to assist the diseased left ventricle and allow it an opportunity to either heal, get the patient to surgery, or perhaps provide stabilization leading up to a transplant. This is something that is in use today, and indeed I saw it used on one of my family members a number of years ago. The techniques used to miniaturize the device's inner workings were developed with engineers working with engineers right next door at the nearby NASA program. He served as an advisor to nearly every United States President for the last 50 years. He traveled, in 1966 very famously to Russia to consult on the surgery for Russian President Boris Yeltsin. And knowing Dr. DeBakey, I have to suspect he did a good deal more than consult on that surgery. During his professional surgical career, he performed more than 60,000 cardiovascular procedures, trained thousands of surgeons who practice around the world. His name is affixed to a number of organizations, centers for learning, and projects devoted to medical education and health education for the general public. But think of this, Mr. Speaker. Dr. DeBakey also underwent an operation that was named for him. Reading in the New York Times on the way up here to Washington last December, I read a story about how Dr. DeBakey had undergone the surgery that he himself had described many years before. In fact, Dr. DeBakey admitted at the time, although he knew he was quite ill, he never called his own doctor and he never called 911. Now, I'm quoting here. He said, ``if it becomes intense enough, you're perfectly willing to accept cardiac arrest as a possible way of getting rid of the pain.'' That's what he told the New York Times. You just have to marvel at the pragmatism of that individual. As previously noted by the other two speakers, he did help establish the National Library of Medicine, which is now the world's largest and most prestigious repository for medical archives. Indeed, I will probably use the medline in the National Library of Medicine this evening as I prepare for hearings on the Energy and Commerce Committee tomorrow. Mr. Speaker, as we talk in Congress about the need for improving the practice of medicine, Dr. DeBakey was on the forefront of that, while most of us in this body hadn't even started school yet. In fact, many in this body were not even born yet. These accomplishments have been honored before. In 1969, he received the highest honor a United States citizen can receive, the Presidential Medal of Freedom with Distinction. In 1976, his students founded the Michael E. DeBakey International Surgical Society. His contributions to medicine and his breakthrough surgeries and innovative devices have completely transformed our view of the human body and of our longevity and, indeed, of the planet. He has been designated a living legend by the Library of Congress, and today we take another opportunity to honor a full and important life by conferring on Dr. DeBakey the Congressional Gold Medal. I want to thank my colleagues who joined me in cosponsoring H.R. 1154, introduced by Congressman Green and cosponsored by Congressman Culberson. Mr. Speaker, imagine a simple country doctor from Louisville, Texas. I got to sit on the phone last Friday with Al Green and sing Happy Birthday to Dr. DeBakey on his 99th birthday. What an honor for me, what an honor for America to be able to afford this individual the rightful accolades that he so richly deserves.

Mr. BURGESS

Mr. BURGESS. I thank the gentleman for yielding, and the notation made of the exception of the last 3 or 4 minutes, and I will do my best to accommodate that. I get asked by a lot of people, why in the world did you make this sixth trip to Iraq in July. You knew what was going on there. What did you expect to see that was going to be different? But I knew we had today's hearing coming up. I knew it was coming down the pike at us fairly fast. I knew the news hadn't been good out of the country of Iraq for about the 10 months before July. I had been in Iraq in July of 2006, had thought there was some measure of success that was beginning to be felt then, but then we had August, September and October, pretty rough months by anyone's estimation. And so I will admit, I was significantly pessimistic when we made that trip back in July. But I knew we were going to hear from General Petraeus today. And I knew that every time I had been to Iraq before I came away learning something that I hadn't seen on CNN or even Fox News. There was information that can only be available to you by going for yourself and looking for yourself, feeling, touching, smelling the situation on the ground. Now, I get a lot of concern from people when I go back home in the district who say, yeah, that's all great what we're doing for Iraq, but we don't know that we care that much about the Iraqis. I will tell the citizens of this country, it is in America's best interest that we succeed. Where we cannot be successful in Iraq, and you've heard other people talk about it this evening, let's be honest, it's not a political party that loses a car, it's not a Congress that loses a war, it's not a President that loses a war, it is a country that loses a war. And again, I reiterate, it is in America's best interests that we be successful because an Iraq that is stable, an Iraq that is able to participate in its own security, an Iraq that is able to act as an ally or partner for peace in the Middle East, what a difference 20 years from now looks like with that scenario compared with an Iraq where we leave prematurely, descends into chaos, is enveloped by Iran, Syria, Saudi Arabia, you name it. And the chaos that has been evident in Iraq in the past suddenly envelopes the entire Middle East, with a country like Iran emerging as the victor. Now, the surge or the reinforcements that we talked about really since January of this year, I think it's probably worthwhile to just touch on the timeline that we've been through this year. Remember, it was January 26, not that long ago, that General Petraeus was unanimously confirmed by the Senate, sent off with a pat on the back out the door, and no sooner had the door closed behind him when the Senate began sniping and criticizing his activity. He hadn't even gotten into the country yet. Ambassador Crocker. You heard my friend from Georgia talk about the wonderful resume of Ambassador Crocker. Many of us who were here in the spring of 2003 remember Ambassador Crocker as one of those stalwarts who came at 10:30 every morning and briefed us in the Armed Services Committee room, whether we were members of the committee or not, came with General McCrystal and briefed us every morning as to what was going on on the ground in Iraq. And I was really very grateful to Ambassador Crocker for having taken the time to do that so meticulously when the active combat phase was going on. On May 26, we finally passed the emergency funding and Bush signed it into law. Mid-July, we took a trip over to Iraq. Again, I didn't know what I was going to see. I was prepared to accept bad news if bad news was all we were going to find. But the reality was the city of Ramadi, which was absolutely off limits to me in July 2006, that's the first place we went. After we landed in Baghdad, we got on the Black Hawk helicopter and immediately went to the city of Ramadi, had a briefing by the Second Marine Expeditionary Force, had a briefing by Colonel Jacobsen there on the ground. After the briefing, instead of just shaking hands and parting ways, we went downtown. We went to the market. We walked through the market. We talked to children in the market. We saw things for sale in the market. We talked to a man who was concerned that one of our JDAMs fell on his building. And I will tell you, it doesn't do much to drive up a deal if that happens to your building. But nevertheless, we had a very one-on-one, close-up discussion with Iraqis on the street in Ramadi. And a year ago, no one in their right mind would have taken a Member of Congress to Ramadi; it was far too dangerous. Now, you can imagine how gratified I was. We got back. We got a call from the White House, and we were invited down to present our findings. I even tried to downplay it a little bit; well, there's some good news, but we've got to be careful because we've had nothing but bad news out of Iraq. And then a week later, two guys from the Brookings Institution, a place that I don't normally agree with, two guys from the Brookings Institution come up with an op-ed that says, this is a war we just might win. Throughout all of that, for the last week we have seen the steady drumbeat of efforts to undermine the credibility of General Petraeus and Ambassador Crocker prior to their hearing today. Today, we did have the House hearing, tomorrow there is going to be the Senate hearing. Arguably, there was not a whole lot new that was discussed because everything had been leaked in the New York Times in the weeks leading up to the hearing. And General Petraeus did say that he expected there was a possibility he would bring one of the Marine units home before the end of September, and that there was reason to be optimistic if things continued on this course, there was reason to be optimistic that other troops could be brought home early, beginning in December, much prior to fulfilling the 15-month rotation that was originally posed to them. That would be good news. I hope he is correct in that. I hope he is successful. The data collection that went on leading up to this briefing, always for the last year you can pick data points out of the air wherever you want to make them. But the discipline to evaluate the trend lines is what is so critical. Today we saw those trend lines established and the data meticulously collected before those trend lines were established. Not all of them showed good news. But a preponderance of them show a positive effect that has happened in Iraq since our reinforcements arrived. None of us can predict what is going to happen beyond the end of this year. I will tell you, Mr. Speaker, as we sit here tonight on the eve of the anniversary of 9/11, I am terribly concerned about what might even happen tomorrow. None of us knows what tomorrow holds. Didn't we learn that lesson Monday, September 10 in 2001 when it seemed like there just wasn't much happening in the world? We have another tape from Osama bin Laden. We are told there is another one out there. What does all this mean? None of us knows for sure. But I reiterate that we are living in a very dangerous time. Now is the time for us not to show weakness and retreat from Iraq. Now is the time for us to redouble our resolve, make certain that we are successful, and for every one of us to give thanks that we have leaders like General Petraeus and Ryan Crocker to lead us in this perilous time.

Mr. BURGESS

Mr. BURGESS. Mr. Speaker, I thank the gentleman for yielding. I thank him for convening this resolution this evening and I thank the Ohio delegation for allowing me to be part of this remembrance of the life of our friend Paul Gillmor. Like everyone else, I was shocked and saddened this morning to hear the news about the loss of our friend. We have heard several people talk about Mr. Gillmor and his work on the committee. I remember last year in the 109th Congress when he was the subcommittee chairman and the work he did on persistent organic pollutants. It really was not something I had ever thought about before I came to Congress, it really wasn't something I ever campaigned on, but Paul had a way of explaining it and making it understandable and worked through a very complex issue working with both sides of the committee dais to get meaningful legislation passed. Then at the end of the 109th Congress, after the election, coming back for the 110th Congress, and someone explained to me the arithmetic that happens when you lose the majority, and counting on my fingers the number of seats we had lost on the Energy and Commerce Committee and I was no longer going to be on that committee, and then later Paul came to me and said, ``Doc, you are too important on that committee, so I am going to stay on Financial Services and I will take a leave from Energy and Commerce.'' You heard Ranking Member Barton mention it. You heard Leader Boehner mention it. I was the guy that he let stay on the committee by his selfless act of taking a leave of absence from a committee that he loved, committee work he loved to do. I thank him so much for giving me the opportunity to stay on the committee. Of course, we welcomed him back a few weeks ago when we needed that extra vote when we were discussing energy legislation. And, sure enough, Paul was there not just to be a vote, but he brought amendments with him. He tied things up. He behaved just like the Paul Gillmor that I had remembered on the committee from the year before. So, to his family, I wanted you to know, you had heard me mention before how selfless Paul was about giving up a place on the committee. I am the guy that he let stay on the committee. I will never forget that, and I will always try to live up to his expectations.

Mr. BURGESS

Mr. BURGESS. And I appreciate the gentleman for yielding. Indeed, I did take my sixth trip to Iraq in July, a weekend trip. And believe it or not, it is possible to make a weekend trip to Baghdad. I've got to tell you, Mr. Speaker, I was concerned. The 10 months prior to my going, we've had just a litany of one bad story after another come out of Iraq, and I was concerned about what I was going to find. The story is a mixed story. I suspect next week when we do hear the report from General Petraeus and Ambassador Crocker, we'll get a mixed report. But I've just got to tell you, it was a vastly different condition on the ground that I saw than what I had been led to believe I would encounter with reading the stories in the paper. Now, just over a year ago I was there. There's a lot that's changed in Iraq. There's a lot that's changed here at home since that year's time. Concerned about what I would find, and again, made the trip over a relatively condensed time frame, we left for Baghdad really early in the morning out of Kuwait City on a C-130. And Mr. Speaker, you always hear people criticize us on these trips. They say, well, you just saw what they wanted you to see. They just trotted out the dog-and-pony show for you and you bought it. But the reality is you get on a C-130, 3 or 4 or in the morning, it's already 90, 95 degrees. You're put in the back of a C-130 with troops being moved into one theater or another. And they don't pick the guys that happen to show up at the airport that morning. You go with whoever is going in or out of the country. Now, when you're on the plane, it's just too noisy and hot and dark to talk. But as the plane landed when we got to Baghdad and they bring the engines down and you can actually hear again, the soldiers that were around became anxious to talk to me when they found out who I was and why I was there. Most of them, it was their second or third rotation. Their deployments had been extended to 15 months, and most of the guys that were on that plane wouldn't see home again for almost a year. Since February, there's been a big change in how they do their job. They're placed alongside Iraqi soldiers in smaller groups, both in Baghdad and out in the provinces, and they're no longer attached to this larger and more protected military base. And clearly, they're seeing a greater amount of activity and, to a large degree, that concerned them. The fellow that was just right across from me I actually spoke with in some depth, and he'd been reading a book all during this hot plane ride for 2 hours from Kuwait City into Baghdad. He obviously voiced a concern. He wondered if the General Officer Corps even knew what they were up to, even knew what they were doing. He wondered if they knew what they were up against. He did complain about the long hours. He complained about the heat. He complained about being separated from his family. Mr. Speaker, he'd been reading a book intently while we were on the plane. And I asked him about this. I said, What book are you reading? And he said it was a book about philosophy. So I naturally assumed that at the end of his deployment he'd be coming home to perhaps finish school, or maybe he had a job waiting for him, and I asked him about this. And he looked at me very strangely and said, I just signed up for five more years. You know, it's that kind of ambiguity, it's that kind of enigma that confronts you when you're in Iraq. Things just don't add up the way you think that they might. Now, we got off that plane and we all went our separate ways. We were taken into the town of Ramadi. And a year ago, there would have been no way to go to Ramadi. We visited with the mayor. And again, as Mr. Akin just alluded to, the good news story coming of out of Iraq is the building up of those institutions of local government just like we have here in this country, county governments, city governments that are doing the really hard work. They're doing reconciliation at the city level, at the provincial level. If it takes the central government a while longer to catch up with them, I've got a lot of hope based on what I saw on the ground. But what really gives me hope is what I saw in the market in Ramadi. Look at the faces on these two young guys. We were just out there walking in the market just in an area that a year ago it had been so dangerous no one in their right mind would have taken us there. Let me just show you this other picture that gives you some idea of the types of thing for sale in the market. Again, it looks like a typical marketplace anywhere you'd find in the Middle East, Jordan or Saudi Arabia. A lot of stuff for sale. I don't know where the stuff comes from, but a lot of stuff for sale. And again, clearly the people who were there did not look to be particularly stressed or aggrieved. They looked half curious and happy to see us. In fact, the kids were starting school in a couple of weeks and would come up to us and ask us for pens and quarters. Apparently our military had given them a good deal of coaching on the kinds of things you can get from a codel as it walks through town. Mr. Speaker, I will conclude here and leave the remaining time to my friend from Texas. I will say I do believe it is in America's interest that we finish the job. The next 30 years will look starkly different if we're successful versus if we're a failure. I will yield back to the gentleman from Tennessee.

Mr. BURGESS

Mr. BURGESS. Madam Speaker, I rise today in memory of Bobby Webber, a former state representative from Fort Worth. Mr. Webber was born Sept. 16, 1937, in Madisonville, Texas. After his family moved to Fort Worth, in the 1940s, he served for five terms in the City Council. After attending Howard University, Mr. Webber joined the Army in 1959, serving in the 101st Airborne as a paratrooper. He was discharged in 1962 and received a bachelor's degree in business administration from the University of North Texas, my alma mater. Over the years, Mr. Webber built up several business interests in Fort Worth, including Angelic Webber Funeral Home, Eastwood Village Nursing Home and a family-owned Insurance company. A continued advocate for Fort Worth's African-American community, Mr. Webber won a seat in the Texas House. He understood the needs of his constituents and represented them with commitment and enthusiasm. Mr. Webber's dedication to Fort Worth was not simply a matter of politics; it was a matter of heart. He served as pastor of Greater St. James Baptist Church in Fort Worth and Community Missionary Baptist Church in Arlington. His survivors include his mother, Charlie Mae Webber of Fort Worth; two sisters, Joann Breedlove and Janyce Avery, both of Fort Worth; a brother, Joseph Webber of Fort Worth; and a daughter, Vanessa Jean Webber, and grandson, Alvin James III, of Atlanta. I would like to recognize Mr. Webber for his tremendous service to Fort Worth and his fellow man. His spirit of fairness and equality should be seen as an example to us all. I was honored to have represented him in the U.S. House of Representatives.

Mr. BURGESS

Mr. BURGESS. Madam Speaker, I rise today to recognize the contributions of the Rev. Weldon G. Daniels who is retiring after 37 years as the pastor of Pilgram Valley Missionary Church. Mr. Daniels accepted the call as pastor of Pilgrim Valley in January of 1971. Under his leadership, the church's membership growth required a new facility, and over the years, he supervised improvements including the addition of air conditioning and heat for classrooms. The sanctuary was also updated with a sound system, worship furnishings, and he secured donated bibles and hymnals for the growing congregation. Rev. Daniels ensured that all of the improvements were accomplished in a financially responsible manner, with all notes retired. His leadership also ensured organization of the Prayer Band, a Young Women's Mission and Orientation Committee and the reorganization of the Angel's Choir. Additionally, his leadership inspired twenty-two from the congregation to enter the ministry and an additional twenty-nine to become Associate Pastors. Rev. Daniels also served as the past president of the Baptist Ministers Union, the Harris Hospital Board, the United Way Board, Chair of the M.L.K. Committee and was both the first African American on the Crime Commission board and founder of Ministers Against Crime (M.A.C.). I am honored to represent Rev. Daniels and the life of service and community leadership that he embodies for the residents of Southeast Fort Worth.

Mr. BURGESS

Mr. BURGESS. Mr. Speaker, I wanted to come to the floor of the House this evening and do as I do many times late in the day after the official business of Congress has concluded and talk a little bit about health care. Health care is going to be one of the things that we hear about a lot over the next 14 to 16 months before the next Presidential election. There are a lot of areas that I could discuss, but I want to concentrate on two areas. Those are the physician workforce itself, who is actually going to provide the care. And we are coming up on the 4 year anniversary of a law that was passed back in my home State of Texas that dealt with significant medical liability reform, and I would like to spend a few minutes talking about that also this evening. We have to, as a Nation, look at the effects that some of the policies that we have generated here in Congress, quite honestly some of the policies that we have had that have been prevalent in our Medicaid and Medicare system that have resulted in physicians not continuing their practices, or, I am afraid to say, in some instances young people even deciding that the practice of medicine may not be for them. Now, right before we left on break, we had an opportunity to reauthorize the Children's Health Insurance Program. It was a program that is now going on 10 years since its inception, passed by a Republican Congress, signed into law by a Democratic President, so truly a bipartisan effort 10 years ago. It is going to expire at the end of this month. Mr. Speaker, every one of us who stood in this Chamber and raised their right hand and swore an oath on January 3 that we were going to do the country's business this year, every one of us knew that the Children's Health Insurance Program expired at the end of the fiscal year, which is less than 30 days away. Still, we waited until the absolute last minute before we broke on our August recess. A bill came to the House floor after some fairly contentious committee proceedings. Regular order in the committees was not adhered to. We didn't go through a subcommittee process. We got a big bill dumped on us right before we had a full committee hearing, and as a consequence, there was no time to evaluate that in my Energy and Commerce Committee. It was brought to the House floor and it passed largely on partisan lines. It is strikingly different than the bill passed in the Senate, and the President had already indicated that he would not sign but veto the bill passed in the Senate. And I have to believe that the bill that was passed at the last minute, in the waning moments before the August recess by the House of Representatives, I have to believe that the President feels the same way about that bill as well. It is significant, of course, because there are a lot of people who depend on the State Children's Health Insurance Program. Mr. Speaker, I don't think I can name one person in this body on either side of the aisle who wouldn't be for a reauthorization of this program if we could simply sit down and do it in a reasonable fashion. Unfortunately, that was not available to us. So now, we will go through and watch the drama of naming conferees and having conference committee hearings and we will have a bill that will come to us which may or may not be acceptable. I have to believe at the end of the day it is going to be very, very difficult for us to pass a conference report that the President can sign before the 30th of September. There was a lot of good stuff in the bill. There were a lot of good things in the bill that should have been tackled as separate entities, not rolled into this one big amalgam that was spread out before us right before the end of the session. One of the things that was addressed in the bill that I was grateful for was an attempt to deal with one of the things that has been a very contentious issue the entire 5 years I have been in this Congress, and that is the issue on physician payments. But as a consequence of how the bill has been handled and how the bill was brought to the floor of the House and how the bill was pushed through the committee process, again it is unlikely that the reasonable things that were in the bill will ever see the light of day and those things will still be requiring our attention before we get to the end of this year. Mr. Speaker, one day right before Chairman Alan Greenspan concluded his tenure as chairman of the Federal Reserve, he came and talked to a group of us here on Capitol Hill, and the question came up: Mr. Chairman, what do you see about the problems ahead for the Medicare program? Chairman Greenspan thought about it and he said: I think when the time comes, you will make the necessary hard choices that are required to keep the Medicare program solvent. He then went on to say what concerns me more is will there be anyone there to deliver the services when you actually require them. Those have been words that have stuck with me since the time Chairman Greenspan came and talked to us early that morning. He has since been back and talked to a different group, and I asked him if he feels the same way today, and the answer was not only yes, but yes and more so. Back in my home State of Texas in March, the lead article in a magazine that is published by the Texas Medical Association called Texas Medicine was an issue about running out of doctors and how medical schools were having to work extra hard to develop new doctors, and since this was a Texas-based article, to keep those doctors practicing in Texas. There is a series of three bills that I have recently introduced this year to try to deal with the oncoming physician manpower shortage as I see it. Now, the first of these bills would be to deal with graduate medical education and some enhancements to graduate medical education. This would help younger doctors with the creation of new residency programs. A strange thing about doctors is, and one of the things that was stressed in this article in Texas Medicine, we have a lot of inertia. A doctor is very likely to go into practice within a 50- or 100-mile radius of where that doctor does their residency. They don't show a lot of originality of thought when it goes into establishing that private practice. They tend to stay where they were in training. There are a lot of reasons for that: Comfort and knowledge of the other practitioners in the medical community, knowing those pathways for referral, perhaps even already having established some pathways for referral sources while in the residency program. For whatever reason, doctors tend to practice very close to where they trained in residency. But a lot of smaller and medium-sized communities with hospitals that have a patient load that would sustain a residency program, in fact, don't have a residency program. The barrier to entry for a hospital like that to set up a residency program is quite expensive, and so the barrier to entry is significant. And as a consequence, those residency programs are just not done. They are not established. The bill I proposed is designed to get more training programs into areas where medical service is less than optimal, perhaps rural or inner city areas, to get young doctors training in locations where they are actually needed. Now, the Graduate Medical Education Enhancement Act, as introduced, would develop a program that would permit hospitals that do not traditionally operate a residency program, it would allow them the opportunity to start a residency training program to begin building that physician workforce of the future. Now, on average, it costs about $100,000 a year to train a resident, and that cost for a smaller rural hospital can, in fact, be prohibitive. Because of the cost consideration, the bill would create a loan fund available to hospitals to create residency training programs, again where none has operated in the past. The program, of course, would require full accreditation and be generally focused in rural suburban, inner urban areas, areas where, again, the need is greatest. Now, a diverse group of professional organizations, including the American College of Emergency Physicians and the American Osteopathic Association, have been very supportive of this legislation, and I think realistically this is something that this Congress could take up and could agree upon in a bipartisan fashion, and in fact, we likely could do that before the end of the year if we were to set our minds to it. But locating young doctors where they're needed is part of solving an impending physician shortage that realistically could encompass the entire health care system in the country. Another aspect that needs to considered is actually training the doctors for those high-need specialties. Now, a second bill introduced, H.R. 2384 for those of you who are keeping score at home, the High Need Physician Specialty Act of 2007, establishes a mix of scholarships, loan repayment funds and tax incentives to entice more students to medical school and to create incentives for students and newly minted doctors. This program will establish a repayment program for students who agree to go into high-need specialties, again family practice, internal medicine, emergency medicine, general surgery, OB/GYN, and practice in a medically underserved area. It will be a 5-year authorization at $5 million per year. This bill would provide additional educational scholarships in exchange for a commitment, and that commitment is to serve in a public or private, nonprofit health facility determined to have a critical shortage of primary care physicians. Other prominent groups such as the American Association of Retired Persons and the American College of Physicians support this high-need physician specialty legislation, and Mr. Speaker, I would just parenthetically point out, we did earlier this year a similar bill to offset some of the costs of educating young lawyers. And perhaps we should devote some similar attention to young physicians as well. But you know, Mr. Speaker, in addressing the physician workforce crisis, in a little bit we're going to focus on some liability concerns in reforming the liability system. I've already talked about placement of doctors in locations in greatest need and the financial concerns of encouraging doctors to remain in high-need specialties. But the other thing we've really got to focus on is perhaps the largest group of doctors, and I know for a fact it's the largest and still growing group of patients, that group that's encompassed by the so-called baby boom generation and their effect on the entire Medicare program. We've all heard it before. The baby boomers are going to grow older and retire, and the demand for services are going to go through the roof, and if the physician workforce trends continue as they are today, that is, a downward trajectory, we may not be talking about just simply funding a Medicare program. We may be wondering where all the doctors are who are supposed to be taking care of those seniors. Again, I allude back to the comments of Chairman Greenspan, and I think those comments echo very strongly today. But year over year, one of the reasons for this happening is year over year there's a reduction in reimbursement payments from the Center for Medicare and Medicaid Services to doctors, to physicians for services that they provide to Medicare patients. Now, Mr. Speaker, this is not a question of doctors just wanting to make more money. It's about stabilized repayment for services that have already been rendered, and it isn't affecting just doctors. This problem affects patients and becomes a real crisis of access. Now, Mr. Speaker, not a week goes by that I don't get a letter or a fax from some doctor back in Texas who said, you know what, I have just had enough, and I am going to retire early or I'm no longer going to see Medicare patients in my practice or I'm going to restrict those procedures that I offer to Medicare patients. Mr. Speaker, I know this is happening because I saw it in the hospital where I practiced in my own hospital environment before I left the practice of medicine to come to Congress back in 2003, but I hear it in virtually every town hall that I do back in my district. Someone will raise their hand and say how come on Medicare you turn 65 and you have to change doctors? Mr. Speaker, the answer is because their doctor found it no longer economically viable to continue to see Medicare patients because they weren't able to cover the cost of delivering the care. Medicare payments to physicians are modified annually under something called the sustainable growth rate formula. You probably hear it referred to in the Capitol as the SGR formula. There are flaws in this formula. There's flaws in the process, and the SGR-mandated physician fee cuts in recent years have only been averted at the last minute by fixes that Congress does legislatively, usually at the eleventh hour right before we wrap things up at the end of the year. If no long-term congressional action plan is implemented, the SGR, the sustainable growth rate, formula will continue year over year to mandate fee cuts. Mr. Speaker, let me also point out that these last minute fixes, Mr. Speaker, they're not free. They add to the cost of ultimately repealing the SGR. One of the things we hear over and over again, it just costs too much, we can't repeal the SGR. But every year that we delay fixing the SGR, we add billions and billions of dollars to the total cost of ultimately repealing this sustainable growth rate formula, the formula under which no physician can continue to practice and see Medicare patients. Mr. Speaker, unlike hospital reimbursement rates, which closely follow what's called the Medicare economic index, that's basically a consumer price index or cost of living adjustment, however you want to look at it, it's called the Medicare economic index which measures the cost of providing care. What is the cost of input for taking care of a patient in either a hospital or medical practice setting? But physician reimbursements don't track the Medicare economic index. In fact, Medicare payments to physicians at present only cover about 65 percent of the actual cost of providing services. Mr. Speaker, can you imagine anyone in business or any industry and ask them to continue in business if they receive only 65 percent of what it costs them to deliver whatever good or service it is that they're providing? There's a recipe for financial disaster if you're in that sort of business. If you're losing 35 cents out of every dollar that is spent on health care, guess what; you don't make it up in volume. Well, currently, the sustainable growth rate formula links physician payment updates to the gross domestic product, and Mr. Speaker, for the life of me I don't understand that. There is no relationship to the gross domestic product to the cost of providing care to America's most vulnerable patients, most complicated patients, our senior citizens. But we hear it over and over again. Simply repeal of the sustainable growth rate formula is cost prohibitive, but you know, maybe if we do it over time, maybe if we don't try to do it all at once right here and now, maybe there is a way forward in this. Last year, I introduced a bill, H.R. 5866, which sought to repeal the SGR straight up, just get rid of it, and the cost for that was scored by the Congressional Budget Office as being $218 billion. Reality is today, because of the cost of doing nothing, that repeal would likely cost in the neighborhood of $265- to $275 billion over that 10-year budget window, that elusive 10-year window that we're always talking about. Mr. Speaker, paying physicians fairly will extend the career of many doctors who are now in practice, who otherwise some mornings may wake up and just opt-out of the Medicare program and may seek early retirement. They may run for Congress or they may restrict those procedures that they offer to their Medicare patients. You know, I talked about ensuring an adequate physician workforce. If we were to fix this problem with the sustainable growth rate formula, if we were to evolve to a Medicare economic index way of paying for those costs of actually delivering the care, maybe then older Americans could have the insurance that they will have the access to the coverage that they want, they need and that they expect. Mr. Speaker, we hear a lot in this body about things like pay for performance. Well, Mr. Speaker, I would just ask the question, how does driving out perhaps some of the most capable doctors, doctors who are mature in their practice, who have developed practice patterns that are economical, they've developed efficiencies in their practice, that they are the doctors who are the most proficient in the operating room, the ones that will come to a diagnostic conclusion quickest, if we drive all of those doctors out of practice, how much are we going to have to pay for performance in that scenario? Mr. Speaker, in a bill that I introduced, H.R. 2585, the physician payment stabilization bill, the sustainable growth rate formula would be repealed in 2 years' time, in 2010. That's 2 years from now, and by some other budgetary techniques, resetting the baseline in the SGR formula, provide physicians the protections that they would need for 2008 and 2009 so they would not see reductions in reimbursements over those years and would then provide them the sustained protection of the Medicare economic index in 2010 and beyond. Now, recently, again the Congressional Budget Office estimated that the practical effect of my payment bill would bring a 1.5 percent update in 2008 and a 1 percent update in 2009 and then a complete elimination of the sustainable growth rate formula in 2010. The CBO also calculates an additional savings of $40 billion off of the total price tag of the SGR elimination. Additionally, Mr. Speaker, we always hear how things like improving health information technology and, indeed, reporting and incorporating some performance measures will lower the cost of care. Included in this bill would be two voluntary programs which would augment physicians' payments 3 percent for a physician or group who instituted some changes in their information technology and a 3 percent update for physicians that would participate in a voluntary reporting process, for those individuals who want to further offset the damaging effects of what the last 10 years of cuts in the sustainable growth rate formula have brought to their practices. But Mr. Speaker, the concept here is very simple. It's so simple that sometimes we forget what the concept is. The concept is stop the cuts and repeal the SGR formula. It's the only logical, economically viable solution, and Mr. Speaker, it is the only solution that has in its focus the long-term problem. Again, a lot of people say why not just bite the bullet and go with the full repeal of the SGR and get it out of the way. I tried that last year. I really found no enthusiasm for it, either in this body or any of the professional organizations that are out there that ostensibly would be there to help push a concept like this. And Mr. Speaker, again, on paper it costs a tremendous amount of money to do that, and we're required here in Congress to live under the rule of the Congressional Budget Office to find out how much things cost: If we're going to be spending the taxpayers' money, how much are we going to spend, over what time will we spend it. Because of the constraints of the Congressional Budget Office, we're not allowed to do what's called dynamic scoring. We can't look ahead and say, you know, I think if we do things this way, we're actually going to save some money. You can't do that under the current Congressional Budget Office constraints, and maybe that's okay, but it certainly puts some limits on some of the things that you're able to do. Mr. Speaker, case in point is the trustee's report from Medicare that came out earlier this summer, and the bad news is that Medicare is still going broke. But the good news is that Medicare is going to go broke a year later than what they told us, 2019 instead of 2018. The reason for that, Mr. Speaker, is because 600,000 hospital beds in 2005 were not filled in the Medicare program. Those were beds that were expected to be filled, but in fact, those patients weren't admitted to the hospital. Because why? Doctors are doing things better. Doctors are doing more procedures and offering more in their offices, in their ambulatory surgery centers. Because of the way that the Medicare payment works in Part a, Part B, Part C and Part D, money that we save for Part A, because we spent more in Part B, never gets credited to Part B. That's why we have such a difficulty in offsetting these costs. This bill that I have introduced would actually take those savings, sequester them, aggregate them, protect them, and 2 years later, cost savings from part A would, in fact, be applied to part B to bring down the cost of repealing the sustainable growth rate formula. One of the main thrusts of the bill is to require the Centers for Medicare & Medicaid Services to look at the top 10 things that cost the most amount of money each year, to require the CMS to adopt reporting measures relating to these top 10 conditions. These things have already been developed. This is not reinventing the wheel. The American Medical Association and several medical consortia have already developed reporting measures on the 10 conditions that drive medical costs so high. We all remember the famous bank robber Willie Sutton. When they asked him why does he rob the bank, he replied because that's where the money is. Let's go where the money is. Let's go with these top 10 things where the greatest amount of money is spent because that's where the greatest amount of savings can occur. If we can deliver care in a more timely fashion, if we can improve outcomes, we are actually going to spend less. If we spend less, let's give credit where credit is due. That's not by building up the trust fund in part A; that's by buying down the SGR formula in part B and ultimately repealing it once and for all. The same considerations may apply to the Medicaid program as well, so it will be a very useful exercise to go through and identify those top 10 conditions, and where the savings can be the most easily gathered. Not only will it have an effect on Medicare, but I suspect Medicaid as well. I think we ought to report back to the doctors to how they are doing, confidentially, of course, and individually. We don't tell everyone about every doctor, but let the doctor know how he is doing compared to his peers, how he or she is doing as far as their Medicare expenditures. You know what? Since we will have the data there, and it's already collected, I think we should share data with the patient as well. How much did your care cost the government last year? Try to encourage patients to do those things to participate in their own care and see if they will not participate in bringing the cost of that care down. Now, why do I spend so much time talking about this? Because it's a very important concept. Now, in the SCHIP bill, as was passed by the House, there was a modest physician fix for 2008 and 2009. It was less than the CBO scores, the physician fix for my bill, but the reality is, that the SCHIP bill, the physician fix contained within the SCHIP bill did not have as an end point the repeal of the SGR. I reiterate, if you don't repeal the SGR, you only make the problem worse than in the out years. By 2010, what happens under the SCHIP bill? All those cuts come back, 10 percent, 13 percent reductions in payments to physicians that year alone, and it continues year over year for the remainder of that budgetary cycle. In fact, the scenario, as it was described to me, is modest update in 2008 and 2009, you fall off a cliff in 2010, and you are frozen in 2013. It doesn't sound like an attractive proposition to me. There is a way forward in this that makes sense. I encourage Members of Congress to look at 2585. It is a reasonable alternative to what was proposed in the SCHIP legislation. The reality is, as we all know, the SCHIP legislation is going to change radically before it ever sees the light of day. It's unclear and uncertain at this time whether a physician fix will, in fact, survive in that bill. Whatever minutes I have left, I want to talk for just a little bit about medical liability reform, because I think this is an issue that this House still needs to address. My home State of Texas, now going on 4 years ago, September 12 of 2003, passed a major piece of legislation that was modeled after a bill passed in the State of California back in 1975. I hate to admit that California was ahead of the curve on this, but the Medical Injury Compensation Reform Act of 1975 passed in the State of California, which capped noneconomic damages, had a very, very significant effect on what, at the time, was an out-of-control liability climate in that State. The State of Texas adopted a similar program in 2003, modeled after the Medical Injury Compensation Reform Act of 1975 in California. The Texas bill actually puts a $250,000 cap on noneconomic damages as they pertain to the physician, a $250,000 cap on noneconomic damages as it applied to the hospital, and a second $250,000 cap on noneconomic damages if there is a second hospital or nursing home involved, for an aggregate cap of $750,000 for noneconomic damages. Actual medical injuries are paid at the actual rate, but noneconomic damages are capped at $750,000 under the Texas law. This was a major, major change for Texas when this happened back in September of 2003. We had been undergoing many years of 20 to 30 percent increases in premiums for physicians' practices in Texas. In the late 1990s, we had 17 medical liability insurers in the State of Texas. In 2002, we were down to two medical liability insurers in the State of Texas. The rest had fled because the litigation climate was so unfavorable in my home State of Texas. You don't get very much competition. You don't get your very best competitive rates when you have only got two companies continuing to write business in your home State. In 2003, we did pass the medical liability reform based off the California law, and a legitimate question to ask is how has Texas done since then? Remember I said we dropped from 17 insurers down to two, because the medical liability crisis rose very quickly. Within 2 years' time, we were back up to 14 or 15. I don't know the total number today, but I believe it is either in the high 20s or perhaps even as high as 30 carriers in the State, a significant change from the environment from just 4 years ago. Most importantly, the carriers that have come back to the State have returned to the State of Texas without an increase in their premium. In 2006, only 3 years after its passage, the Medical Protective Insurance Company had a 10 percent rate cut, which was its fourth reduction since April of 2005. Texas Medical Liability Trust, my last insurer of record, declared an aggregate of 22 percent cuts. Advocate MD, another company, filed a 19 percent rate decrease, and Doctors Company announced a 13 percent rate cut. Real numbers, real numbers that affect real people and affect real access for patients in a State that realistically was in peril in 2002, a significant reversal. More options mean better prices and a more secure setting for medical professionals to remain in practice. One of the unintended beneficiaries of this act was the effect on small community not-for-profit hospitals, the type of hospital who would have been self-insured for medical liability. They have been able to take money out of their escrow accounts and put it back to work in those hospitals to capitalize improvements, pay for nurse's salaries, just the kinds of things you would want your small, medium-sized not-for-profit community-based hospital to be doing, not holding money in escrow against the inevitable liability suit that might occur. I took the language of the Texas plan, worked it so it fit with our constructs here in the House of Representatives. I took that language to the ranking member of the Budget Committee before we did our budget vote earlier this year. Representative Ryan, Ranking Member Ryan on the Budget Committee had that proposal scored by the Congressional Budget Office. The Texas plan, as applied to the House of Representatives, to the entire 50 States, would yield $3.8 billion in savings over 5 years' time; not a mammoth amount of money, but when you are talking about a $2.999 trillion budget savings of any size, moneys that we will leave on the table in this budgetary cycle that could have gone into some other spending priority, I've got to ask you, I've got to tell you, I just frankly do not understand why we would not look more seriously about taking up that type of plan. Now, on the fourth anniversary of the passage of the Texas plan, I do intend to introduce this legislation. I think it is commonsense legislation that would bring significant relief to our doctors in practice and be a significant source of monetary savings for this House. If Texas is doing such a good job as a State, why do I even care about it? Why do I even bring up that maybe we ought to look for a national solution? Well, consider this. A 1996 study done at Stanford University revealed that in the Medicare system alone, that's a system that we pay for, that we have to come up with the money for every year, in the Medicare system alone, the cost of defensive medicine was approximately $28 to $30 billion a year. That was 10 years ago. I suspect that number is higher today. That's why we can scarcely afford to continue on the trajectory that we are on with medical liability in this body and in this country. Again, I frankly do not understand why we will not embrace and capture those savings that are sitting out there within easy reach. I began this hour talking about the physician workforce, and let me conclude this part of the liability discussion by coming back to the issue of the physician workforce. No other issue in the practice of medicine, and I speak to you for someone who had a medical license and who still has a medical license, but it was an active practice for over 25 years before coming to Congress. No other issue grates on the sensibilities of a doctor in practice as a constant concern about a medical liability suit. We go into practice to do good work. We go into practice to do good things. If a mistake is made or if an outcome is bad, it doesn't always mean that the next step has to be a trip to the lawyer's office and going through one of these egregious, emotionally trying lawsuits. That's one of the things that keeps young people away from the practice of medicine. They look at it and they think, well, it will cost me an awful lot to get that education. You know what, those courses are real hard, and by the time I get there, I will have to pay an enormous amount of money for my liability policy, and I don't even want to think about what it would be like if I actually got sued. Young people getting out of college, are they considering medical school under those conditions? Unfortunately, a lot aren't. We are keeping some of our best and brightest young people out of the health care profession because of the burden that we put upon them, the burden economically that we put upon them to get that education, just the burden that the education itself entails. It can't lighten that burden. It takes a lot of effort to study medicine. It takes more effort, I would suspect, here in the early 21st century than it did late in the 20th century when I was in my medical school classes. But we have to consider the emotional price that we are asking young people to pay if they are go into the practice of medicine. It is within our grasp to reform this system. It is within our best interest as a country to reform this system, and financially, it makes tremendous sense to reform this system. So I ask other Members of Congress to join me when I introduce this legislation later this month. This, again, is a commonsense, practical approach, proven in the laboratory of the States, my home State of Texas, to be a proven and effective method of reducing the cost of medical liability. You have been very indulgent this evening.

Mr. BURGESS

Mr. BURGESS. Madam Speaker, I rise today to congratulate Pilot Point native Colt Knost on his victory at the 107th U.S. Amateur Championship. Knost defeated Michael Thompson, 2 and 1, in the 36-hole final match. The Amateur is one of 13 national championships conducted annually by the United States Golf Association, 10 of which are strictly for amateurs. The USGA is the national governing body of golf in this country and Mexico, a combined territory that includes more than half the game's golfers and golf courses. Colt Knost, 22, played at Southern Methodist University. With this victory, Knost became the sixth golfer in history to win two USGA championships in the same season, and the second to win the Amateur and the Amateur Public Links in the same year. Knost has a very tough decision ahead of him for he must decide if he will wait to use those amateur berths at Augusta and Torrey Pines or if he will turn pro. I would like to offer my sincerest congratulations to Mr. Colt Knost. His commitment to being the best in his sport shows that drive and dedication can make the difference between good and great. I wish him success in the future, and I am very proud to have him as a constituent of the 26th District of Texas.