Michael Burgess

Mr. BURGESS

Mr. BURGESS. Madam Speaker, I rise today to congratulate Mr. Phil Diebel upon his retirement after over 27 years with the University of North Texas in Denton, Texas. In 1981, Mr. Diebel joined the UNT family as controller, and soon became vice president for finance and business affairs, his role for over 20 years. By 2001, he held the position of vice chancellor for finance for the UNT System. His long and distinguished career meant that he worked for North Texas State University, before its official name changed to the University of North Texas. During his tenure Mr. Diebel worked with two chancellors as well as three presidents of UNT. He watched the UNT system grow from what was largely known as a commuter school to a thriving public university system; one of only six in Texas. Under his tenure, the student size dramatically increased, the university purchased and constructed seven new residence halls, the UNT Dallas Campus opened, involvement in the present effort to secure a UNT law school in Dallas took place, and the UNT health science campus in Fort Worth became a significant asset in the university system. His decades at UNT were not simply a matter of Mr. Diebel's official positions. He served and gave leadership in many UNT efforts over the years, including serving as chair of the responsibility center management (RCM), tuition review, and capital projects planning committees. He was executive sponsor of the Enterprise-wide Information System (EIS), and served on the Southern Association of Colleges & Schools, SACS, reaffirmation team and as a chair for committee with the Texas Higher Education Coordinating Board. But Mr. Diebel's giving nature was not only directed at UNT. An active member of the north Texas community, he served on the Denton advisory board for the Salvation Army; governing board of the North Texas Public Broadcasting, KERA; advisory board of the Denton Regional Medical Center; governing board of the Texas Guaranteed Student Loan Corporation; governing board of the United Way of Denton County; Board of Trustees of the Selwyn School; redistricting committee of the Denton Independent School District; and Denton County Housing Finance Corporation. So with great respect I extend sincere congratulations to Mr. Phil Diebel on his much-deserved retirement. He is a true friend of UNT and the Denton community and I have been honored to know him as a friend and wish he and Polly much satisfaction in retirement.

Mr. BURGESS

Mr. BURGESS. Let me respectfully point out we call that the Dallas- Ft. Worth area back where I come from. I am going to reiterate many of the points that have already been made tonight. It's hard to not cover ground that's already been covered. This was my sixth trip to the country of Iraq. I was there a year ago. We went in July, toward the end of July, a weekend trip, as Mr. Carter already pointed out. I didn't know it was possible to do a weekend trip to Baghdad but, indeed, it is if the circumstances are correct. The year before I was there and heard about some of the things that were happening in a hospital, a little town called Ramadi. General Peter Chiarelli, as I recall, said, I am not sure what this means and probably too early to talk about it, but it seems as if we have been invited into the hospital, which was one of the main headquarters of the insurgents, the Sunni insurgents there in Ramadi, and the building was turned over without firing a shot. A year later, the situation is completely reversed, and Ramadi was so stable that not only could we talk about visiting it, we, indeed, did visit. It is that trip that really embodies the success that has occurred and, largely, the success that has occurred since beginning the additional troop strength in February and, of course, the ascension of General David Petraeus to be the commander of the forces in Iraq. The fact is, I don't think you can deny that significant successes have been made and they continue to occur on an ongoing basis, returning control of the country to the Iraqi Government and to its people and delivering it out of the hands of criminals and murderers. But I don't think any of us would disagree. It's still a very dangerous situation and the sacrifice that's being made by all participants in the country is very, very real. It is my opinion, and I spoke on the floor of this House right before we had the decision to support the President on the surge, it is my opinion that it is in America's broad interest that we be successful in this endeavor. It is also my opinion that it is, indeed, possible for us to be successful. Nothing that I saw on this trip would discourage me from either one of those points. It is my opinion that a stable country in Iraq, with a representational government that's able to act as a partner in peace in the Middle East, would be vastly preferable to a lawless land ruled by terrorists, criminals, with sources and training capabilities where they would be able to expand their activities, not just to other areas of Iraq but, indeed, to other areas of the Middle East and, indeed, to other areas of the world. Almost without question, the divergent future, the potential divergent future of that country was on the minds of almost everyone we encountered during that very brief 2-day trip. Certainly America's interest is going to be best served by stability in the country and their active participation in quieting a very troubled region. In July of 2006, there was no way that we could have taken a congressional delegation into Ramadi. It would have been too dangerous, and we would have been turned down had we asked. But this time we got off of the C-130 in Baghdad and loaded onto the Black Hawk helicopters, and we were taken to Ramadi. We met with the soldiers there. We met with the soldiers of the II Marine Expeditionary Force, which are part of the surge. General Gaston, who I believe is on the pictures with President Bush over the weekend, was part of that briefing that we had there, met the mayor, met the health minister. The mayor of Ramadi sounded like a mayor in any one of the 60 cities that are in my district. He said, I need more Federal money. By the way, if you come back and visit next year, this place is really going to be something, so plan on coming back and spending some money when you get here. He sounded like a combination mayor and chamber of commerce guy, but he really believed in what he was doing. I guess, of all of the things that I didn't expect to find when I got to Iraq this time, it was that slow building of the institutions of local government, which previously had been lacking, that building of the institutions of government at the local level, which heretofore I had not witnessed on any of the trips that I had made to Iraq. That was the thing that probably gives me the most hope for what the overall future for that country may entail. When we got to Ramadi, we had our briefings. We had our visits with the health director and the mayor. And then we went downtown. We went to an area that previously was involved in very, very heavy ground fire and ground fighting for the control of that city. Remember, Ramadi is a city about the size of Fort Worth, Texas. It's about 400,000 to 500,000 people. It was designated to be the provincial capitol of the resurgent caliphate in western Iraq. Well, we walked through the market, and it looks like a very normal market in a Middle Eastern country. And you can see the look on the faces of the people there. They're curious about people walking through their market. Clearly, we did not look like we were typical shoppers. But you see the faces of the children there, inquisitive and friendly. A lot of stuff available for sale there, much more than I would have thought in an area that had been recently so hard pressed. One of the very striking things to me again is the faces of the children, very energetic, very engaged, very trusting. These two young men came right up to us. I think they were interested in if we had any pens or quarters. Clearly, the close association with the American military has taught them a few things about life in this country. But clearly, a very different picture on the street in Ramadi than you would have encountered a year ago. From a military perspective, there's no question that success has been made and continues to be made on a near daily basis. The primary enemy, which is al Qaeda in Iraq, has not only been beaten but they've been vanquished every time there is an encounter. Al Qaeda has now about three options: they can move, communicate, or shoot. And if they do any one of those three things, they are met by our military, and they are dispatched. Because of the increased military presence of our troops in Iraq, the confrontations are more frequent, and you see that reflected in statistics coming out of that country. From the government perspective, there's not a Sunday morning that goes by that we don't hear someone complain about the government in Iraq, and I'll do the same thing. It's astounding to me that a country that young, a government that young can already have entrenched bureaucracies that exist within it. Iraq has a very centralized government. But, again, I would stress the building up of the work that's going on currently of that sort of bottom-up work of building governments does seem to be a cause for some optimism. Probably this conflict, unlike any other in our Nation's history, there are data points which are distributed all over the map. And anybody can take a handful of those data points and make whatever conclusion, draw whatever conclusion they have in their mind to make. It is going to take a lot more discipline for this body to look at the trends, analyze the data trends, look at the trend lines. But that's a discipline that we just have to undertake. There are people in the field who are counting on us to be able to make that rational, dispassionate assessment of trend lines; and it is the obligation of Congress to follow through on that. There have been two or three years of serious brutality at the hands of al Qaeda, and this population now sees Americans as helpers and protectors. The tribal leaders that originally feared that the Americans would be occupiers quickly came to understand that the Americans have no such interest, but the same could not be said for the al Qaeda interests. Their clear intent was to hold territory for their own purposes for the foreseeable future. The point was made over and over again on our trip that there is no easy, there is no overnight solution to the problems that confront us in Iraq. Unfortunately, leadership cannot be bought, and it has to be grown. It has to be part of an evolutionary change. But it can occur if the right environment is provided and appropriate, but not indefinite, time is given to develop those institutions of government. Everything we have asked of our military they have delivered, they have produced for us. What we have asked of the Iraqi Government is still a work in progress, and we've set a pretty high bar. And it's a much shorter time frame than even our own country had available to it. I think of the Articles of Confederation that ultimately led up to the Constitution. What if someone had said to us, time's up, and you've just got to get it done? With continued pushing on the Iraqi Government and the recognition that there are cultural challenges before them, I am hopeful that it can mature into a stable partner for peace in the Middle East. My opinion, my conclusion is that our presence in Iraq is still necessary. It's necessary for America's interests, not for Iraq's interests. I've said, and I think everyone in our group said every time we'd sit down with representatives from one of the ministries, you've got to show some evidence of success. You've got to achieve some benchmarks. I think when we met with Dr. Sharistani, the oil minister, it's probably most evident. They've got problems in trying to achieve these benchmarks. Not every country that surrounds them is interested in Iraq being successful. Yeah, we all know about Iran and their influence; read more about it today. We all know about Syria and their influence. But what about the Saudis? Do they have an interest in perhaps not getting that oil revenue sharing law passed? Well, this was brought up to us. It would have never occurred to me that this might be an obstacle to getting that law passed and enacted, but apparently there are some forces, and maybe even just some media forces within that country that work in a detrimental way to that kind of progress. But progress has to come and it has to be clearly evident for those on the outside. We perhaps have asked them to achieve the impossible in such a short time frame. But, again, many of us here tonight have made multiple trips to Iraq. Every trip I've made, I have seen progress, evidence of significant progress since the trip before. And I have no doubt that that progress has continued since our trip there the latter part of July. Again, my opinion: it is in America's interest that we be successful. And to answer the question, is success still a possibility, I don't think there's any question after this last trip. The answer to that is a resounding yes. I'll yield back to the gentleman from Texas, and I truly appreciate him calling this Special Order tonight.

Mr. BURGESS

Mr. BURGESS. I thank the gentleman for yielding. I am on the Committee of Energy and Commerce, but because of the restrictions of time for this very important bill, I appreciate him giving me time off the Small Business Committee's timeline. Mr. Chairman, I come to the floor of the House to actually educate Members about some stuff that is in this bill of which they may not be aware. I had an amendment in subcommittee and full committee, and the again yesterday in the Rules Committee that was not made in order. But this amendment deals with the timeline that is going to outlaw the incandescent bulb in this country by 2012. That means, for the current time, you will be using one of these for your light bulbs at home, a compact fluorescent bulb. Perhaps a good idea. They last a long time, they consume less energy; but, Mr. Chairman, they also contain mercury, about 5 milligrams per light bulb. What is the problem with that? The problem with that is these light bulbs can break. And if they do, what does the Environmental Protection Agency recommend? It recommends you open the window and leave the room for 5 minutes. It recommends that you double-bag your vacuum cleaner bag to pick up all the parts you can without vacuuming, and when you do vacuum put the vacuum cleaner bag in a double plastic bag and send it only to a landfill that accepts mercury. A pretty onerous burden to put upon the taxpayers of the United States. But the real concern that I have is that we have locations in this country where we have vulnerable populations that are difficult to move: a nursery in a hospital, a daycare center, a nursing home with nonambulatory patients. If you break a compact fluorescent bulb in one of those locations, you are in for big trouble. You have got to move 20 children who are in a nursery before 15 minutes time is up? Most nurseries that I worked in, in hospitals, don't even have a window to open. So how are you going to comply with those EPA guidelines? The fact of the matter is, my amendment would have had language that said: no nursery, hospital, nursing home is compelled to use a compact fluorescent bulb where the population might be vulnerable if there were the escape of mercury out into the environment. Unfortunately, the House Speaker, the House leadership did not want that amendment made in order. We now all have these in our offices over in the Longworth Building. I know I found two. I wasn't told that they were being put in the office. People need to know, they need to be aware that there are very specific guidelines that deal with the breaks of these bulbs, and it is important that they not be compelled to be used in nurseries or with vulnerable populations.

Mr. BURGESS

Mr. BURGESS. Mr. Chairman, I thank the gentleman for yielding me this time. I regret that it is necessary for me to come down and talk during the time for general debate because this is an amendment that should have been made in order by the Rules Committee, and I frankly do not understand when it so significantly affects food safety and would have been a perfecting amendment on the underlying bill, I frankly do not understand the inattention of the Rules Committee to this important issue. We hear time and again the United States being besieged with dangerous food from certain countries. According to testimony before the Energy and Commerce Subcommittee on Oversight and Investigations on July 17, 2007, former FDA Associate Commissioner William Hubbard testified that in 1999 the FDA drafted a legislative proposal that would have given the Food and Drug Administration authority to require certain foreign countries to take more responsibility for the foods that they send into this country. The agency proposal would have allowed the FDA to embargo a given food from a given country if there were repeated instances of that food being found contaminated when it arrived in the United States. Countries that send safe food, they have no reason to be concerned. They would be unaffected. But countries that demonstrated a pattern of disregard of United States safety standards would have to increase their oversight of foods exported from their country. Have we heard of any examples of that in the past 6 months? Unfortunately, Congress did not accept the recommendation, and the situation with some imported foods from some countries has only gotten worse. On page 96 of the committee report for H.R. 3161, it states that ``the Committee believes that the Food and Drug Administration is failing to do what is needed to ensure the safety of our food supply.'' Furthermore, ``the Committee directs the Food and Drug Administration to develop a performance plan that establishes measurable benchmarks for concrete improvements in the performance of food safety missions.'' In formulating the plan, the FDA is to look at the process for reviewing food safety systems in countries that export to the United States, and that these proposals are not dissimilar to measures the Food and Drug Administration has proposed in the past or may be considering currently. On page 97, the committee report states that ``the Committee provides for an additional $7 million for increased activities to protect the safety of imported foods.'' My amendment would not have allocated any new funds to the FDA. But instead, it seeks to direct a portion of these funds already allocated towards increased activities to protect the safety of imported foods and on formulating an embargo plan. This plan would allow the FDA to prohibit a specified food from a specified country from entering into the United States if there were repeated instances that that food was found contaminated when it arrived in the United States. Again I submit, we have heard several news report over the last 6 months where exactly this scenario has played out. We have to stop them from sending harmful food into our country. This would have been a good amendment, and I don't understand why it was not taken up by the Rules Committee.

Mr. BURGESS

Mr. BURGESS. Mr. Speaker, I thank the chairman. One minute is scarcely enough time to discuss what we need to discuss today. So I would, just like the chairman of the full committee, put my entire statement into the Record. Mr. Speaker, I want to confine my comments today to issues that surround issues for physician reimbursement. I had two amendments last night in Rules Committee that were not made in order that would have vastly improved physician reimbursement. Instead, we have language in the Democratic underlying bill that provides a small uptick for the next 2 years, then you fall off the cliff, and then you're frozen for the next 10 years. Hardly measures that will encourage people to go into the practice of medicine in the future. I also want to reference section 651, the whole hospital exemption. Mr. Speaker, I would just point out that in the Rules Committee it was made in order that several hospitals would actually be grandfathered out or carved out of that exemption, and most of these hospitals lie in Democratic districts. I have a letter from 75 constituents, physicians back in my home State of Texas, who strongly object to the whole hospital exemption in this bill, and I will submit that for the Record as well. The Democratic party is prepared to take its first step toward cradle to grave government involvement in the lives of all Americans. The 40- plus page SCHIP bill that was unveiled to this committee in the wee hours of last Wednesday represents legislative malpractice. We shouldn't be surprised because we've been here before. A handful of Democratic staff, working behind closed doors, without any input from the real world have produced just what we should expect: a bloated and complicated proposal that grows the size of government, diminishes state fiscal accountability and an individual's personal responsibility, and likely erodes the independent practice of medicine. I doubt anybody in this body, Republican or Democrat, really understands what is in this proposal. We've not had one legislative hearing on this bill and haven't even taken this bill through regular order in the Energy and Commerce Committee. As a member of the Health Subcommittee of that panel, I'm disappointed in that fact because the subcommittee has shown an ability to come together and work out partisan differences. I haven't spoken with Chairman Pallone, but I imagine he shares that sentiment to some degree. Just recently, Republicans and Democrats came together to report out a bill that improves drug safety and FDA review of new drugs and devices. We worked through our differences and produced superior legislation. But all that bipartisan comity has been thrown out the window. Any rationalization of how we can vote on this bill and report to our constituents that we conducted an in-depth review of this legislation would be farcical at best, especially when we have learned that the Rules Committee plans to report out a completely different measure in the dark and early hours this coming Wednesday. Kids need a safety net, but the safety net shouldn't apply to those that can and should help themselves. Taking money from taxpayers to give it to families that have the resources to purchase health insurance for their children is irresponsible. And if affordable options don't exist for these families, well forget it, because this bill doesn't lift a finger to reform an insurance market burdened by regulation and lack of choice. On immigration, this bill all but ensures that states like mine and other border states will be saddled with more cost as it rewards those that illegally enter our country. The debate on illegal immigration is often ruled by emotion but the provisions in this bill relating to immigrant health care are equally suited--this bill makes little to no effort to understand this dynamic and only serves to pour gasoline on an inferno. On Medicare, this bill misses the mark widely. This bill would make a bad investment in an attempt to fix Medicare physician payment and in doing so, members will find themselves in the position of spending billions more in the future to fix the problem again. We shouldn't fool ourselves that this is realistic policy making. For those members about to head home and face their constituents at coffees, lunches, and town halls they should be wary of what Speaker Pelosi is force feeding this body. Baylor Medical Center at Frisco, Frisco, TX, August 1, 2007. Hon. Michael C. Burgess, MD, U.S. Congressman, Washington, DC. Dear Congressman Burgess: We are physicians that practice at Baylor Medical Center at Frisco. Today, we are writing to express our deep concern about the language in the S-CHIP bill (CHAMP Act) once again attempting to prohibit physicians from owning or investing in any hospital. While this legislation contains many important and generous provisions, such as the reauthorization of SCHIP and the SGR fix, Section 651 virtually eliminates physician owned hospitals for no reason other than the enmity of certain competitors. Much has been written about the negative effect this ownership has had on our community hospitals where we also practice. Many of the large hospital systems claim they are being harmed by physician-owned specialty hospitals in their communities. Yet none of them has provided any factual data to support their claim that they are unable to provide ``essential services'' as a result of specialty hospitals. In fact each of the last 6 years the American Hospital Association has reported a 6% increase in profits in their member hospitals. And many of their arguments (e.g. ``specialty hospitals typically do not provide emergency care'') simply is not accurate. The benefits of the physician ownership model are so convincing that a growing number of not-for-profit healthcare systems, including some of the largest members of the American Hospital Association, have embraced the concept of physician ownership. MedPAC, CMS, and GAO have all studied this issue. Not one of them has concluded that physician owned hospitals represent a threat to the community hospitals where they exist. To the contrary, some have concluded that the overall increase in quality of care greatly benefits the communities in which they exist. We believe that a major part of our success is due to the fact that individual physicians are partners in the ownership in the facility. As any business owner, we take pride in our facility and have worked hard to make sure the quality of medical care remains high. And frankly, we are much more aware of the costs and how to better deliver care more cost effectively. Through disclosure policies our patients are aware of the physician ownership and our surveys reveal very high patient satisfaction. The best way to manage health care costs is to encourage physicians to become involved in the development of new models for the delivery of surgical and other health services. Maintaining the status quo by giving acute care hospitals protection from market forces will only lead to higher health care costs for us all. When voting, please consider carefully the decision you will be asked to make regarding physician ownership, it will not only affect your constituents' rights as a patient to have the most convenient cost effective care, it will affect the delivery of health care for generations to come. Sincere regards, Benton Ellis, MD; James Gill, MD; David Layden, MD; James Montgomery, MD; Mark Allen, MD; Dawn Bankston, MD; F. Alan Barber, MD; Richard Bowman, MD; Dale Burleson, MD; Cameron Carmody, MD; John Schweers, MD; William Cobb, MD; Stephen Courtney, MD; A. Joe Cribbins, MD; Bruce Douthit, MD; Dennis Eisenberg, MD; Berry Fleming, MD; Richard Guyer, MD; Lloyd Haggard, MD; Stephen Hamn, MD; Andrea Ku, MD; Briant Herzog, MD; Stephen Hochschuler, MD; James Hudguns, MD; Fawzia Jaffee, MD; Warrett Kennard, MD; Adam Kouyoumjian, DO; Jimmy Laferney, MD; Stephen Lieman, MD; Samuel Lifshitz, MD; Earl Lund, MD; Gary Mashigian, DPM; Mark McQuaid, MD; William Mitchell, MD; Dr. Keith Matheny; William Montgomery, MD; John Moore, MD; Mickey Morgan, MD; William Mulchin, MD; John Peloza, MD; Ralph Rashbaum, MD; Jon Ricks, MD; Alfred Rodriguez, MD; Vince Rogenes, MD; David Rogers, MD; Ivan Rovner, MD; Michael Schwartz, MD; James Smrekar, MD; Robert Taylor, DPM; Ewen Tseng, MD; Gary Webb, MD; Stanley Whisenant, MD; Michael Wierschem, MD; Kathryn White, MD; Kathryn Wood, MD; Iddriss Yusufali, MD; Roger Skiles, MD; Scott Fitzgerald, MD; Leonard Bays, MD; Donald Mackenzie, MD; Lloyd Haggard, MD; David Holder, MD; Joe Hughes, MD; David Perkins; Robert Purnell, MD; Eddie Pybatt, MD; Elaine Allen, MD; Steven Michelsen, DO. amendment to h.r. 3162 This amendment would modify Title III of H.R. 3162 that addresses Medicare physician reimbursement. While H.R. 3162 provides temporary relief to address scheduled Medicare physician payment cuts, it does nothing to address the problem in the long-term, and would in fact exacerbate the problem in the long-term. The amendment does the following: 1. Reset to 2007 the base year for application of the Sustainable Growth Rate (SGR), and eliminates the Sustainable Growth Rate in 2010. The practical effect of this on Medicare physician payment would provide physicians with over a 1 percentage increase in 2008 and 2009, and stable and sustainable growth rate in payment from 2010 and into the future. 2. Makes available incentive payments for increased quality reporting and implementation of health information technology. 3. Provides annual reports to physicians on billing patterns under Medicare. 4. Provides an annual report to Medicare beneficiaries on annual Medicare expenditures. 5. Mandates a study on whether quality reporting requirements on health care disparities. Amendment to H.R. 3162, as Reported [By The Committee on Ways and Means] Offered By Mr. Burgess of Texas (CHAMP amendment) Strike sections 301, 302, 303, 304, and 307, and insert the following sections (and redesignate sections 305 and 306 accordingly):

Mr. BURGESS. I object.

Mr. BURGESS

Mr. BURGESS. Madam Speaker, I rise today to submit a record of how I would have voted on Thursday, July 26, during which I was at the Oval Office with the President discussing my recent mission to Iraq. (1) Stearns Amendment (15 minutes)--The amendment would prevent the U.S. Equal Employment Opportunity Commission (EEOC) from using any appropriated funds for the purpose of bringing lawsuits against a company that requires its employees to speak English. It would not affect any current case, only future suits. Vote: Yes. (2) Flake Amendment (2 minutes)--The amendment would strike $200,000 in funds for the Lobster Institute at the University of Maine. Vote: Yes. (3) Flake Amendment (2 minutes)--The amendment would strike $720,000 in funds for the meteorological equipment at Valparaiso University, IN. Vote: Yes. (4) Pence Amendment (2 minutes)--The amendment would prohibit funds in the act from being used to enforce ``the amendments made by subtitle A of title II'' of the Bipartisan Campaign Reform Act of 2002. This amendment would prohibit the DOJ from enforcing the electioneering communications section of the McCain-Feingold campaign finance law. Vote: Yes. (5) Upton Amendment (2 minutes)--The amendment states that no funds shall be made available to purchase light bulbs that do not have the ``ENERGY STAR'' or ``Federal Energy Management Program'' designation. Vote: Yes. (6) Jordan Amendment (2 minutes)--The amendment would reduce spending across-the-board by 3.0% to reflect FY 2007 levels-- Vote: Yes. (7) Price (GA) Amendment (2 minutes)--The amendment would reduce funding in the bill by 1.5%. (30 minutes) Vote: Yes. (8) Musgrave Amendment (2 minutes)--The amendment would reduce spending across-the-board by 0.5%. (30 minutes) Vote: Yes. (9) Republican Motion to Recommit (15 minutes)--Vote: Yes. (10) Passage--H.R. 3093--CJS Appropriations (5 minutes) Vote: No.

Mr. BURGESS

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

Mr. BURGESS

Mr. BURGESS. Madam Speaker, I come to the floor tonight for what was to be the leadership hour, but the hour has gotten so late that this will really only be a few minutes of discussion on the reauthorization of the State Children's Health Insurance Program, the program known as SCHIP. This program was introduced 10 years ago by a Republican House of Representatives. It was a bipartisan plan to help low-income children to have health care coverage. This program was to be reauthorized in 10 years' time. That 10 years is up on September 30, 2 months from tonight. We all agree, on both sides of the aisle, that we want to make sure children of low-income families have the health care coverage that they need. But, Madam Speaker, we are also anxious to be certain that we don't do so at the expense of senior citizens on Medicare. We would like to make sure we don't raise taxes to do this. And a lot of us are concerned about permanently expanding yet another entitlement program. Anyone who reads the newspaper today knows that we already have trouble with the entitlement programs that are already there. The problems with the bill that has been introduced by the Democrats that we had read in our committee last week: the Democratic bill reauthorizes the SCHIP program as a permanent entitlement, $159 billion over 10 years. One of the biggest problems is there is no income limit for SCHIP eligibility. Current SCHIP guidelines are for families at or below 200 percent of the Federal poverty limit. Some States go higher than that. But, Madam Speaker, look what happens when you go to these higher levels: The current authorization, again, is for 200 percent of the Federal poverty limit; 50 percent of those children actually already are covered under a private insurance or Medicaid. As you go to successively higher income limits, between 300 and 400 percent of poverty, nearly nine out of ten children are already covered on a private insurance plan or Medicaid. The SCHIP program, by expanding it to these levels, will crowd these individuals out of private insurance and drive them onto government-subsidized health care. I would ask you if that is the best expenditure of our Federal health care dollar. The open-ended Federal funding in the program proposed by the Democrats allows States to go over their budget. It shifts children participating in private insurance to government insurance. A child is now defined as an individual up to 25 years of age, and, once again, adults are covered under this plan, which really has been one of the failings of the previous SCHIP authorization. A big problem is cutting Medicare Advantage plans by $157 billion, denying seniors access to plans that have enjoyed widespread popularity in areas where they have been introduced. It cuts Medicare provider payments, reduces inpatient hospital payments, cuts skilled nursing facilities and home health care, and reduces payments for imaging and oxygen or mobility devices. It does increase taxes. It creates an entirely new tax, one that has yet to be scored by the Congressional Budget Office on all private health insurance plans, an assessment, if you will, on private health insurance plans. It increases taxpayer liability for immigrants and illegal aliens. It eliminates the 5-year waiting period for people who are in this country legally to participate in Medicaid and CHIP. Wisely, a moratorium for 5 years was placed on SCHIP and Medicaid so that people would not seek to come to this country simply to participate in the welfare state but would come because they wanted to be good citizens and be workers and produce in this country. More pernicious, in my opinion, is allowing illegal aliens to receive Medicaid and SCHIP by weakening citizen verification standards. A net cost of $76 billion over 10 years certainly flies in the face of fiscal responsibility. And, more importantly, it repeals the trigger that was put in the Medicare Modernization Act 3 years ago that would require the President and the Congress to reaffirm if Medicare expenditures went above a certain amendment. Madam Speaker, there is a right way to do this, and I don't want to get too bogged down in process because the time available to me is very short, but recently we underwent an FDA reauthorization bill in my committee, the Committee on Energy and Commerce. It went through subcommittee. It went through full committee. And at the end of the day, we had a bill that was much better than the bill that was originally delivered to us, the committee print of the bill. We weren't allowed to do that on the SCHIP bill. The subcommittee legislative markup was completely eliminated. We just bypassed it. We didn't even do it. The committee print was dropped on the minority members of the committee some 24 hours before we had the legislative markup in full committee. There was no time to evaluate this nearly 500-page bill that had many, many new provisions in it. And as a consequence, many of those on my side of the aisle felt it was inappropriate to deal with such a large transformational piece of legislation in such a short time interval. Now, it is important to note that there is a Republican alternative out there. It is called the Barton-Deal SCHIP reauthorization, and I think this is a balanced approach to actually getting back to the original intent of what the State Children's Health Insurance Program was, in fact, to be: a program for low-income children. The original intent was to cover those children whose parents made too much for them to be covered under Medicaid, but not enough to be on private health insurance. That gap between 150 percent of poverty and 200 percent of poverty was identified as the level at which SCHIP benefits really would have the maximum impact. And in the Barton-Deal reauthorization legislation, it allows States to continue that program, but after a State covers at least 90 percent of the children that should be covered, they can then expand that coverage up to 250 percent of the Federal poverty level. The Federal poverty level for a family of four would be about $41,000 per year at the 200 percent of poverty. At 250 percent of poverty, it is about $51,000 or $52,000 a year for a family of four

Mr. BURGESS. Madam Speaker, I ask is there anyone to claim time?

Mr. BURGESS. Madam Speaker, under the Barton-Deal plan, new enrollees would be strictly limited to services provided to children and pregnant women with household incomes under 200 percent of the Federal poverty level. And, again, when those States can demonstrate that they are covering the 90 percent of the kids in the bracket, then they could expand to the 250 percent of poverty level. Under the Barton-Deal plan, it does require citizenship to be verified. Many people in my district, certainly many people across the country, feel very strongly about this position, and I have heard from constituents even just this morning in a community coffee in a small town in north Texas. This was something that people were very vocal about it. Once again, we need to reaffirm that the SCHIP program was designed for children who were in need, not for children who had access to health care coverage by other means. The Barton-Deal plan does allow for some individual choice in health care and really, once again, reaffirms that the ``C'' in SCHIP stands for children. And, indeed, that is as it should be. I also want to draw Members' attention to the fact that in the Democratic bill they do attempt to deal with the physician payment cuts that many doctors are going to see. The way they have gone about this, though, I believe is a flawed process. A much better process is one that has been put forth in H.R. 2585, which would actually be a repeal of what is called the SGR formula. That is the thing that has been bedeviling physicians for years and years, certainly since I first came to Congress. This is good legislation that should be looked at. If a Member is concerned about being able to provide or postpone or eliminate those provider cuts that are going to happen to physicians in future years, I don't think the SCHIP bill gets you there. I don't think it takes you far enough to where you want to be. Indeed, there are exclusions for 2008 and 2009, but what happens after 2010? You basically fall off a cliff again. And that is the problem we have had year in and year out with doing these 1- or 2-year fixes on physician reimbursement. H.R. 2585 is a much more sensible way to go about this because it actually puts you on a trajectory for repeal of the SGR and getting out from underneath the tyranny of that SGR formula once and for all. And, again, one of the other final things I would mention is that there is nothing in this SCHIP bill that makes any impact on one of the fundamental problems we have in the practice of medicine today, and that is dealing with the liability crisis that we have had in this country and that we still have in this country. My home State of Texas has made significant strides towards sensible, commonsense liability reform. I was hoping we could see language incorporated via the amendment process in the SCHIP reauthorization, but apparently that is not to be, either. Madam Speaker, I know it has been a long day on the floor of the House. I appreciate the indulgence of the Chair in allowing me the extra time

Mr. BURGESS

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

Mr. BURGESS

Mr. BURGESS. Madam Speaker, I rise today to congratulate Mr. Lee McGilvray of Denton, Texas on his retirement from the City of Denton Solid Waste Department. Mr. McGilvray held employment in the City of Denton for 39 years and 33 days. For nearly 4 decades, Mr. McGilvray has provided the service that makes our everyday lives easier. He worked both in the Commercial Division as well as the Landfill Operations Division. Mr. McGilvray is also a valued member of the Solid Waste Road-e-o Team. A vehicle obstacle course, Road-e-o gives drivers the opportunity to demonstrate their skills that are highly developed but often unnoticed by the general public. He placed 1st place in the state dozer competition in 2005, 3rd place in the national dozer competition in 2005 and 3rd place in the state dozer competition in 2006. The Road-e-o Team represents the department at statewide and national Road-e-o events aimed at promoting the safe operation of heavy equipment through competitions. I extend my sincere congratulations to Mr. Lee McGilvray on his retirement. His dedication and commitment to serving the citizens of Denton made us all lead better lives. Thank you.

Mr. BURGESS

Mr. BURGESS. Madam Speaker, I rise today to recognize the service of Mr. Leon Brachman with Baylor All Saints Medical Center Board of Trustees. Dr. Brachman was recently selected to receive the Texas Healthcare Trustees' 2007 Founders' Award. For over a half of a decade, Mr. Brachman has shown unwavering commitment to leadership and service to the health care industry in the City of Fort Worth. In 1958, he oversaw the construction of the initial building for All Saints Hospital, an Episcopal Hospital, that later became affiliated with the Baylor Healthcare system. Mr. Brachman has served as a trustee for over 50 years as the hospital has expanded throughout the North Texas community. Through his efforts, in an ever- changing and challenging health care arena, Fort Worth now stands as an excellent model for other communities hoping for a strong health care system. The Texas Healthcare Trustees Founders' Award is the highest honor for a Texas hospital and health system trustee. It is a state-wide award, given to only one person in the state, per year. Mr. Brachman was selected as the distinguished trustee in honor of his record of leadership in health care governance. The Founders' Award remains a symbol of dedication and excellence in service in the health care field. It is with great honor and pride that I recognize Mr. Leon Brachman today, and I encourage him to continue to serve as an example to us all in putting our community and the needs of others ahead of ourselves. His vision will ensure a healthier future for Texans.

Mr. BURGESS

Mr. BURGESS. Madam Speaker, because of traveling back to the States from Iraq, I missed the following votes: (1) H.R. 404--Federal Customer Service Enhancement Act (15 minutes)-- ``no.'' (2) H. Res. 553--Mourning the passing of former First Lady, Lady Bird Johnson, and celebrating her life and contributions to the people of the United States (5 minutes)--``yes.'' (3) H. Res. 519--Honoring the life and accomplishments of renowned artist Tom Lea on the 100th anniversary of his birth (5 minutes)-- ``yes.'' (4) Previous Question--Rule for H.R. 3074--Transportation-HUD Approps (5 minutes)--``no.'' (5) Adoption of the Rule for H.R. 3074--Transportation-HUD Approps (5 minutes)--``no.''

Mr. BURGESS

Mr. BURGESS. Madam Speaker, I come to the floor of the House tonight having just returned from the country of Iraq yesterday afternoon. And even given the lateness of the hour, I wanted to come address the House because there are some issues that are, in fact, very timely and time- sensitive, and I thought it was important to get them spoken on the floor of the House. My intention is to come back with the other Members who were on the trip with me, Mr. Carter of Texas, Mr. Brady of Texas, Mr. Jordan of Ohio, Mr. Davis of Tennessee, and talk about this in some depth in the weeks to come. Mr. King of Iowa was also with us on the trip. But because of the lateness tonight and the lateness that we are likely to go tomorrow night and Thursday night, it may be next week before we can actually do that formal presentation, and there were some things that I wanted to get on the floor of the House this week. Madam Speaker, I would report to the House that as of the third week of July 2007, it is still a very mixed report about the situation in Iraq. My overall impression from this latest trip is that significant successes have occurred and are likely to continue to occur as far as returning control of the country to the Iraqi Government and delivering it out of the hands of criminals and murderers. At the same time, it is still a very dangerous situation, and the sacrifice is very real. Madam Speaker, the future of America is vastly different depending upon the outcome of what happens in the country of Iraq. A stable country, a country with a representational government, a country able to act as a partner for peace in the Middle East would be vastly preferable to a lawless land ruled by terrorists and criminals providing a base for training operations and, Madam Speaker, a source for funding for further enlargement of their activities. Almost without question, the divergent future was on the minds of almost everyone I talked with during the 2-day trip. Certainly America's best interest is going to be served by stability in that country and with their active participation in stabilizing a very troubled region. It has been just over a year since I last traveled to Iraq. A lot has changed both at home and in Iraq over that time. There is no question that the news reports coming out of Iraq have almost been universally pessimistic for about 10 months' time. I was obviously very concerned about what I would encounter upon my return to that country, but the trip made over the weekend, a Saturday and Sunday, a very condensed time frame with a great deal to see, we learned a great deal. Starting with a 2 a.m. departure from the military airport in Kuwait City, we loaded on the C-130 for the flight into Baghdad. The plane was cramped and fully loaded. Already at 2:00 in the morning, it was over 90 degrees. The plane contained a large number of soldiers and marines who were returning to Baghdad. Because of the very early hour and the loudness of the aircraft, there was not much time for conversation; but after the plane landed and the engines were stopped, there was a brief episode where conversation was possible. For most, this was their second or third rotation. Their deployments had been extended through 15 months, and most would not go home for almost a year from that point. When several who were standing next to me learned who I was, there was obviously an eagerness for conversation. Since February, there has been a change in how they have done their work. Now most were placed alongside Iraqi soldiers in smaller groups around town. They were no longer attached to the larger, more protected bases, and the soldiers were clearly seeing a greater amount of activity, and it concerned them. I spoke in some depth with the soldier in front of me. He had 10 months left in his rotation, and sometimes he wondered if the generals knew what they were up against in this deployment. He complained about the long hours and the heat. He complained about being separated from his family. He had been reading a book on the plane, and I asked him about this. He said it was a book about philosophy, so I naturally assumed that upon leaving the Army at the end of his deployment, he would likely return to school, or perhaps he had a job waiting for him, and I asked him about this. He looked at me strangely. ``Well, I just reenlisted for 5 years,'' he said tersely. We left the plane and parted ways. He got on an armored convoy, and we were loaded in Blackhawk helicopters for the next leg of our trip down to Ramadi. It was still very early in the morning, and the sun was barely breaking through the low dust layer that always seems to hang over Baghdad in the summer. The temperature was already in excess of 100 degrees, but in many ways my conversation with this soldier underscored the ambiguities, the inconsistencies, and the incongruous nature of life in Iraq. Over the next 48 hours, we would see stories of great heroism and great hope. At the same time, the frustration of buying time and space for a young government, sometimes a dysfunctional government, of a war- torn country was underscored at several junctures. From a military perspective, success has been made and continues to be made on a near daily basis. Indeed, the primary enemy, al Qaeda, has not only been beaten, but vanquished every time there has been an encounter. And because of the increased military activity, the encounters have been more frequent. At the same time, a very young government seems to have already developed entrenched bureaucracies because of the centralized nature of the government in Iraq. As military successes are happening around the country, aid from the central government is slow to be dispatched out to the outlying communities. As is probably the case with every other conflict in our Nation's history, there are widely distributed data points, and one can take one or two of these and make virtually any argument that one wishes to make. It takes a more disciplined outlook to analyze the data, look at the trendlines, but that is a discipline that must be exercised. Madam Speaker, the city of Ramadi in the al-Anbar Province in Western Iraq was the first stop for us on Saturday. This is a city the size of Fort Worth, Texas, back in my home district. One year ago when I was in Iraq, Ramadi was held by insurgent representatives of al Qaeda. In July of 2006, there would have been no way for a congressional delegation to travel to this city as it would have been seen as too dangerous a mission. But things began to change last February. The historic tribal leaders began to clearly understand that life alongside al Qaeda was not going to improve; and in a stunning reversal, the town's leaders began to seek out and embrace American protection. Popular support was now no longer available to al Qaeda in a city that had been destined to be the provincial capital of the resurgent Caliphate. This represented a striking strategic failure for the enemy. Their shadow government which had intended to establish a capital of a radical Islamic state was forced out of the city, and, indeed, subsequent armed attempts to retake control were successfully repelled. People in town began identifying where the terrorists lived, who was making the bombs, who was putting the city and their daily lives in jeopardy. Now, the task of rebuilding a civil society, the municipal government has certainly significant tasks ahead of it. And, Madam Speaker, I might add to that it was the additional soldiers and marines provided by what is called the surge last February, particularly the soldiers of the 2nd Marine Expeditionary Unit force just north of al-Anbar, that made a lot of this possible. They intercepted the vehicle-borne improvised explosive devices as they were on their way down to Ramadi; they found the factories where these were manufactured, and were able to provide additional breathing space and additional room as the city was recontrolled by the Americans. Because of the distance from Baghdad and the central government, there has been some isolation, and significant efforts have been made by the Army to ensure that the local mayor has the ability to provide for his citizens. And this, Madam Speaker, underscores one of the real difficulties ahead for this country. As areas are reclaimed and stabilized, the central government must be able to quickly provide the financial and security support that will be required to sustain this early success. This also underscores one of the important recognized benchmarks, that of holding the provincial elections. During the electoral process 2 years ago, most of the Sunni population was involved in an electoral boycott. Now they see the fundamental error of that decision, and they are eager to see new elections that would permit a more popular representation. After 2 or 3 years of serious brutality at the hands of al Qaeda, the population now sees America as helpers and sees Americans as protectors. The tribal leaders had originally feared that Americans were occupiers, that they would stay forever, but now they have come to understand that the Americans have no such interests. The same could not be said for al Qaeda's interests. Their clear intent was to hold the town for their purposes for the foreseeable future. The point was made during our visit that there are no overnight solutions to the problems in Iraq. Leadership cannot be bought, and this has to be an evolutionary change. But this change can occur if the correct environment is provided. As if to underscore the recent success in Ramadi, we were taken out of the military base, down the main street of town, right into the marketplace. We were permitted to walk freely in the marketplace and observed many of the items for sale in what appears to be a very normal Arab market. Madam Speaker, I did provide a photograph from that visit, and here you can see again one of the stalls of the market. You can see the goods for sale, the pots and pans up there, coolers for water or whatever other beverage one might want to have. You can see the smiles on the young children. They didn't know we were going to come to town that day; it just happened that we showed up, and they were apparently glad to see us. You see the men there bargaining in the background. It doesn't really look like a street scene of people that are under great stress or duress. It looks like a normal marketplace with normal people doing normal Saturday-morning activities. The vehicle you see just a portion up here at the edge of the photograph was actually a municipal vehicle, a city vehicle. They were repairing one of the sewer lines in the street. Many of the sewer lines and water lines in this town had been broken by improvised explosive devices that had gone off during the more active and kinetic phases of the retaking of the city from the al Qaeda groups. But it wasn't Americans who were out repairing the sewer pipe, it was actually the municipal government of the city of Ramadi who was taking care of that task, as they should, as is appropriate for a municipal government, the appropriate way for a municipal government to behave. I would also point out some of the clothing that is for sale. Madam Speaker, I just have to say in this trip to Iraq one of the things I saw that really struck me as being significantly different from other trips, not just in Ramadi, but in Baghdad and some of the other areas we visited, many more women were in evidence out on the streets and out in public, significantly different from other times when I have been there. And I take that as a good sign, a good sign as for the resurgence of civil society. But there is pretty striking evidence of the prior combat in the town all around us. But the evidence of active reconstruction and a crew working on the sewer line in the middle of the street as we walked through town really again gave me some hope that there was some stability for these young children. And let me talk about the future for a moment. That is a future that these young men now have that actually was going to be denied to them just a few short months ago. And, again, you can see the look of curiosity on these boys' faces. This boy is not quite sure whether to smile or run away. But, nevertheless, these kids were all over in the marketplace. And you see back there again some of the brightly colored glass and things that weren't for sale in the market. I don't know where these shirts came from; presumably that represents some sort of local sports team. But, again, a very different scene in Ramadi today than would have been evident a year ago. When I returned yesterday, one of the things that I encounter in the headline in the Washington Times was also of encouragement to me. We had spent some time during the trip on Saturday at a place called Camp Taji, which is north of Iraq. Camp Taji is where a good number of our soldiers are stationed, a lot of our National Guardsmen are stationed. And again, Camp Taji, the same situation: they've moved soldiers out the relatively large base. They've moved out to work with the Iraqi units, to work in the towns. And one of the things we learned on that trip through there this weekend, the commander told us that there had just been a meeting with 150 sheiks, both Sunni and Shiia, and the reason for the meeting, the meeting was called by the sheiks. They wanted to meet with the American military, and the reason for that meeting was they wanted this same type of success for their communities. They wanted to ask if the same type of return to civil society that is going on, that's breaking out in the country of Ramadi, they wanted to know if it was possible in their communities. And, again, not just Sunni leaders, Shiia leaders as well. And I'll quote from yesterday's, this is the Washington Times from Monday, July 23, 2007. And it says: ``U.S. forces have brokered an agreement between Sunni and Shiia tribal leaders to join forces against al Qaeda and other extremists extending a policy that has transformed the security situation in western Anbar province, and they wanted to extend that to this area north of the capital.'' A startling story. We just heard about this on Saturday when we were there. In fact, I was kind of given the impression that it was so new that maybe we shouldn't talk about it. But here it is on the front page of the Washington Times, so I'm going to assume it is okay to bring that up. Very significant because, of course, in the Sunni areas of Iraq, al Qaeda's dominant. In the Shiia areas the Mahdi Army from Maktadar al Sadr was dominant. Neither one of these groups is seen as really furthering the common interests of the country of Iraq, and both Sunni and Shiia were asking for help from the Americans. Another headline that greeted me Monday morning when I woke up in Germany on the way back, one of the generals, General Mixon, has proposed a shift in strategy in Iraq. He says, they're so calm up north, maybe we should be able to bring some of our troops from up north down to the areas around Baghdad to provide additional security there because, quite frankly, they're not needed in Nineveh province. They're not needed in these areas where just a year ago there was significant terrorist activity occurring and United States troops were required. Madam Speaker, you have been very generous with the time. I hope to be back here next week with the other members of the congressional delegation that went to Iraq. We'll talk a great deal more about this subject, but some of these issues were time sensitive and I wanted to get them on the record while they were still very relevant.

Mr. BURGESS

Mr. BURGESS. Madam Chairman, I rise tonight in support of the Barton amendment. I hadn't intended to speak about this, but I was listening over in my office, and I am extremely concerned about the structure of this provision that has been added to the bill. By increasing the percentage of the ``hold-harmless aspect'' the concern has to be about where are those dollars going to come from to pay for those increases? My understanding is that other communities where authorized identified need may now be placed at risk. And yes, that would include my home district in north Texas. That would include the City of Fort Worth, Texas, where there are great numbers of people who, where unfortunately, the rate of acquisition of AIDS is increasing. Madam Chairman, this was a carefully negotiated compromise on our committee, appropriately so. It was an authorizing committee. At best, this activity tonight is authorizing on an appropriations bill. At worst, it is a thinly disguised earmark for the Speaker of the House. I urge my colleagues to vote for the Barton amendment. I yield to the ranking member of the committee.

Mr. BURGESS. I'll be happy to yield to my friend from California.

Mr. BURGESS. Madam Chairman, I move to strike the last word.

Mr. BURGESS

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

Mr. BURGESS

Mr. BURGESS. Mr. Speaker, I do have a lot of material to cover in the time that is available. I thought it was appropriate, as we end this legislative day here in the United States House of Representatives, that we talk a little bit about health care, because health care will be one of the central arguments, one of the central themes that consumes this country over the next 16 months as we lead up to the presidential election. Indeed, you are already hearing presidential candidates talk about their various visions for health care. One of the things that concerns me greatly is the issue of the issue of the state of our physician workforce. In my home State of Texas, the Texas Medical Association puts out a periodical every month. In March the title of the magazine they put out was ``Running out of Doctors,'' a great concern of mine. A year and a half ago Alan Greenspan came and talked to a group of us right before he left as Chairman of the Federal Reserve board. And someone asked him about Medicare and about how we are going to pay for Medicare in the future. He acknowledged that it was going to be difficult, but at the appropriate time he felt that Congress would be able to step up to the job of doing what was going to be necessary to pay for Medicare. He paused, and he said, well, what concerns me greatly is will there be anyone there to provide the services that you need? That's what I would like to address this evening. I think if I could, I am going to confine my remarks to the limited time I have to four areas. I want to talk a little bit about medical liability, I want to talk a little bit about the status of the physician workforce in regards to the developing physician, the person who may be in college or high school considering a career in health care, I want to talk about the physician in training, and I want to concentrate greatly on what I call the mature physician, the physician who is in practice, and some of the effects of current governmental policy where we reduce payments to physicians year over year and the pernicious effect that is having on the physician workforce. First, just touching on liable, my home State of Texas had a significant problem with he had some call liability. In 2003, the State legislature passed a medical liability reform based off of a prior California law, the Medical Injury Compensation Reform Act of 1975, which was passed by California, but we updated it for the 21st Century. Indeed, the law passed by the Texas Legislature in 2003, was based off the California law, that had as its basis caps on noneconomic damages, but in California, that was a fixed $250,000 cap for all noneconomic damages. As you can see from the visual aid, Texas trifurcated the cap. We have a $250,000 cap on physicians for noneconomic damages, $250,000 cap on a hospital for noneconomic damages and a $250,000 cap on a second hospital or nursing home, if one has been involved. Well, this was passed back in 2003. How has the Texas plan fared? The year I first ran for Congress, 2002, we had dropped from 17 insurers down to two. It was almost impossible to get medical liability insurance at any price because of the effects of the legislation passed. There are now 14 insurers back in the State, and most of those have come back in without an increase in premiums. Three years after passage, the Medical Protective Company had a 10 percent rate cut which was their fourth since April of 2005. Texas Medical Liability Trust, my last insurer of record, declared an aggregate cut over the past 4 years of 22 percent. Another company called Advocate MD filed a 19.9 percent rate decrease. And another company called Doctors Company announced a 13 percent rate cut, real numbers that affect real people and affect real access to care. Probably one of the most significant unintended beneficiaries of this legislation that was passed in 2003 in my home State of Texas was the smaller not-for-profit community hospitals. These were hospitals that were self-insured and had to put large amounts of cash up as a cash reserve against a potential lawsuit. What has happened since this law has past is these hospitals have found they have been able to take more of that cash and invest it in capital, invest it in nurses' salaries, exactly the kinds of things you want your smaller, not-for-profit community hospital to be doing in your community. Mr. Speaker, I took the language of the Texas plan and modified it so it would work within the constructs of our language here in the House of Representatives and actually offered this language to the ranking member of our House Budget Committee, who had the bill scored by the Congressional Budget Office. And the Texas plan, as applied to the House of Representatives to the entire 50 States, would have yielded a $3.8 billion savings over 5 years. Now, not a mammoth amount of money in Congress speak; but when you talk about a $2.99999 trillion budget, any savings that you could manage is in fact significant. And this is money that could have gone for a pay-for for many of the other things that we talk about doing for health care in this body. Mr. Speaker, a lot of people ask me: Well, if Texas has solved the problem, so why are we even concerned about it on the national level? One is the savings that was demonstrated by the Congressional Budget Office. Another is this, Mr. Speaker: consider the cost of defensive medicine. A 1996 study, 11 years ago, done by Stanford University revealed that in the Medicare system alone, just Medicare, not Medicaid, not the Federal prison system, but in the Medicare system alone the cost of defensive medicine was approximately $28 billion to $30 billion a year. Ten or 11 years ago it was at that expense, and I submit that that number is significantly higher today if anyone would rework those numbers. Another consideration is young people getting out of school. They look at the cost of professional liability insurance and say, you know what, I am going to stay out of those higher risk specialties because it is just not worth it to me. Now, I do want to draw my colleagues' attention to a bill, H.R. 2583. This bill addresses graduate medical education. It is an enhancement for graduate medical education, and would develop a program that would permit hospitals, hospitals that do not traditionally operate a residency program, the opportunity to start a residency program to help again build physician the workforce of the future. On average, it costs $100,000 a year to train a resident, and that cost for a smaller hospital can actually be an impossible barrier to entry. But because of this bill, that would create a loan fund available to hospitals to create residency programs where none has operated in the past; and it would require full accreditation and be generally focused in rural suburban or inner urban communities. Another bill that I would direct my colleagues' attention to, H.R. 2584, this bill is designed to help medical students and those who have just recently graduated from medical school with a mix of scholarship, loan repayment funds, tax incentives to entice more students into medical school and create incentives for those students and newly minted doctors. The program will have an established repayment plan for students who agree to go into family practice, internal medicine, emergency medicine, general surgery, OB/GYN, and practice in an underserved area. It is a 5-year authorization. It is fairly modest at $5 million a year and would provide additional educational scholarships in exchange for a commitment to serve in a public or private nonprofit health facility determined to have a critical shortage of primary care physicians. Mr. Speaker, in whatever time I have left, I do want to address again the group that I call the ``mature physician,'' and I want to address that from the perspective of the formula that is called the ``sustainable growth rate formula.'' That is the formula under which Medicare reimburses physicians. Why is that important? Let me show you this. If we look at how Medicare pays for the administration of care in this country, we have a situation where doctors are paid under a different formula from hospitals, from insurance plans, from drug companies, from nursing homes. And look at this graph, Mr. Speaker. What you see is that physicians receive cuts year over year, unless Congress steps in at the last minute and does something, which we did for several years here right after I first got to Congress. But compare that with Medicare advantaged hospitals and nursing homes where every year there is a cost-of-living update, the Medicare economic index, if you will, that adjusts payments upward. But year over year there is a reduction in reimbursement, and the Center for Medicare and Medicaid Services for Physicians provides this cut for physicians who take care of the patients. It is not a question of doctors wanting to make more money; it is about a stabilized repayment system for services that have already been rendered. And it is not just affecting doctors; it affects patients. Not a week goes by that I don't get a letter or a fax from some doctor, usually in my home State of Texas, oftentimes in my district but sometimes it is someplace far afield. But they say, You know what? I have just had enough of what Medicare is doing to my reimbursement schedule and I am going to retire early. I am no longer going to see Medicare patients in my practice, or I am going to restrict the procedures that I offer to Medicare patients. In fact, I had a young woman come up to me that I trained with at Parkland Hospital and tell me what Medicare was doing to her wasn't right and, as a consequence, she was not going to be offering a certain set of high-risk procedures to her patients any longer. And the question is, where will those patients go for that treatment? I saw it in the hospital environment before I left practice to come to Congress and, again, I hear it in virtually every town hall that I hold back in my district. Someone will come up to me, either as a question in the formal part of the meeting or afterwards, and say, how come in this country you turn 65 and you have got to change doctors? And the answer is, because the doctor they were seeing found it no longer economically viable to continue to see Medicare patients because this was happening to them, and year over year they weren't able to pay the cost of delivering the care, never mind taking a paycheck home to support their family. Medicare payments to physicians are modified annually under this SGR formula. The process is flawed, it needs to be repealed, because it mandates physician fee cuts that have gone on in recent years be continued indefinitely, and they become quite substantial over time. Now, the quandary that you always hear quoted is that simple repeal of the SGR is cost prohibitive. But we could, Mr. Speaker, consider doing that over time. We could consider setting a date in the future by which the SGR would be repealed and perhaps bring that cost down to an attainable level. The bill that I have recently introduced, H.R. 2585, would repeal the SGR in 2010. Now, in the new physician payment stabilization bill, 2 years from now the SGR formula goes away. But there are incentives provided to physicians in the year 2008 and the year 2009 based on some quality reporting and technology improvements. More importantly, by resetting the baseline of the SGR formula, the CBO estimates that the practical effect of my bill would bring a 1.5 percent update in 2008 and a 1 percent update in 2009, and a complete elimination of the SGR by 2010. The CBO score calculates a savings of $40 billion off the total price tag of an SGR elimination. Again, there are also in addition to essentially what is a Medicare economic index update for 2008, a little less than that for 2009, and then elimination of the formula and a full MEI update starting in 2010, which would be a significant change from where we are now. In addition to that, bonus payments for physicians who are willing to voluntarily do some quality reporting and bonus payments for physicians who are willing to voluntarily participate in some health information technology upgrades, computerization of their practice, if you will. One of the main thrusts of this bill, Mr. Speaker, is to require the Center for Medicare and Medicaid Services to look up, to ascertain the top 10 conditions that drive the highest percentage of payments, and then require CMS to adopt reporting measures relating to those conditions. In fact, those have already been developed. We are not going to reinvent the wheel here. The American Medical Association Physician Consortium has already developed those reporting measures that are driving spending so high. Mr. Speaker, the old bank robber Willie Sutton, when he was asked, Why do you rob the bank? He said, Because that's where the money is. Mr. Speaker, let's go where the money is. Let's go to those top 10 things where the greatest amount of money is spent, those top 10 diagnostic codes or top 10 diseases where the major amount of money is spent in Medicare, and it amounts to about 70 percent of the savings in Medicare, because that is where the greatest amount of savings is going to occur. If we can deliver more care in a timely fashion and we can improve outcomes, you are actually going to spend less. And, again, that is the thrust of this bill. That is why you postpone the repeal of the SGR by 2 years, to get that savings that is going to happen by doing things better, quicker, smarter, the same types of things we saw when we began to provide a prescription drug benefit under the part D part of Medicare. Those costs that were originally projected by CBO and the Office of the Management of the Budget of the White House, actually, those scores were way too high. The actual figures for the first year of the operation of the Medicare prescription drug program came in lower. Why did it come in lower? Partly because of competition and partly because the cost- effective thing also turns out to be the right thing to do oftentimes in the practice of medicine. A lot of savings are in fact available in this system if we only again have the courage to do that. Let me just speak briefly about health information technology, because it does receive a lot of attention. Here in the House of Representatives we worked on several bills last year. We will probably have an opportunity to have several bills this year. Indeed, a reform in health information technology is part of the bill that I introduced, H.R. 2585, to repeal the sustainable growth rate formula. But let me just point out a couple of things. I don't know that I was a big believer in electronic medical records when I left the practice of medicine and came to Congress. They are expensive, a big cost for a small practice to set it up. They slow you down. When you are in practice, it adds minutes to each patient; and if you are seeing 30 patients a day and you add 2 minutes to each patient, that is an extra hour. How are you going to be compensated for that extra hour that you spend? Mr. Speaker, this is a picture of the medical records room at Charity Hospital in New Orleans. It was taken in January of 2006, 5 months after Hurricane Katrina hit there. And this had been completely under water, of course, when the city was flooded. When the Corps of Engineers got the water out, this is what was left. And you see a typical medical records room with all of these paper charts. But this black discoloration is not from smoke or soot; that is black mold that has grown on these charts. It is not safe to let anyone go in there and try to retrieve data from those charts because of what has happened with the mold contamination. All of those records are lost, tens of thousands of patients. A patient who might have been waiting for a bone marrow transplant or a kidney transplant, a patient who is in the middle of their cancer therapy, All of that was lost in those records. Mr. Speaker, in January of this year we heard a lot of stories about Walter Reed Hospital, and I went out to Walter Reed to look for myself about what was happening with the treatment of our soldiers who are on medical hold. And Sergeant Blades took me around the complex and showed me the things that had been in all of the newspapers. And then he said, You know what bugs me even more than anything else. I could live with all of the other stuff, but here is the real problem I have. He was trying to assemble his medical records so he could make his case to the VA about a disability claim he had. He had been in the service for a number of years, he had suffered some injuries during his time in the service, and he wanted to be able to make his case for disability payments. He said he will spend probably 20 to 24 man hours on his medical records making the case, going through it with a yellow highlighter. And then he said, It goes and sits on someone's desk for 2 week's time and then it is lost. And the reason for that is there is not an electronic medical records system that the Department of Veterans Affairs and the Department of Defense can communicate with each other. So he has to go back and reconstruct the paper trail of his 20 years in the service and document all of the problems that he has had with his injuries over time in order to make his case for a disability claim. And that is what was concerning him more than anything else that day, was that it took so much time to get these things assembled and he was at the mercy of someone misplacing that record off their desk, and he would have to go back to square one. His medical hold would be either extended or denied, and he would have to start all over again with assembling his medical record. He advised his men to make two or three copies of their medical records before they submitted it to the appropriate person in the infirmary. Mr. Speaker, I know our time is about up. I appreciate the indulgence of the time this evening. Again, health care is an important topic. We are going to spend a lot of time on it in the weeks and months to come. And, again, it will be part of the central theme of Presidential elections on both sides of the political spectrum. And to be sure, I will be back here on several occasions talking about some of the things that I think are most important. But when you look at the problem with losing physicians, when you look at the problem with how we treat our Medicare physicians, the problems they have in getting their payment rates straightened out, what happens if you don't take care of that? You lose doctors. Patients don't have the physicians to see. What will Congress do in that event? I don't know. Parliament over in Great Britain decided it was in their best interest to bring physicians in from overseas on visas and give them waivers. Someone else paid for their education and they worked cheap. But we also saw in Scotland over the 4th of July weekend, that didn't turn out to be a good idea. Health Care Introduction This evening I will address my concerns about the delivery of health care services in this country. The future of medical care in this country will be hotly debated in Congress and especially over the next 18 months as we approach the 2008 Presidential elections and the 111th Congress that convenes in 2009. We will be deciding the avenue through which our system will be based--on the table exists two choices. First is to expand the government or public sector's involvement in the delivery of services-- popularly referred to as ``universal health care'' or termed in the early 90s as ``Hillary Care.'' Or second, whether we encourage and continue the private sector involvement in the delivery of health care. These two options bring about a plethora of questions and concerns, and I am hopeful that my explanations tonight will shed light on the direction we should be taking to have the United States remain as the best health care system in the world. Now some people may feel that is an overstatement. They will cite uninsured numbers of the cost of prescription drugs. But while these issues abound, they are statistics and the old adage remains, ``there is truth, there are lies, and then there are statistics.'' You can make the numbers say whatever you like or the outcome of polls can be manipulated just by massaging how you ask the question. So I will dispense with these avenues and simply explain the situation at hand and the solutions currently available. I'll be discussing different principles guiding the debate about private versus public delivery of health care services, but let me give you a background on how we got to the system we have today. The idea that we must solve this problem is not new. Secretary Leavitt has even remarked the necessity tackling the decision between these two philosophies. As he said in an op-ed recently, ``Should the government own the system or should we organize the system.'' History Coming out of World War II, the United States had a flourishing economy and an upsurge in the birthrate clearly coining the phrase ``Baby Boom'' generation. The U.S., unlike many of our allies coming out of the war was able to benefit from the economic prosperity by developing a hybrid system for the delivery of health care including both a public and private involvement. Europe, in contrast, was suffering from depleted resources and fatigue after World War II. It was clear from the outset that their economies, in particular that of Great Britain, were unable, from the private sector, to uphold the delivery of health care. The government had to run the health care system. Next we fast forward roughly 20 years to the mid-60s and the Presidency of Lyndon Baines Johnson, a fellow Texan from across the aisle. During his tenure, both Medicare and Medicaid programs were signed into law. These large, government-run programs were created to focus on hospital care for the elderly and basic health care services for the poverty-stricken respectively. Decades later, it was evident that the government-run Medicare program was slow to change, a behemoth to operate and extraordinarily expensive. By 2003, Congress recognized that the outdated model of providing largely hospital-only care to the elderly was insufficient. The government system needed to catch-up to the robust private system that was already focused on prevention and disease management. Finally, Congress passed the Medicare Prescription Drug Plan that gave seniors coverage for the medications. While the program has been successful, and has provided greater benefits for seniors, it did not come without considerable discussions and a massive push by the success of the private sector. And here is our crossroads today. Currently the government pays for nearly half of all health care administered in this country. With a current GDP of roughly $11 trillion, the U.S. Department of Health and Human Services states that Medicare and Medicaid Services alone cost $600 billion. The other half of health care is broken down with primary weight being carried by the private industry, and charitable and self-pay accounting for the rest. As these numbers increase, and the Federal Government continues to funnel the American taxpayer's dollars into its coffers, we must ask if this is the best use of taxpayer dollars? Is the government doing an excellent job of managing your money? Do you think the government is better suited to care for your health care needs? Who is better to handle the growing health care crisis in this country? I argue that the government-only, or universal health care system, is unsustainable in America and will hamper our innovation and delivery of the most modern health care services available. I can site two specific examples that support my premise that a private-based system is better equipped, more flexible, and less expensive (being driven by the market) than a government-based system. First we can look to our northern border at Canada. Canada boasts a universal health care system but what it fails to highlight is the tremendous wait list for treatment that patients must endure. Their access to care is limited. Now this is not a significant problem if you are a wealthy Canadian because you can take your money, cross the southern border in the U.S. and receive care immediately. If you were waiting for bypass surgery, would you prefer to get into the hospital as quickly as possible or be placed on a waiting list that could take months? Is your health, or the health of your loved ones something that you can take a gamble with? My second example stems from the British Isles where they suffer so of the same fate. The British National Health Service is a 2-tier system that faces continued allegations of ageism. The system can simply no longer treat patients over 80 because the system recognizes that the patients at this age will simply not survive their wait time. It is a sad reality, but it is true. So I return to my premise that the private sector is more nimble and financially a more stable arena from which to build our future health care system. Noting this complex relationship, how should Congress do its job to ensure we have the best health care system possible? Congress must promote policies that keep the private sector leading the way with some interaction by the well-run government programs. Uninsured One issue that springs to mind concerns the uninsured population, which the U.S. Census Bureau estimated at some 46 million back in 2005. Now I want to be specific . . . access to health care is not the issue. Those individuals classified as ``uninsured'' means they are not covered by a specific plan; it does not mean they cannot seek health care services. In fact, no one is denied health care services in this country. Two specific examples of where access is available through the State Children's Health Insurance Program and Federally Qualified Health Centers.

Mr. BURGESS

Mr. BURGESS. Madam Speaker, I rise today to commend Mr. Dan Fette of Denton, Texas on starting Dan Fette Builders, Inc. Mr. Fette graduated from Texas A&M with a BS in Building Construction and a MS in Construction Management. He worked in the construction industry for many years before starting his own company. He set out with the goal to build a few really great houses. He wanted to be able to focus all of his attention on one house so the customer would be exceptionally pleased. Mr. Fette is currently the chairman of the Green Building Program of the Home Builders Association (HBA) of Greater Dallas and will soon become the president of the HBA Denton Division. The goal of the HBA's Green Building Program is to bring more energy efficient and environmentally friendly homes to the Metroplex. This local effort is being supported by the Green Building Initiative (GBI) and the National Association of Home Builders (NAHB), which will provide area builders with resources and technical support. Additionally, the Green Building Program will maintain a database of ``green builders'' and ``green built'' homes in the area for potential homebuyers. In addition, Mr. Fette is a member of Green Built North Texas, a voluntary partnership of local home builders, industry supporters, and sponsors committed to creating awareness and interest in the construction of higher-performance, lower-impact residential homes in North Central Texas. Members of Green Built North Texas work to meet the highest standards in relation to site management, waste recycling, water efficiency, indoor air quality, energy efficiency, materials, and homeowner education. In an age when energy conservation is at a critical point, I am honored to represent a man who is using his talents and skills in construction, to better our community. I extend my sincere congratulations to Mr. Dan Fette for starting his own company, Dan Fette Builders, Inc. I wish him success in the future.

Mr. BURGESS

Mr. BURGESS. Mr. Speaker, may I inquire as to the time remaining.

Mr. BURGESS. Mr. Speaker, I yield myself the balance of my time. Again, Mr. Speaker, I want to point out, Mr. Waxman in his remarks discussed the Institute of Medicine study, and in fact, when we talked about the issue that's still the unresolved issue of the conflict-of- interest waivers, the Institute of Medicine itself recommended that the Food and Drug Administration advisory panels, those panels that are convened to advise the Food and Drug Administration on the acceptance or rejection of new drugs and new devices, that that panel could be comprised of up to 40 percent of individuals for whom a conflict-of- interest waiver was obtained. The current legislation has language in it that will restrict that waiver to one such individual, and as we've already heard from the other side, even that one conflict waiver is too much for some people to tolerate. But the reality, if the FDA is allowed to issue only one waiver per panel meeting, they will find themselves seeking the guidance of fellows that have just passed their boards and are beginning their practice of medicine. The drafters of the code of Federal regulations did not intend that only the most recent graduates of a fellowship program or residency program be considered the so-called expert. At present, medical societies find restrictions on the FDA panel nominees increasingly difficult due to a number of criteria that must be met in addition to considerations for the conflicts of interest. The Food and Drug Administration panels must have geographic, ethnic and gender diversity. We've already heard discussion from the other side of how they're concerned about aggravating ethnic disparities. Here's another place where we could perhaps reverse that trend. For clinical representation, panel members on those Food and Drug Administration advisory panels, panel members should be practicing physicians and, in fact, should have practiced for many years. They should have accumulated a body of experience. They should have knowledge of the conduct of clinical trials. They should have knowledge of statistics. They should have intricate knowledge of the specific anatomy if they're on a device panel. They may need to know about the biomechanical forces imposed on the anatomy if a device is implanted or the cellular biology to determine wear and tear on the devices and knowledge of the American Society for Testing and Materials or international standards organizations. Members may also need to know about the packaging and the effects of radiation on many of the device components. For some panels, such as on March 29 of this year, the Cellular Tissue and Gene Therapies Advisory Committee meeting to provide guidance to the Food and Drug Administration on biological license applications, such as the medicine that might be used for treatment of men with asymptomatic metastatic hormone refractory prostate cancer; these panels must have a specific knowledge base that far exceeds that of a practicing physician. And indeed, I heard from other individuals where the universe of patients may be quite small for patients who have a certain type of brain malignancy. The universe of patients may be only 1,000 or 1,500. The people that develop the drugs are of necessity going to be people who have been employed by those industries that were developing the drugs. Why exclude them from the panel? Why craft a law where the only people in the room are, by law, going to be people who have no knowledge of the intricacy of the specific disease being treated or no knowledge of the surgical procedures required to implant those medical devices? Why restrict ourselves in that way? We just heard eloquent testimony from the gentlewoman from Arizona talking about the devices and those medications and treatments that are just over the horizon to us right now that we can't imagine, we can't envision. Why restrict those Food and Drug Administration advisory panels to one conflict-of-interest waiver? Mr. Speaker, I will submit being in public service can be expensive, it can be time-consuming, and it can be embarrassing. Why make it harder for these individuals to participate in these panels? Frankly, I do not understand that. I hope we will continue to work on that process as we get to the conference activity on this bill. I'm looking forward to those discussions. But in reality, the bill that is before us today is, in fact, a good bill. The committee staff on both sides did great work as far as getting language that would be acceptable to both sides, and we were not an easy audience to please on many occasions through the debate on that bill. But Mr. Speaker, I do rise in support of the bill. I do think it is worthy of the House's consideration and passage. Mr. Speaker, I yield back the balance of my time. General Leave

Mr. BURGESS. Mr. Speaker, I am pleased to yield 4 minutes to the gentleman from Pennsylvania (Mr. Murphy), a member of the committee.