Michael Burgess

Mr. BURGESS

Mr. BURGESS. Mr. Speaker, I rise today to remember Charles Gaines, the 49 year old Fire Chief for the city of Fort Worth. I was blessed with meeting the Fire chief several times during his 4 year tenure as Chief of the Fort Worth Fire Department. The commitment and dedication he showed to his profession was evident from the moment we met. Under his leadership, Chief Gaines was accountable for oversight of the 745 Fire fighters that compose the Fort Worth Fire Department. As Fire Chief he also oversaw the department's response to over 57,000 incidences annually in the city of Fort Worth Before serving as the Fire Chief of Fort Worth, Mr. Gaines served in the United States Air Force as a fire protection specialist. He worked on crash-rescue teams at various Air Force bases until his promotion to Air Force assistant chief. After receiving an honorable discharge from the Air Force in 1980, he continued his career as a member of the Oklahoma City Fire Department in 1981. During the 1995 bombing of the Murrah Federal Building in Oklahoma City, Chief Gaines served as the fire department's operations safety officer. His service and leadership during this national tragedy ensured that the first responders and civilians were informed and received all medical attention necessary. His detail-oriented approach to problems within the department ensured that issues were addressed the first time around. After earning his Masters Degree in Business Administration from Oklahoma City University, Chief Gaines incorporated efficient management techniques throughout the Fort Worth Fire Department. This management style allowed him to incorporate and encourage innovation and alternative thinking; Chief Gaines was able to initiate solutions that would more effectively safeguard the citizens of Fort Worth, while saving tax dollars in the process. His leadership, professionalism and dedication will not be forgotten in the City of Fort Worth or Oklahoma City. Mr. Gaines' devotion to his career and his fellow officers was absolute, and his service to the Fort Worth community will be deeply missed.

Mr. BURGESS

Mr. BURGESS. Mr. Speaker, I rise today to recognize participants and sponsors of the Community Symposium on ``The Silent Killer in African American Families'' in Denton, TX. This event explores several topics regarding the HIV/AIDS epidemic in African American communities. It provides citizens with answers concerning HIV/AIDS and presents support networks for families struggling with this terrible disease. The effects of HIV and AIDS can be devastating to communities. To prevent further infection among our citizens, it is vital that programs such as this community symposium exist. With Congress's recent reauthorization of the Ryan White Care Act, funding for both treatment and prevention programs can continue. Mr. Speaker, I am pleased to recognize the Community Symposium for HIV/AIDS awareness in Denton County for their continuing commitment to AIDS prevention and treatment. The participants and sponsors that provide support to the AIDS/HIV symposium are crucial components in the fight against this worldwide epidemic.

Mr. BURGESS

Mr. BURGESS. Mr. Speaker, I rise today to recognize Donald Elementary School located in Lewisville for being named a No Child Left Behind Blue Ribbon School of 2006. Only 26 schools in Texas will receive this award certificate. The No Child Left Behind Blue Ribbon Schools program recognizes schools that make significant progress in closing the achievement gap or whose students achieve at very high levels. Schools must make adequate yearly progress in reading, language arts and mathematics. The No Child Left Behind Act is the bipartisan landmark education reform law designed to change the culture of America's schools by closing the achievement gap, offering more flexibility to States, giving parents more information and options and teaching students based on what works. Under the law's strong accountability provisions, States must describe how they will close the achievement gap and make sure all students, including those with disabilities, achieve academically. I extend my sincere congratulations to Donald Elementary School for receiving this award. This school's contribution and services should serve as inspiration to us all.

Mr. BURGESS

Mr. BURGESS. Madam Speaker, I yield myself such time as I may consume. I would like to read a letter from Leo T. Furcht, M.D. who is the president of the Federation of American Societies for Experimental Biology. In his letter to Chairman Barton Dr. Furcht wrote: ``We thank you for your leadership in protecting the National Institutes of Health from disease-specific funding set-asides. From the FASEB perspective, directed research initiatives fail to recognize several principles inherent to the nature of medical research. Thus, we doubly appreciate your legislation's emphasis on investigator initiated competitive research.'' Madam Speaker, I yield 2 minutes to the gentleman from Pennsylvania (Mr. Murphy), an esteemed psychologist.

Mr. BURGESS. Madam Speaker, it is now my pleasure to yield 3 minutes to the chairman of the Health Subcommittee, the gentleman from Georgia (Mr. Deal).

Mr. BURGESS. Mr. Speaker, on that I demand the yeas and nays.

Mr. BURGESS. Mr. Speaker, I yield back the balance of my time.

Mr. BURGESS. Madam Speaker, I yield myself the balance of my time. I want to add to the list that Chairman Barton read about individuals and groups that support this NIH reauthorization: the American Society of Clinical Oncology, the Autism Society of America, the Colorectal Cancer Coalition, the Men's Health Network, the Society for Gynecologic Oncologists, and the Deirdre Imus Environmental Center for Pediatric Oncology. Truly a diverse group that supports this legislation. Madam Speaker, last week, many of us had constituents from our districts come through our offices who were cancer survivors, and the question always comes up, and Mr. Markey asked it tonight, are we doing enough? Well, another question that we could ask, and we should ask, is do we know what we have already done? Let me quote, Madam Speaker: ``This year, for the first time in history,'' for the first time in history, ``the absolute number of cancer deaths in the United States has decreased. We now have 10 million cancer survivors. We can detect and treat cancer at earlier stages. Targeted therapies have emerged, using specific molecular targeting to treat tumors with new agents.'' This quote was from Elias Zerhouni as he addressed our committee. Madam Speaker, let me just add that, thanks to the tools and technologies developed by the Human Genome Project at the National Institutes of Health, changes in the genetic blueprints that are associated with all types of cancer are now known. A new generation of targeted diagnostics, therapeutics, and preventatives for all cancers will pave the way for more personalized cancer medicine. What does this mean? It means that we are well on our way to a time when, should a person be diagnosed with cancer, their physician will be able to say whether or not certain therapeutics are appropriate. Think of the dollars that that will save. Not everyone who receives a diagnosis has to go through the same treatment. There are some genetic makeups that will be helped; there are some that will not be helped. Let us target our therapy where it does the most good. We are clearly moving in the right direction in this regard. We heard the chairman, we heard people from the other side describe the National Institutes of Health as the crown jewel of the Federal Government. I believe that is correct, and we should all be proud of the organization's dedication to improving the health of Americans and mankind. The bill before the full House tonight improves on that commitment by providing sustainable funding increases for medical research, granting the NIH Director more authority and increasing accountability, and it creates the Common Fund to put dollars toward trans-NIH research activities. These trans-NIH research initiatives will make historic breakthroughs in medical research. Already, the National Cancer Institute and the National Human Genome Research Institute are collaborating on the Cancer Genome Atlas. This project will develop a useful atlas of the changes that occur in the human genetic blueprint associated with all types of cancers. This project will give medical professionals a new generation of targeted diagnostics, therapies and preventative services to treat a host of different cancers. We are, indeed, Mr. Speaker, moving in the right direction. We are, indeed, doing good work for the American people with the reauthorization of this bill, and this bill maintains that important momentum. Be it a cure for cancer or greater understanding of the human genome or advances in heart disease, an avian flu vaccine, the National Institutes of Health has a proven record of innovation. Mr. Speaker, this is a good bill. By increasing the authorized level by 5 percent, Chairman Barton and Chairman Deal have produced a bipartisan approach to capitalizing on the gains made by the NIH over the past several years. Vote for your constituents and the future of medical care by voting in favor of H.R. 6164. Federation of American Societies for Experimental Biology, Bethesda, MD, September 26, 2006. Hon. Joe Barton, Chairman, House Energy and Commerce Committee, House of Representatives, Washington, DC. Dear Chairman Barton: Please accept my thanks again for the opportunity to testify in support of your NIH reauthorization legislation on behalf of the Federation of American Societies for Experimental Biology (FASEB), The biomedical research community continues to support your vision for our nation's premier medical research agency. I fully appreciate that one of the fundamental questions faced by your committee in producing this legislation was how to balance the responsibility of setting priorities for funding within NIH. FASEB strongly concurs with your view, as delineated in the reauthorization bill, that Congress continue to set overall funding levels for Institutes, Centers and the Common Fund, but that the selection of specific research areas to be funded remains principally the responsibility of NIH, through merit-based peer review. We believe that the NIH has the fullest understanding of not only the human and economic costs of a disease, but also of the scientific challenges and current opportunities that exist in specific areas and more broadly in biomedical research. Moreover, FASEB feels this role will only be strengthened by the portfolio management provisions of the NIH Reform Act. We thank you for your leadership in protecting NIH from disease-specific funding set asides. From the FASEB perspective, directed research initiatives fail to recognize several principles inherent to the nature of medical research. Basic research, recognized universally as the foundation of most advances in disease-specific research, will inevitably suffer in a politically based system of allocating scarce dollars. Thus, we doubly appreciate your legislation's emphasis on investigator-initiated competitive research. ``Furthermore, earmarking by disease is not necessarily the way to produce breakthroughs in a particular area, since research in one area often produces unpredictable results that find specific use in another. There are numerous examples of the ``serendipity of science'' and there will be many more in the future. Disease specific funding runs counter to this well observed phenomenon. In conclusion, FASEB reiterates its support for the NIH Reform Act of 2006. It is a tremendously successful balance that both improves upon the current system and preserves those aspects that have allowed NIH to achieve its global preeminence in medical research. Sincerely, Leo T. Furcht, FASEB President.

Mr. BURGESS. Madam Speaker, I would remind the gentleman that President Reagan was no fan of high taxes, and I would also remind this body that the Republicans in this body have been responsible for the largest increase in NIH funding in America's history, period, end of discussion; except to add that Chairman Barton was a leader in that regard. Madam Speaker, I reserve the balance of my time.

Mr. BURGESS. Madam Speaker, it is my great pleasure to yield 2 minutes to the gentleman from Michigan (Mr. Rogers).

Mr. BURGESS

Mr. BURGESS. Mr. Speaker, today north Texas and indeed the country lost a great, great man, the legendary golfer and humanitarian Byron Nelson. He passed away at the age of 94 at his home in Roanoke, Texas, where he lived with his wife Peggy on 11 Straight Lane, a road that was named for his year of 1945 when he won 11 straight golf tournaments. Like all Americans, I am saddened by the news of the death of Byron Nelson. He was indeed the best of men and he was a gentleman to all. His strength of character and generosity to others set him apart. Mr. Nelson's accomplishment as a professional golfer are as impressive as his golf swing. There is a reason why he is the only PGA professional golfer that has a PGA tour named in his honor, the EDS Byron Nelson Championship. Mr. Nelson won 54 career victories, including winning two Masters, two PGA championships and the U.S. Open in 1939. He is one of only two golfers to be named Male Athlete of the Year twice by the Associated Press, and the World Golf Hall of Fame honored Mr. Byron Nelson in 2004 by featuring an exhibit entitled, ``Byron Nelson: A Champion . . . A Gentleman.'' While Lord Byron has obtained the status as a world class athlete, it is his humanitarian efforts that are truly first class, Mr. Speaker. He is a champion for the underprivileged and has given his time, his talents and his funds to make this a better world for those who are not as well off. Byron Nelson and the EDS Byron Nelson Championship have raised well over $100 million for the Salesmanship Club Youth and Family Centers, a nonprofit agency that provides education and mental health services for more than 2,700 children and their families in the greater Dallas area. Additionally, the Byron and Louise Nelson Golf Endowment Fund has provided over $1.5 million in endowment funds to Abilene Christian University in Abilene, Texas. Another example of his service is his dedication to the Metroport Meals on Wheels which provides daily, home-delivered, hot lunches for the frail, elderly and chronically ill residents in his area around Roanoke, Texas, where he lived with his wife Peggy. Byron Nelson has been an active honorary chairman of that group since 1992. Some of our local papers in the north Texas area talked about Byron Nelson in their on-line editions for tomorrow. The Fort Worth Star- Telegram quoted Byron Nelson, ``I have not ever said that I want to live to this age or that age,'' he said. ``I don't believe in doing that. I'm going to try and maintain myself in a way that I'm up and able to move about and participate in things going on in my life. My heart is good. My cholesterol's good.'' Earlier this year, many Members of this House will remember that we carried a bill to honor Byron Nelson with a Congressional Gold Medal. It is ironic that today I learned that the medal bill which passed the House last May had indeed received the requisite 67 cosponsors on the Senate side and may well be acted upon soon. I am very fortunate to have spoke with Mr. Nelson as recently as late last week and informed him of the fact that we did indeed seem to have the Senate cosponsorships necessary to get the Congressional Gold Medal bill done for him. He was very humbled by that, and in fact, he asked, ``Well, Congressman, what can I do to help you?'' And I said, ``Mr. Nelson, you just stay strong for me.'' Well, unfortunately, it did not occur that Mr. Nelson was still alive when he got that gold medal, but I do believe in his heart he knew that this Congress was indeed going to honor him. Dallas Morning News, in their lead editorial for tomorrow morning, ``Lord Byron: He was a rare golfer and humanitarian,'' leads off with the comment: ``What was remarkable about Byron Nelson's life was that the late golfer remains a household name, especially in north Texas, six decades after retiring from an active career on the PGA tour.'' Mr. Speaker, Mr. Nelson retired in the early 1950s. Indeed, Mr. Nelson was not my sports hero; he was my mother's sports hero. He truly transcended generation after generation of north Texans, and he and his wife, Peggy, have given back so much to the citizens in our area. The Channel 8 news this evening, in their evening broadcast, had a small clip of Byron Nelson in his famous chair there at his home and ranch in Roanoke, Texas, saying, ``I just wanted to live my life good enough that one day I could get into heaven.'' Dale Hansen, the sportscaster who was monitoring the broadcast, finished up with, ``Mr. Nelson, you did and you will.'' I believe him to be correct. Mr. Nelson, we honor your life and your service. Godspeed. We will see you at the top.

Mr. BURGESS. Mr. Speaker, I ask unanimous consent to speak out of order and address the House for 5 minutes.

Mr. BURGESS

Mr. BURGESS. Mr. Speaker, I rise today to remember Lobis Adams, the 99-year-old retired pastor of the Corinth Missionary Baptist Church. Reverend Adams pastored the Corinth Missionary Baptist church for 33 years before retiring in 2003. As a faithful servant to the Lord, Reverend Adams spent his life in the service of others by volunteering in countless Baptist organizations. His commitment to the church and the community are still visible today through the many organizations that he helped establish and lead. His dedication to education in the Baptist community is shown through his tenure as Director of Christian Education at the Texas State Missionary Baptist Convention. He also served as a board member to the Texas Baptist Foreign Mission board. It was my honor to represent Reverend Adams. I extend my sympathies to his family and friends. May the example of this man, whose contributions made richer the fabric of our faith, be inspiration to all.

Mr. BURGESS

Mr. BURGESS. Mr. Speaker, I rise tonight to honor the life and the memory of Fort Worth Fire Chief Charles Gaines. Chief Gaines passed away this past Saturday evening rather suddenly of natural causes. Chief Gaines was 49 years of age. Mr. Speaker, our paths crossed several times during Chief Gaines' 4- year tenure as fire chief and my 4 years in Congress. The commitment and dedication that the chief showed to his profession was evident from the moment we met. Under his leadership, Chief Gaines was accountable for the oversight of 745 firefighters that composed the Fort Worth Fire Department. As fire chief, he also oversaw the department's response to over 57,000 incidents annually in the city of Fort Worth. Before serving as the fire chief of Fort Worth, Chief Gaines served in the United States Air Force as a fire protection specialist. He worked on crash and rescue teams at various Air Force bases until his promotion to Air Force assistant chief. After receiving an honorable discharge from the Air Force in 1980, he continued his career as a member of the Oklahoma City Fire Department in 1981. During the 1995 bombing of the Murrah Federal Building in Oklahoma City, he served as the fire department's operations safety officer. His service and leadership during this national tragedy ensured that the first responders and government workers were informed and received all medical attention. Fire Chief Gaines was known throughout the department as a man of integrity. While negotiating with the firefighters' union early in his Fort Worth career, his calm, collective demeanor earned him the respect of the department and his co-workers. He was able to compromise with the union and resolve differences between the two sides. He had a detail-oriented approach to problems, and this meant that problems within his department, those issues were addressed the first time around. Chief Gaines earned his Master's Degree in Business Administration from Oklahoma City University, and he incorporated efficient management techniques throughout the Forth Worth Fire Department. This management style allowed him to incorporate and encourage innovation and alternative thinking. Chief Gaines was able to initiate solutions that would more effectively safeguard the citizens of Fort Worth, while saving tax dollars in the process. Chief Gaines was the first African American fire chief in the city of Fort Worth. The city has a 113-year history of that department. Chief Gaines brought a new wave of energy to the Forth Worth Fire Department. His policy of requiring a minimum of four firefighters to each fire truck helped Fort Worth become one of the top 10 safest cities in America. His leadership, professionalism and dedication will not be soon forgotten in the city of Fort Worth or Oklahoma City. His devotion to his career and his fellow officers was absolute, and his service to the Fort Worth community will be deeply missed. Godspeed, Chief Gaines. We will see you at the top.

Mr. BURGESS. Mr. Speaker, I ask unanimous consent to speak out of order for 5 minutes to address the House.

Mr. BURGESS

Mr. BURGESS. I was actually coming to do a memorial for one of our firefighters who we lost over the weekend, but I certainly want to echo the sentiments and the comments that you have made. I, like many of my colleagues, was outraged by Hugo Chavez in this country, and I think he was appropriately reprimanded and upbraided by a Member on the other side of the aisle, Charles Rangel, in whose district the gentleman from Venezuela chose to make his rant public. It is indeed unfortunate that people feel that they have the license to come to this country and criticize our government as our guests. It is I suppose just a fact of life when there are people who are as kindhearted and as generous as we are that from time to time we are going to be abused by those in the world who choose to behave that way. The gentlewoman also mentioned the 9/11 Commission, and we hear from time to time about the 9/11 Commission and how many of the recommendations of the 9/11 Commission have not been met. But two of those recommendations I think are extremely important. The 9/11 Commission said that, number one, you have got to secure your borders. You have got to know who is in your country, when they come, when they leave, what they are doing here while they are there. The 9/11 commission was very explicit in this instance, and I think it is critical that this Congress in the time that we have left this year make certain that we indeed get that legislation passed. The other thing the 9/11 Commission brought up was that we ought to be encouraging democracies particularly in unstable parts of the world, such as the Middle East, and certainly the President has done just that. It is not always easy, it is not always straightforward, it is not always a job for which we are thanked, but it is the right thing to do. And if you take the long view and if you look out over the next 20 or 30 years' time, I think that history will judge this time and this Presidency as having been absolutely critical for reestablishing that degree of stability that we may achieve in the Middle East by establishing those democracies. I thank the gentlewoman very much for yielding time.

Mr. BURGESS

Mr. BURGESS. Mr. Speaker, I rise today to honor Hurst-Euless-Bedford Independent School District's L.D. Bell High School as it celebrates its 50th anniversary of providing quality education for its students. L.D. Bell has been a fixture in the H-E-B community since 1957. Lawrence Dale Bell High School was opened on a site donated to the school district by the late Larry Bell, Founder and President of Bell Helicopter Textron in Hurst. Rapid student growth and academic excellence have been the cornerstone of Bell High School. During its 50-year history, L.D Bell has earned state and national recognition in academics, athletics, fine arts, leadership training and service disciplines. These numerous honors resulted in the recognition of L.D. Bell as a National Blue Ribbon School during the 1994-1996 school terms. L.D. Bell's high school motto affirms that they ``Do not imitate but are a role model for others.'' The accomplishments that L.D. Bell High School has achieved in its first 50 years certainly exemplify this. With half a century of success behind them, I am confident that L.D. Bell will continue to educate and inspire the young adults that walk its halls today. Mr. Speaker, it is with great pride that I stand here today and honor the 50th anniversary of L.D. Bell High School for their dedication and continuing commitment to education in my congressional district.

Mr. BURGESS

Mr. BURGESS. Mr. Speaker, I rise today to recognize Representative Mary Denny for her service in the Texas House of Representatives. Representative Denny has played an intricate part in the development of the Republican Party in Denton and the North Texas region over the past 20 years. She has helped in over 300 State, Local and National elections in her career and has represented Denton County in both State and National Republican conventions. As a local businesswoman and former teacher, she graduated from the University of North Texas with a bachelor's degree in Education. She is presently serving her 6th term as State Representative for the 63rd district in Texas. Currently Mrs. Denny is assigned to several House Committees including; Chairman of Elections, House Criminal Jurisprudence, House Administration committee, and the Select Committee on Ethics. Throughout her amazing career Mrs. Denny has received several awards recognizing her achievements as both a businesswoman and a legislator. She has been recognized for the past four consecutive terms as a Leader of Excellence by the Free Enterprise Committee, a special honor given to the top ten percent of conservative legislators. She has also been recognized as a Friend to the Taxpayer and honored as an Outstanding Legislator by the American Family Association of Texas. Mr. Speaker, it has been my distinguished honor to work alongside Mrs. Mary Denny for the improvement and development of Denton, Texas. Her leadership and commitment to the citizens of Denton County is remarkable and it has been a privilege to know such a dedicated individual.

Mr. BURGESS

Mr. BURGESS. Mr. Speaker, I ask unanimous consent to claim the time of the gentleman from Nebraska.

Mr. BURGESS. Mr. Speaker, we heard a lot last spring about the voluntary Part D prescription drug program that seniors had available to them for the first time. We haven't heard much about it recently, but it is important to revisit the concept because of two aspects. One is the open enrollment period, which is going to begin the middle of November and run through the end of the year; and the other is to address the fact that some seniors are coming upon what is called the coverage gap. They have received enough help in the prescription drug program, and they have come into a period of spending where they are expected to cover the whole cost of their prescription drug components until they get up to a catastrophic level, after which they will only be responsible for 5 percent of their drug expenditures. Mr. Speaker, last spring when we talked about the Medicare prescription drug program back home, I would tell my constituents to focus on cost, coverage and convenience. If cost is your biggest driver, then look for the plan that has the lowest cost. That is pretty easy to do if you have got a computer and can go to Medicare.gov and scroll through the various computer screens of the plans out there. In my State in Texas, there were some 48 different plans and combinations of plans that were available, but it is pretty easy to pick out the ones that are the lowest cost. If cost was the main driver, that is what I would encourage people to do, and then focus in on those three or four that were the lowest-cost plans. If coverage was the main driver, there was a column devoted to coverage as well. You can certainly pick and choose from plans that covered 95, 98 percent or even 100 percent of the drugs in the Medicare formula. Finally, convenience. If you want to use mail order, make sure that the program that you are looking at conforms to that expectation. If you want to use the Wal-Mart pharmacy, if you want to use the mom-and- pop drugstore down on the corner, make certain that that dispensing entity is available on the drug plan. But by focusing on cost, coverage and convenience, then this rather daunting prospect of looking at 48 different drug plans became a whole lot easier. Remember, Mr. Speaker, when we passed the Medicare drug prescription program, the idea was with the finite number of dollars we had available we were going to cover the people most in need. That meant the people who had the most trouble with illness, who were on the most medications, and those people who were the least well off. The sickest and the poorest received the greatest amount of help from the Medicare prescription drug program. And that indeed has been borne out. But of necessity, those of us who are more well off or perhaps not as ill will find ourselves exposed to some expenditure for prescription drugs in the so-called coverage gap. Well, 92 percent of the people who signed up for Medicare are not affected by the coverage gap. That is, 45 percent of all Medicare beneficiaries will be eligible. Some fall into a category where they are eligible for low-income subsidies and therefore not affected by the gap. They have annual drug expenditures well below the $2,250 level and will never reach the gap, or they have chosen an enhanced Part D plan that provides some coverage in the coverage gap. An additional 47 percent have prescription drug coverage from plans outside of Part D, government plans, veterans plans or another Federal program, or an employer-sponsored program. Or there are those 9 percent who just said, I don't get sick, I don't need drugs, I don't take drugs, and I am not going to sign up. Forty-seven percent of Americans fall into that group. So 92 percent of people will never be affected by the coverage gap. But of those 8 percent who are, and this is the most important part, they need to concentrate on one of the enhanced plans when the open enrollment period comes up on the 15th of November. Every Medicare beneficiary, every single Medicare beneficiary, 100 percent are covered for catastrophic. What I would like to do with the balance of the time is to focus on the individuals who would benefit from being on an enhanced drug program. Mr. Speaker, I have just taken a random page from some of the plans that are available in my State of Texas. This is what will appear on someone's computer screen. You have the company name, the plan name, monthly drug premium, the annual deductible, the cost-sharing coverage in the gap, the formulary percentage of drugs covered, and a checkmark for whether or not someone is enrolled in that plan. If the plan you are in leaves you exposed in the coverage gap, I encourage people to go back to the computer screen or have their grandchild go to the computer for them and scroll through the plans available. If you look down, Mr. Speaker, you will find that some of the plans, albeit they are more expensive from the standpoint of the monthly premium, but look, here is one with a zero dollar annual deductible. Yes, it has some cost sharing, between $2 and $40. Coverage in the gap, yes. Generic only, but if a person is on a blood pressure medicine, cholesterol-lowering medication or reflux medication, this may be a very valuable plan. And then the one right below it, again no deductible, but generic and branded. This is the type of coverage someone needs to focus on if they found themselves having the expenditures in the so-called coverage gap.

Mr. BURGESS

Mr. BURGESS. Mr. Speaker, I rise today to congratulate the City of Denton, TX, for receiving its second StormReady recognition. I commend Mayor Perry McNeill and the City of Denton's Office of Emergency Management for their commitment to supporting broader region and State efforts, both in planning and response, to the weather-related challenges we have faced in 2006. The National Weather Service issues StormReady recognition to cities, such as Denton, that establish a level of preparedness beyond the minimum standards of severe weather operations. These leading cities are selected based on their readiness in six areas, including the receipt of National Weather Service information, local weather and water monitoring, local warning distribution, communication of information to the National Weather Service in Fort Worth, community preparedness, and administrative tools. The City of Denton met or exceeded each of these areas. Under the capable direction of Denton's Emergency Manager Michael Penaluna, Mayor McNeill and the City of Denton have demonstrated their commitment to protecting and preparing citizens for severe weather emergencies. Thanks to the hard work of these individuals, the City of Denton is a safer place and a model for communities around the nation. I extend my sincerest congratulations to the City of Denton, Mayor Perry McNeill and the Office of Emergency Management on receiving their second StormReady emergency response recognition.

Mr. BURGESS

Mr. BURGESS. Mr. Speaker, tonight I would like to take a little time and speak about the state of our trauma system here in the United States. I recently introduced a bill, H.R. 5555, the Trauma Care Systems Planning and Development Act of 2006. H.R. 5555 would provide grants to State trauma systems to improve the coordination of emergency departments and bolster the safety net from point of injury, transportation, to triage and treatment. Mr. Speaker, traumatic injury is the leading cause of death in the United States for people under the age of 45. It is the third leading cause of death in the general American population, and each day more than 170,000 men, women, and children are injured severely enough to seek medical care. About 400 of these people will die and another 200 will sustain long-term disability as a result of their injuries. The total cost of traumatic injury in the United States is largely due to motor vehicle trauma, an estimated cost of $260 billion. Experts estimate that many injury-related deaths could be prevented if a minimum standard of trauma care were available to all Americans. Many areas in the United States do not have appropriate emergency medical services. Several areas report large gaps in transportation coverage and lack of access to emergency nurses and doctors. To illustrate this point, I have a map that shows the areas of the country where residents can reach a trauma center within 60 minutes by flying or driving. This map was created by the Trauma Resource Allocation Model for Ambulances and Hospitals, which is a computer model designed to aid State and regional planners in their decisions to locate or relocate designated trauma centers and helicopter pads. It is designed to help maximize access to lifesaving trauma care for our constituents. Mr. Speaker, the blue areas are within 1-hour driving distance; the pink areas are within 1-hour flying distance. The 1-hour time limit is not arbitrary. In emergency medicine, the first hour after injury is referred to as the golden hour. Patients treated within this timespan are more likely to recover or have less long-term effects of their injury. The longer a person waits for treatment, the worse the outcome is likely to be. Mr. Speaker, I represent an area of north Texas around the Dallas Fort Worth Metroplex, and if you drive from Dallas to Los Angeles, you travel about half of that distance in Texas. Well, that distance in Texas from the Dallas-Ft. Worth area to El Paso is a 10-hour trip. And you can easily make that trip and be outside the range of trauma service almost the entire time. That is a long drive with the potential for an accident throughout. In fact, it would be possible to drive from Mexico to Canada and always be more than an hour away from a trauma center. Members might find that parts of their districts fall outside the 1-hour marker. The Institute of Medicine recently put out a report in June of this year titled The Future of Emergency Care. They found four things. First, many emergency rooms and trauma centers are overcrowded. Demand is growing; supply is dwindling. Ambulances are often diverted from crowded hospitals to others that may be farther away, delaying treatment time and providing less optimal care. Patients end up boarded in the emergency room while they wait for a hospital room. Secondly, emergency care is highly fragmented. Cities and regions are often served by multiple 9/11 call centers. Emergency medical services agencies do not coordinate with their emergency rooms and trauma centers. And some emergency rooms are overcrowded, while others remain nearly empty. There is not effective communication between public safety agencies and public health departments. They often use different radio frequencies and have different emergency plans. Interoperability, which was a big issue during Katrina, is still an ongoing concern. There is no nationwide standard for training and certification of emergency medical personnel, and Federal responsibility for oversight is scattered across multiple Federal agencies. Thirdly, critical specialists are often unavailable to provide emergency trauma care. Three-quarters of hospitals report difficulty finding specialists to take emergency and trauma calls. Key specialties are in short supply. Specialists often treat emergency room patients without compensation. And there is extremely high medical liability. Fourthly, the emergency system is ill-prepared to handle a major disaster. There is little surge capacity. The emergency medical services received only 4 percent of Department of Homeland Security first responder funding in 2002 and 2003. Emergency medical technicians in nonfire-based services have less than 1 hour of training in disaster response, and hospital and EMS personnel lack protective equipment to effectively respond to chemical, biological or nuclear threats. In response to these four deficiencies, the Institute of Medicine made the following recommendations. One, create a coordinated, regionalized and accountable system. Two, create a lead agency. Three, end emergency department boarding and diversion. Fourthly, increase funding for emergency care. Fifthly, enhance emergency care research. And finally, promote the EMS workforce standards. I have sought with the bill, H.R. 5555, the Trauma Care Systems Planning and Development Act, to address this issue. A coordinated and thoughtful plan must be applied to improve our trauma care system in this country. Anyone or their family member could need trauma care in the blink of an eye. Wouldn't we all want to know that we are receiving the very best trauma care available quickly and efficiently

Mr. BURGESS

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

Mr. BURGESS

Mr. BURGESS. Madam Speaker, I too would like to say it is a privilege to come to the floor of the House and be able to address the House on important matters of the day. In my first term in the House, the 108th Congress, and my background is actually as a physician, and when I came to Congress in 2003, one of the things that you do with a doctor when you put them in Congress is put them on the Transportation Committee. So I had a very good session of Congress on the Transportation Committee. I was fortunate enough after my reelection in 2004 to be placed on the Energy and Commerce Committee on the Subcommittee on Health. So having had experience in Congress on both roads and now health, what I thought I would talk about tonight is the road to affordable health care. Some of the things that I want to talk about tonight are the overall affordability of health care and where we are in this country and where we are going. I want to talk about the public versus the private systems in this country. We obviously need to talk about the uninsured and some of the programs to help with the uninsured, federally qualified health centers, association health plans and health savings accounts. You almost can't talk about health care in this country without talking about liability reform, and, indeed, we do need to touch on that, and the sustainable growth rate, patient access for Medicare patients, how physicians are reimbursed under the Medicare system, an item that is becoming of critical importance if we want to keep some of our best doctors providing care for some of our most complex and challenging patients. Information technology has been one of the buzzwords up here ever since I started my time in Congress, and, indeed, we need to talk about that. Preparedness, whether it be from terrorism, whether it be from natural disaster, or whether it be from an outside source like the worldwide flu pandemic that hit this country in 1918, we need to be prepared for that should it happen. We need to talk a little bit about the number of State mandates that are on insurance policies that tend to drive the cost of health insurance up and thereby reduce the overall affordability of health care. There are some interesting things that are being done in some of the States as they approach some of the difficulties they had in providing health care to their citizens. I would like to particularly talk about Governor Mitt Romney's plan up in Massachusetts that provides for personal responsibility in health care. Finally, if there is time, we will talk a little bit about the reauthorization of trauma centers in this country. We will talk a little bit about transparency, raise transparency for price cost and quality in our health care system and maybe just a little bit about long-term care, because that is one of the drivers that is going to vastly increase the cost of Medicare and Medicaid as more and more baby boomers retire. Let me just remove this for a minute so it is not distracting to any other Member of the House who might happen to come by and look at it. We talk about the current problem facing us. We spend a fair amount of money in this country on health care. We have a gross domestic product of upwards of $11 trillion, and we spend about 16 percent of that on health care; $1.4 trillion is spent on health care in this country. In fact, Medicare and Medicaid alone in our HHS appropriations bill, which we have yet to pass, that bill will probably be upwards of $660 billion just for Medicare and Medicaid. Of course, we have the Indian health service, the veterans health service, Federal prisons also providing health care, so there is a significant chunk of this Nation's health care that is already borne by the Federal Government. The other approximately 50 percent is broken down to that care that is just simply not compensated or not remunerated. You might call it charity care or just simply uncompensated care. Some of it is paid for out of pocket or self-pay, and certainly the lion's share is borne by the private insurance market in this country. Well, between the public and the private sectors, how is the best way to get more health care coverage into the hands of more people? Should we just simply expand the public sector to the point where it encompasses all or nearly all of the health care expenditures in this country, a so-called Canadian system? I don't think so. Even the Canadian Supreme Court in 2004 and 2005 said that they had a problem with access in their country, and, in fact, access to a waiting list did not equate to access to care. In the British national health service, some of the most expensive care in the world is in Great Britain. They have a two-tier system. They have their national health service, and then they have private care, and that private care in that country, the cost for that, has gone significantly up. The waiting time for someone who is over 80 years of age, that becomes really problematic. You put someone over 80 years of age on a waiting list for a procedure, a hip replacement, a heart bypass, and the likelihood of them being able to sustain themselves until they receive that service starts to go down. That's unfair as well. Well, what about the private sector? I believe that we have the best health care system in the world in this country, largely because of contributions of the private sector. We have more innovation in this country than almost anywhere else in the world. We have the ability to integrate new technologies rapidly into the treatment rooms, the operating rooms, into the health care system in general in this country. Finally, because we have such a significant component that is borne by the private sector, we have willing sellers and willing buyers. The waiting list is not as big an issue, if an issue at all, in most parts of this country. Some of the other things that we will talk about, as we talk about expanding the private sector, or at least maintaining the component of the private sector in this country, is the little bit of the history of what we called at one time ``medical savings accounts.'' We now refer to them as health savings accounts as they were expanded significantly under the Medicare Modernization Act of 2003. But the old medical savings accounts had a lot of restrictions on them. There weren't many companies who stepped up and provided that type of an insurance product, and, as a consequence, you never saw the savings with medical savings accounts that, really, should have been there. I will contrast that with health savings accounts now. You can go to your search engine, you can type in ``health savings account'' into Google, and you are offered a vast array of different companies and plans that sell, market on the Internet. With, in fact, the competitive power of the Internet, many of these plans, these high-deductible health savings account plans are priced well within reach, of, say, a young person just getting out of college. Contrast that with the mid-1990s when a young person getting out of college who didn't have an employer-based health insurance, who just wanted to go buy an individual policy, I know, because I had experience with that in my own family, you just almost could not buy an individual health insurance policy for a single individual in the marketplace. No one was interested in selling that to you at any price. But now you can go on the Internet, and you can find a lot of products that are available. The last time I looked, which, albeit it was a couple of months ago, but for a young person, 25 years, male, in the State of Texas, for a high-deductible plan, would range between $50 and $60. There were some that were even cheaper, but they were companies that I didn't recognize the name of, and I certainly wouldn't recommend that someone buy from someone they have never heard of before. But there were some reputable names, named insurance companies that had providers, provider lists that were more than adequate, that were for sale at a price that I would consider affordable for a young entrepreneur just perhaps starting their own business or leaving the protective fold of a group health plan from their employer. How we keep the private sector involved and keep health care affordable is truly one of the challenges that we in this Congress, not just Republicans and not just Democrats, but both sides of the aisle, need to take on and meet head on. Some of the downsides of going to a completel nationalized system is I am afraid we will lose a lot of the energy toward innovation. When you stop and think about it, we have had three Presidents in my lifetime who have espoused programs of a nationalized health insurance, President Truman, President Nixon and President Clinton most recently. Under Truman, if they had gotten their way and nationalized health care, what if, what if we had stifled innovation with that type of maneuver? The antibiotics that we used today would be penicillin and tetracycline, those that were most commonly in use in the late 1940s and early 1950s. Under the Nixon administration, what if they had gotten their way with the nationalized health insurance with, again, a chilling effect on innovation? We might be looking at treating psychiatric illness still with Thorazine rather than having the availability of the very potent antipsychotics and the selective serotonin reuptake inhibitors that we have now today. During the Clinton administration in the 1990s, there are just untold innovations that have happened. Even in the last 15 years, there are innovations in the treatment of arthritis, innovations in the treatment of osteoporosis. In fact, if innovation had been stifled in 1992, osteoporosis would be treated today with estrogen replacement and pain medicines, as opposed to having the newer phosphonates or medicines like Fosamax and Actonel and Boniva that are available to us today. When we look at the uninsured in this country, it is an election year, so we can certainly expect the number to go up. The most recent U.S. Census Bureau was 46 million people uninsured. Interestingly enough, between the years 2004 and 2005, there were 1 million more people who had health insurance in 2005 than had it in 2004, and I suspect the reason for that was because of the expansion of health savings accounts. But when someone is labeled uninsured, it means that for any portion of a year they lacked health insurance. It doesn't always mean, though, that they have no access to health care. Access to health care, I will tell you as someone who made a career of being a physician, access to health care is uniformly available. It may be expensive care, it may be care that is accessed far later in the course of the disease than anyone would recommend, but access to health care does not, or not having health insurance, does not equate to not having access to health care. In fact, this Congress in the 1980s mandated that anyone arriving in an emergency room would have access to health care, whether or not they had the ability to pay for it. In fact, as a physician, I was required to respond to that patient within 30 minutes or a reasonable timeframe or face some rather significant civil money penalties. So lack of insurance does not equate to lacking access to health care. We also have a system in this country, under the Federally qualified health center system, that provides health care and continuation of care in a medical home to between 15 and 17 million recipients. That is a significant number of people who lack health insurance but have access to a medical home and have access to care when they need it and, in fact, have continuity of care that in a lot of cases rivals that of any HMO out there. There are some things we could do, I think, to strengthen the ability of federally qualified health centers to provide care when it is needed. I represent an area of north Texas, Denton County, Tarrant County. Fort Worth is the largest city in my district. Last year when Hurricane Katrina hit the gulf coast, we had a number of persons who were displaced by Hurricane Katrina, who came to the Dallas-Fort Worth area, individuals who came needing medical services and not being able to wait the 6 to 8 years that is now required to set up a federally qualified health center. Indeed, last year, the Deficit Reduction Act, I tried to introduce amendments that would streamline the process of setting up a federally qualified health care that would make more of those facilities available to more patients so that they could have more services available to them. Unfortunately, those amendments did not stand during the conference report. But there is still an opportunity to work on streamlining the startup procedures for federally qualified health centers. Indeed, in my district I am working on a couple of those even as we speak. Another issue is having affordable products for companies to sell. You got 46 million uninsured. Don't think that Aetna Life and Casualty wouldn't look at that as potential market share if we would provide them the tools that they need to have an affordable policy available to individuals. We will talk about this a little bit more in just a moment, but to give some relief for some of the mandates that are put on insurance companies, where they have to offer brow lifts and involved infertility treatments to every person who purchases their insurance when it may not be necessary, and, indeed, the cost of adding those benefits may be keeping insurance benefits from a greater segment of the population. On the concept of health savings accounts, we did expand them significantly during the Medicare Modernization Act. There, in fact, is legislation out there this year. Eric Cantor, from Virginia, and myself have introduced legislation to expand and make a little bit more flexible the health savings account. One of the things, in the interest of full disclosure, some employers will provide employees an amount of money to have each year to perhaps pay incidentals or eyeglasses or maybe even help pay for a higher deductible that is selected to offset some of the cost of the insurance premiums, these so-called use-it-or-lose-it funds that a company might provide a patient every year. But when you get toward the end of the year, and gosh, nobody wants to lose that money, they want to get the use of that money, it may be as much as $1,800 or $2,000, so we actually incent people to go out and spend more money on health care that perhaps they might not even need. There was a big, full-page ad in the Dallas Morning News right before I left to come back up here about a doctor who provides refractive surgery, or LASIK, for someone's eyes, and if you have a use-it-or- lose-it policy at your work, look into buying yourself LASIK for Christmas this year, because you will lose that money if you don't spend it. Again, a kind of the wrong incentive and the wrong message to send to employees that yes, you have to spend at least $2,000 on health care every year or you are going to be penalized. For people who are young and healthy who feel that they are bulletproof and they don't even need to buy insurance, making these HSA premiums payable with pre-tax dollars would be a powerful incentive to get these individuals to buy into the concept that they do need to insure themselves. For low-income individuals, people who don't make enough money to even cover the relatively low cost of a Health Savings Account insurance premium, provide them with a pre-fundable tax credit or a voucher, if you will, to be able to buy that insurance, or perhaps at least buy down the cost of the insurance premium for someone who is not unemployed but doesn't make enough money to pay for health insurance. What about someone who has got a chronic disease? A Health Savings Account may not be the best option for them. It might be, if we allowed employers to make a larger contribution, a larger or greater HSA contribution for someone with a chronic illness, say someone with diabetes, someone who is in remission from leukemia, a valuable employee that an employer wants to be able to keep on the payroll and keep on providing their insurance benefit and would welcome the opportunity to be able to buy one of these lower cost Health Savings Accounts and yet contribute a greater amount to that person's deductible. Allowing flexibility to coordinate Health Savings Accounts with existing health coverage, like a flexible spending account or a health reimbursement account, and allowing early retirees to use HSA savings to pay for insurance coverage premiums until they are of an age that they can be covered on Medicare. But probably the most powerful tool that we could employ is providing a pre-tax treatment of health care expenses incurred under HSA compatible plans. That has been something that has met with some resistance, but truly I think it is time to investigate that and take that up. Association Health Plans. You hear it talked about. I have heard it talked about every year since I have been in Congress. Over 60 percent of all uninsured workers are employed by small businesses with fewer than 100 employees. But what if we were to give small business, give those small employers the ability to pool together, and if they are of a similar business model, say they are chambers of commerce, or say they are realtors, or say they are physicians or dentists offices, if they could pool together to be able to get the purchasing power of a larger entity, then they would be able to command more control in the insurance market and command a more cost-effective premium. What if we allowed them to do this across State lines? That has been the difficulty in allowing, or for the Senate or the other body to allow the institution of Health Savings Accounts. They came very close this past year. I know they worked very hard on that over there. Association Health Plans may not immediately bring down the number of uninsured like expanding Health Savings Accounts will, but allowing Association Health Plans would provide some measure of stability and affordability in insurance premiums that would allow small businesses more certainty in that market and would keep them from leaving the health insurance market for their employees. Well, as promised, it is almost impossible to talk about the affordability of health care and not bring up the question of liability, medical liability reform. We have done that I don't know how many times on the House side. Some states, my home State of Texas, has made great strides in improving the liability picture back home in the State of Texas. But these State-by-State solutions are in constant jeopardy by special interests who will reappear every legislative session to try to undo, for example, the good that they did in my home State of Texas. When we passed H.R. 5, which was the Medical Liability Reform Act in this body in 2003, the Congressional Budget Office scored that as a savings of $15 billion over 5 years. I believe the amount really will turn out to be much greater than that because of the pernicious effect from a spending standpoint of defensive medicine. In fact, a study done out of Stanford, California, in 1996, in the Medicare population alone showed that the practice of defensive medicine cost about $30 billion a year in 1996 dollars to the Medicare system. So there would be a significant cost savings across the board in this country if we would be able to pass some type of meaningful liability reform. We are wasting money by not pushing for this on a national level. What happens if we don't change? Well, several years ago when I was on the transportation committee we had a field hearing up in ANWR. On the way back we stopped in Nome, Alaska, for lunch and kind of had a Chamber of Commerce type lunch there in Nome, Alaska Because it is unusual to have a congressional delegation come through Nome, Alaska, all of the people turned out for that, including all 19 members of the medical staff of the hospital there at Nome. They spoke to me with great concern saying, I hope you will be able to get that medical liability bill passed, because we can't afford the insurance premiums for an anesthesiologist at our hospital. I said to the person sitting next to me, what kind of medicine do you practice, sir? He said I am an OB-GYN, just like you. How do you practice OB-GYN without an anesthesiologist in your hospital? Forget an epidermal for pain relief during labor. What do you do if the patient requires a C-section? He said, we get an airplane and take the patient to Anchorage. Anchorage is an hour-and-a-half away, and that is if the weather is good. Nome, Alaska, as I understand it, has episodes of bad weather where aircraft can't take off. I fail to see, Madam Speaker, how we are furthering the cause of medical safety, patient safety, by allowing this system to continue. In addition, the head of one of the residency programs in New York was speaking with me one night. I asked if the medical liability climate was affecting their ability to get OB-GYN residents into their program. It was related to me that evening that, well, Congressman, we are taking people into our program that we wouldn't have interviewed 5 years ago. Wait a minute. These are our children's doctors they are educating today. How are we furthering the cause of patient safety, how are we enhancing patient safety by allowing that system to continue? The best and the brightest are not going to go into fields like OB-GYN or neurosurgery, so-called high-risk specialties that might expose them to a greater degree of liability peril. Well, in Texas, we did do what I consider a very good thing as far as medical liability was concerned, and we did pass a so-called cap in Texas, a cap on non-economic damages. It was a little different from the House-passed bill. The House- passed bill was a $250,000 cap on non-economic damages. In Texas we passed a bill that would cap $250,000 of non-economic damages for the doctor, another $250,000 for the hospital, and another $250,000 for a second hospital or nursing home, if one was involved. This bill required the passage of a constitutional amendment in Texas in 2003, and it did indeed pass, and now Texas is well into its third year of this medical liability reform. What have been the results? Texas Medical Liability Trust, my old insurer of record when I left the practice of medicine in early 2003, the cost for premiums from Texas Medical Liability Trust, coupled with the rebates that had been given to doctors who were their customers over the last 3 years, have now totaled to over 20 percent. That is significant, because in the 2 years before I left the practice of medicine, my rates went up by 20 percent and 30 percent for those 2 years before I left the active clinical practice of medicine. So it is a significant change that has happened in Texas. One of the major advantages has been what has happened with mid- sized, not-for-profit hospitals who were self-insuring for medical liability before. Many of these smaller hospitals have found millions of dollars that are now returned to them in medical liability premiums that are available for capital expansion, to hire more nurses, the kinds of things you want your mid-size, not-for-profit community hospital to be able to do. We have some other options in our Committee on Energy and Commerce on our Health Subcommittee. We have talked about some of the other options. Arbitration, mediation, certainly if there could be an expansion of those to allow for an earlier settlement or even the concept of an early offer for someone who actually has been harmed. One of the really unspoken but one of the significant downsides of our medical liability system is it takes on the average of almost 8 years for a patient who is truly harmed to receive any type of compensation. Then the amount of compensation they receive is strikingly reduced by legal fees and court costs and preparation costs and all of the things that go into that. So there is a very lengthy process that doesn't really help anyone as far as getting money to someone who is truly injured. The concept of an early offer or even arbitration or mediation, we will have to make some adjustments to what is referred to as the National Practitioner Data Bank, and hopefully my committee will be able to take that up in the near future. Let's shift gears for just a minute and talk a little bit about something that significantly affects patient access to physicians, and that is the proposed reductions in physician payment that are going to occur under the Medicare system, the so-called reductions because of the sustainable growth rate formula, something that I believe needs to be fixed and it needs to be fixed this year. Under the sustainable growth rate formula, physicians' compensation is basically set. It is an attempt to limit the amount of expenditures of medical care under the Medicare system by controlling volume and intensity of services. Other parts of medical care delivered under the Medicare system, the year-over-year rate is calculated based on the cost of input, a market basket type of update that is based on medical inflation. This rather graphically shows the results of the two different types of formulas. Compare the reimbursement for the Medicare Advantage Plans, compare the reimbursement rates for hospitals or nursing homes with the reimbursement rate of physicians. This blue line here represents the year 2002. That was the first year that a cut was allowed to proceed under the sustainable growth rate formula. It was about 4.4 percent, what is euphemistically referred to as a ``negative update.'' The next 3 years, Congress came in at the last minute and said, we will give you a little bit of a bump up. As you can see, a little bit less than 2 percent for each of those years. Last year, we held the SGR rate at a zero percent update. It didn't go up or down. Almost anywhere else in Washington, if you hold spending level for a year, you are accused of having cut benefits. But that is what we did for our physicians last year. And really part of that story is we didn't do it by January 1, we had to come back after the first of the year to provide that zero percent update. In reality, January 1 physicians got again a 4.4 percent negative update. Yes, the administrator of the Center for Medicare and Medicaid Services did come in and say that as long as Congress does what it is supposed to do at the end of January, which we did, that CMS would come back and reimburse physicians for that amount of money to bring them up to that zero percent. Unfortunately, there are many private insurance companies out there that pay into Medicare; so doctors took a pay cut for other private insurance, which was never the intent of this Congress. It was never the intent of the administration of the Senate, but nevertheless, that is what we did. The purple line here represents the proposed 5.1 percent negative update that is to go into effect if we do not affirmatively do something before January 1, and that is why I say it is incumbent upon us to do something, in fact, this month before we wrap things up on the 30th of September. I would just like to make a couple more points about this graph. Cutting Medicare rates hurts all physicians and patients. Private health plans and other government programs follow Medicare's reimbursement trends. They look at Medicare's reimbursement rates, and they structure their plans to pay physicians the same, regardless of how much it costs the physician to provide the care. TRICARE, for example, reimburses at a rate that is 85 percent of Medicare. Many of the private plans will reimburse at rates that vary between 85 percent and 120 percent of Medicare. But, again, it was never the intention of this Congress to provide a break for private insurance with the SGR formula. Setting up the silos for Medicare reimbursement is itself flawed. We have a silo for the Medicare Advantage programs, a funding silo for hospitals, for nursing homes, and physicians. With more procedures and more services being delivered outside of hospitals, the payments should be based on the highest quality and most cost-effective treatment setting. Elements of the sustainable growth rate formula originally were designed to control utilization by reducing physician fees. The primary drivers of utilization, however, are new, improved technologies, patients' increased awareness of treatment options, and the general shift from inpatient to outpatient care. Physicians control none of these factors. And there is even one more factor over which physicians have no control, and those are the mandates that this Congress puts on Medicare for types of medical care that have to be included. The Welcome to Medicare Physical, I personally think that is a good idea. I think you are going to pick up problems where you can more timely diagnose and treat those problems. But it costs money and that money comes out of the physicians' position of the SGR formula. Again, in the Deficit Reduction Act, we passed a measure that would require every person on Medicare to have an EKG at age 65. That money comes from somewhere. It does not come out of the hospitals. It does not come out of the Medicare Advantage plans. It comes out of the physicians' part of the sustainable growth rate. We also decided that everyone should have a screening for an abdominal aortic aneurism. It may or may not be worthwhile, but that money is going to be taken out of the physicians' portion of the SGR formula. And, again, physicians have no control over that utilization. The legislation introduced right at the end of July, H.R. 5866, would put the focus to ensure that elderly patients have better access to the health care they need. Four goals of this legislation: ensure that physicians receive a full and fair payment for services rendered; create quality performance measures that keep consumers informed; improve the quality improvement organizations' overall accountability and flexibility; and, finally, find reasonable methods, reasonable offsets for paying for these benefits. For fixing the SGR, for title I of that bill, it ends the application of the sustainable growth rate formula January 1. So January 1, instead of a pay cut, SGR would go away. It substitutes for the sustainable growth rate formula a different formula. One that was derived by a group called MedPAC, the Medicare Payment Physicians Advisory Commission, called the Medicare economic index. And this shifts physician compensation so it will more closely mirror hospitals and Medicare Advantage plans. It bases updates and physicians' compensation on the market basket. What does it cost to deliver the care and how much did that cost increase over the past year based on medical inflation? That is the Medicare economic index. We will use the Medicare economic index minus 1 percent, which will be an increase of about 2 percent for physicians for the year 2007. And it basically puts us back on a more market- sensitive system. What is health care inflation? What is it costing the hospitals, the Medicare Advantage plans, and the doctors to deliver the care and compensate them accordingly? Under the quality measures, in conjunction with physician specialty organizations, it creates a voluntary system of evidenced-based quality measures. It gives doctors feedback on their performance. As a physician, you are always wondering how you are doing; how do you compare to your peers; how do patients rate you. This is information that we are always seeking. It also allows patients to be selective. If a doctor elects not to voluntarily report, that information could be available to patients when they make their selection as to what physician they see. There will be offsets in the bill. Currently, the offsets that are made are looking at the Medicare Stabilization Fund from the Medicare Modernization Act and eliminating the double payment for medical education costs in the Medicare Advantage plans. The important thing here is it keeps the power in the health care community. It does not devolve that power to the Federal Government. And it is just a start. It is a start on the path of developing a product that will ultimately be satisfactory to all of the stakeholders. A quote from the AMA news: ``We are encouraged by the introduction of this legislation that would replace the current flawed Medicare formula,'' from the AMA Chair, Dr. Cecil B. Wilson. One of the things that is talked about a lot here on the House floor, and, in fact, we passed H.R. 4157 in July, which is the Health Information Technology Promotion Act, there is no question that health information technology holds a great deal of promise for being able to streamline the delivery of medical care to provide a method of continuity of care if something happens. With electronic medical records, those are then available online. And if something happens to a patient's original medical record, all is not lost. You can go to a safe, secure, sequestered Web site in order to retrieve that patient's medical data. I will admit I came late to the table on health information technology and its promise to improve medical care in this country. My own attempts at electronic medical records, electronic prescribing seemed to increase the time involved with every patient interaction. And, of course, there is no additional compensation for that increased time with every patient interaction. But last January, my committee, the Oversight an Investigations Subcommittee of Energy and Commerce, went to New Orleans and had an opportunity to visit Charity Hospital. And there in the basement in Charity Hospital we were still walking through water that was still in some places ankle deep, looking in the medical records room there in the basement of Charity Hospital. Here were rows and rows and rows of medical records that were absolutely ruined when the basement flooded and the water came in and now had black mold growing up and down the sides to some places where you couldn't even read those bright pastel numbers that were on the sides of medical records. Clearly, Katrina showed us how vulnerable our medical data can be even in a venerable institution like Charity Hospital in New Orleans that you just assume is always going to be there and those records are always going to be there. Well, this time they weren't. And when some of those individuals came to Texas and came to north Texas, it made delivery of their medical care much more difficult. The bill that we passed does provide for updating some standards, reporting on the American health information community, with a strategic plan for coordinating the implementation of health information technology. Well, talking about Charity Hospital, talking about New Orleans, I mentioned that we were going to discuss preparedness. And we are just beyond the 1-year anniversary of Hurricane Katrina. We have to step back and ask what we have learned. While we watched that hurricane, my wife and I, coming up the Gulf of Mexico, it was almost like watching a train wreck in process. We were transfixed by the hourly reports of the progress of the hurricane. It looked like it was just going to hit the central city of New Orleans and just at the last minute took a little bit of a turn back to the east, and the central city of New Orleans was spared. And I think the headline in my paper was ``Bullet Dodged,'' or something to that effect. It was only later, not even that day but the next day, on Tuesday, when we realized how serious the situation had become because of the flooding caused by the breaches in the levees. Back in my district, my home district in north Texas, we watched, of course, as people were taken into the Astrodome and then, of course, as the waters rose. And people who had not left the city of New Orleans had to be evacuated. Many of them were evacuated to Dallas, Texas, to Fort Worth, Texas, where my district office is in southern Fort Worth. A gymnasium on the same campus where my district office is was converted to a shelter for individuals who had been displaced. We set up 250 pallets that night. We had chicken dinners that were donated by a restaurant, waiting for displaced persons from Katrina when they arrived. Some very tragic stories from some of the individuals who arrived there over the next couple of days. I got a call from my staff, and they asked me how soon can a woman who has had a C-section sleep on the floor? I said, why do you want to know this information? They said, well, we have three women here who just had C-sections, and we want to know if we can put them on pallets or if we have to find cots for them. I said, I will be right there. One of these individuals, her baby had been in intensive care. They were separated in the process of the evacuation. And it was only after several days with my staff spending every hour on the phone that we were finally able to reunite mother and baby. And just this past week they had a 1-year anniversary there in Mississippi with mother and baby, celebrating the anniversary of not the child's birth, but the mother and baby getting back together after the hurricane was over. The Dallas County Medical Society, on a holiday weekend, Labor Day weekend, the blast fax went out to probably 800 members of the Dallas County Medical Society. A quarter of them showed up in the parking lot of Reunion Arena to help with the medical care for people who had been evacuated from the Louisiana Gulf Coast. What a tremendous story of all of the individuals getting off the buses that evening. They had a triage desk set up. If someone had been off their meds and simply needed meds, there was a mobile pharmacy set up where they could be administered those medications. And of all of the people who got off the buses that night, in the thousands, only about 200 required hospitalization as a result of having been in a shelter and off their medications for several days. The doctors that were there did a tremendous job of identifying who was sick and who was simply in need of a hot shower and a warm place to sleep and getting back on their medications. One of the other great stories was there was a lot of fear with this many people crowded into a shelter, would there be an outbreak of transmissible illnesses like gastrointestinal illnesses, infectious diarrhea? They had hand sanitizers. You could not walk 10 feet without someone putting a bottle of hand sanitizer in your hand. People used them repeatedly throughout the day and night, and as a consequence, only a very limited number of people actually had any type of gastrointestinal illness. They were quickly sequestered in another facility, and as a consequence, a public health crisis was averted. In follow-up, I have traveled to New Orleans twice in the past year, once in October at the request of one of the hospitals down there to try to get some help for their medical providers. And then in January, as I mentioned, our Oversight and Investigation Subcommittee went to New Orleans, and we had a hearing down there. It really was remarkable to see what the difference in preparedness between the Charity Hospital and the private hospitals, Tulane University Medical Center. HCA hadn't planned necessarily for a hurricane, but they had some disaster plans in place. They had been rehearsed. They had been practiced. And as a consequence, when we were there in January, they were about ready to open their emergency room again. Charity Hospital still appeared to be light years away from being able to reopen. So some of the lessons that came out of that trip down there were when you have disaster plans, when you have preparedness plans, it is not good enough to just have them and have them on the shelf. And I heard this from nursing homes, and I heard this from hospitals that, unfortunately, there were places that had purchased disaster plans but no one had looked at them. You have got to take them off the shelf, you have got to break the seal, you have got to break the shrink wrap that surrounds them, and you have got to practice them. Our chairman of the House Government Reform Committee held a series of hearings on what happened in the aftermath of Hurricane Katrina. And for any House Member who hasn't read or at least looked at that publication that they put out as a result of those hearings, the title was ``Failure of Initiative.'' That is truly an outstanding work that Chairman Davis did, and I know every House Member got a copy of that and I would recommend that they look at that. Remember, this was a committee, a special select committee. It was bipartisan, though many people on the other side of the aisle chose not to participate. It wasn't an unelected, unaccountable commission like the 9/11 Commission. These were our House Members who were truly interested in what happened in the aftermath of Katrina and were very interested in getting it right. As you think about Hurricane Katrina, as you think about 9/11 and some of the disasters that have befallen not just this country but the world, with the tsunami right after Christmas in 2004, the fact of the matter is we just can't afford to fail next time, whether it is a hurricane, whether it is a terrorist, or whether in fact it is a problem with a worldwide pandemic. And I won't spend a lot of time on this, because I can talk about the avian flu for an hour in and of its own right, but just a couple of points. As of September 8, 2006, just last week, the World Health Organization had confirmed 244 human cases of avian flu with 143 deaths. What is so remarkable about this illness is that it seems to be so lethal. That is an over-50 percent mortality rate for influenza. That is unbelievable to have that type of mortality rate. During the summer months on a trip over to Iraq and Afghanistan, I was actually able to stop in Geneva for a few hours and talk to some of the folks at the World Health Organization. At that time, when I was there, there were coordinating efforts between 192 different countries. Dr. Michael Ryan, who is the director of the Strategic Health Operations Center, provides strategic support and global coordination to the World Health Organization, the Center for Disease Control, and our own Health and Human Services Administration. Dr. Ryan, I should point out, is on loan to the World Health Organization from the Centers for Disease Control. And the idea is that we won't reinvent a global CDC over there, but we will take the expertise of the CDC, apply it to the World Health Organization, and allow them a greater reach as far as monitoring and notifying. The concept is to control the disease at its source, culling of infected avian populations, isolation of infected avian populations, or humans should they become infected, vaccination and antivirals for people who are exposed or infected. We need intelligence, we need verification, and we need assessment, and we need a response, all of which can act globally, because as this map shows, it is indeed a global issue. This shows eight areas where the avian flu has occurred and areas where human cases have occurred. If you notice the time line, the arrows are pointing from east to west. And with the migratory flyways, it is possible that in wild birds and wild water fowl, the carriage of this disease could occur from the eastern hemisphere to the western hemisphere perhaps as early as this fall or winter. To date, it has not been detected in the western hemisphere. To date, there has not been an easy or facile transmission from human-to-human. Human-to-human transmission only occurs with great difficulty. The virus hasn't undergone that mutation that would allow for facile transmission from human to human. But clearly, with a disease that is so widespread in the avian population and with a disease that has shown such a striking lethality rate, it is critical to keep the surveillance up and to make certain that other countries do what they are supposed to do in this regard. International transparency is absolutely key. A country keeping silent on a problem it is having with this illness is not only not acceptable, but it may be lethal to other areas in the world as well. It is already a pandemic in birds but not in humans. The best way to prevent a pandemic is to control it in animals before effective human- to-human transmission occurs, meaning to minimize cross-species contact and make certain that in countries where avian populations are infected that there is the proper culling of avian populations, and that it is done safely without unduly exposing those people who are handling the infected birds. Protecting North and South America from this global health threat, all of the outbreaks have been contained so far. Indonesia was a point of particular concern a few months ago where many people appeared to be infected in a cluster, but it does appear that those were all a direct result of either living with infected birds or close human-to-human proximity that allowed for that human-to-human transmission. Clearly, we have got to prevent the spread to the United States and Central and South America. The disease at this point may know no boundaries because of its distribution in the avian population. And other countries, it is critical we have got to monitor the disease at the border. I did also take a trip just up the street to Bethesda, Maryland to meet with Dr. Anthony Fauci to talk with him about a vaccine development. There are some remarkable things that are going on as far as vaccine development. I guess one of the important aspects of bird flu is we are going to develop more capacity for delivering more vaccine for just the regular flu as a consequence for the preparedness that is happening with getting ready for the possibility of a worldwide pandemic. This may not be the one. Avian flu may sputter out and never be the pandemic that everyone fears. But the fact remains that almost for every century that anyone has kept track, about three pandemics per hundred years do occur. We did indeed have three during the last century, and even a relatively mild pandemic of the Hong Kong flu still claimed 50,000 lives in this country. So it is a matter of no small importance. Additionally, we have got to be certain that, just like the nursing home in Louisiana that left their disaster preparedness plan on the shelf with the shrink wrap still on it, we have got to be certain that we take those plans down and we talk to our local first responders, our local health departments. And I had such a roundtable just last week in my district, very well received by the folks at the health department, by the administrators in all three hospitals in one of my counties. I wish we had a little more participation of the medical staff, but we did have some and I did at least receive an invitation to talk at one of thei medical staff meetings. But the key for us here in Congress is when faced with whether it be the avian flu, terrorist attack, another hurricane, we have got to be honest. No spin, no sugar-coating, no BS. And, above all, we have to communicate with our constituents and with our first responders back at home. One other thing that I want to talk about as time runs short here is, and I mentioned this earlier, about a bill that is out there to reduce or restructure the number of mandates that are on health insurance. Again, Aetna Life and Casualty might look at 46 million uninsured individuals as potential market share if they only had a product that they could sell. Now, in our Committee on Energy and Commerce we had a debate on a bill that would reduce significantly the number of State mandates on insurance policies in the individual market. This wasn't even discussed in the group health insurance market, but just the individual market. It was a pretty contentious debate and there wasn't a lot of agreement across both sides of the aisle, and that is unfortunate, because when the American people watch what this body does, they are really not interested in the tennis match or volleyball match that goes on from one side or the other. They want results. They want more affordable health care, health insurance. They want Aetna Life and Casualty to be able to look at that 46 million uninsured as a potential market share. Well, what if we could get together across the aisle and discuss what is that basic package of benefits that we would like to see available in a health insurance policy, one that could be sold on the Internet from State to State. It seems like an almost impossible task, or at least it seemed almost impossible that night when we were debating this bill in the Energy and Commerce Committee. But the fact is we have already done that work. I say ``we.'' I wasn't here 30 or 40 years ago when the federally qualified health center statutes were first written. But in fact, in that statute in law is identified a basic package of benefits that has to be offered at every federally qualified health center. Well, we have already agreed then in principle what that basic package of information is. Now, the information may be 30 or 40 years old, but perhaps we could sit down and decide which of those things we could eliminate because they are no longer necessary, which of those things we would have to add because we have learned some stuff since then, and then go to our private insurers and say, here is a basic package of benefits that, if you will abide by these rules and make certain people know what they are buying, that there is full disclosure about what is covered and what is not covered in these insurance policies, that you can then market this to the uninsured. And then give individuals who are unemployed a voucher or a pre-fundable tax credit to purchase that insurance. Or give that family that is of a low-wage earner, give them some additional health, buy down that premium. These are the types of concepts that, really, the American people are anxious to see us work on, and I for one would really welcome the day that we could do that. Just one last brief thing about the Medicare part D, the Medicare prescription drug program that actually started the first of this year. At the end of the enrollment period, well over 38 million people had prescription drug coverage under Medicare. This was the population, the Medicare population that was the largest population that didn't have access to a prescription drug plan if their employer or retiree insurance did not offer it. This is a tremendous benefit. We will and do hear a lot of discussion about people who are caught in the so-called gap coverage. But remember, there are plans out there that if a person is willing to consider a generic compound, there are plenty of plans that cover in the gap; and in my home State of Texas, there was at least one insurance company that would cover both brand and generic in the gap. So I would encourage people who have looked at the difficulty they are having with the so-called donut hole, when they re-up on their insurance plan, their prescription drug plan in November in that open enrollment period, look at one of those plans that will provide for coverage in the gap. Madam Speaker, I yield back the balance of my time

Mr. BURGESS

Mr. BURGESS. Madam Speaker, I ask unanimous consent to claim the time.