Charles Dent

Mr. DENT

Mr. DENT. And that is a very important point. You know, there are so many people out there who need coverage, and there are so many things we can do to help. You just mentioned the idea of allowing employers to reach across State lines and realize greater discounts. That is critical. But the other issue, too, to help the uninsured, we know that employers receive favorable tax treatment. They get a tax exclusion that is very beneficial to helping them provide health care coverage to their employees. That is a good thing. We want to protect that. There are about 165 million Americans that have health care through their employers in many respects, and what we should do is give the individual who lacks insurance, if his employer cannot provide it to them or if they are self-employed or on their own, give them the opportunity to buy health insurance and give the same kind of favorable tax treatment to the individual that we currently give to the business. That would do a lot to help cover particularly that younger population that is relatively healthy and insurable.

Mr. DENT. And if the gentleman would yield, to follow up on that point you were just making about government ownership and autos and financial services and elsewhere, let's talk a moment about health care. And there's an idea being floated about called a government option, which needs to be, I think, fully understood and vetted before the public. But that government option many fear may become the only option for insurance because a government option coverage perhaps would be able to offer it at a much lower cost than any kind of a private sector insurance product. And the fear is that you would have a backdoor government takeover of our health system through this government option, a very real concern. And again, I just don't think that we should lose sight of the fact that if we--this turns into a backdoor, single-payer system or a government takeover of health care, what will soon follow will be rationed care, that is, waiting lines, delays, denials of care.

Mr. DENT. If the gentleman will yield, one of the interesting demographics with respect to the uninsured population, I think we really need to focus on this like a laser beam. Over half, I believe, 55 percent of the people lacking coverage in America are under the age of 35. Many of them are insurable. Those college-age kids up to age 35, they tend to be more insurable than much of the rest of the population. So I believe we do have some suggestions and proposals as a way to cover that population, get them into an affordable catastrophic coverage that they will need in the event that something dramatic happens in their life where they need that kind of coverage. I would like to talk about that a little later. But that is another statistic I don't think we talk enough about. Also, there are a large number of people uninsured who are currently eligible for programs, whether they be Medicaid or the Children's Health Insurance Program.

Mr. DENT. Absolutely not. The point is, this drives up costs, not just in terms of the liability payments that the doctors and the hospitals must incur, and many physicians are now working in hospital-based practices in part because they can't afford liability insurance, so the hospital must pick up that bill and they are struggling to make these payments. The point is, it raises costs not just for the doctors and the hospitals, but the tests that are going to be prescribed and administered and treatments perhaps proposed just to protect themselves. This will drive costs up. They are protecting themselves against lawsuits. What is the other issue? Access to care is a consequence, that there will be less access, that doctors won't deliver babies in the city of Philadelphia. That means people don't have access to an OB. That is important. I think that is the point. It drives up costs and it limits access, and Americans want access to health care and need the care when they must get it.

Mr. DENT. Before we get on to our next topic, I just want to mention one thing. What's the point of this whole discussion? I was talking about the rising costs. But in Philadelphia, premiums rose 221 percent for OB/GYNs in the city of Philadelphia. That is between 2000 and 2008. Premiums rose 149 percent for general surgeons in New Jersey. Premiums rose 348 percent for internists in Connecticut over that 2000-2008 period.

Mr. DENT. And the physicians and hospitals have to hire attorneys to defend themselves. So there's a lot of time, effort and money expended just to prepare and fight this battle, only to have it dropped. So there is still a cost incurred even though the case is dropped.

Mr. DENT. I would like to get in a few statistics about this. This is a very interesting and pertinent subject, this whole discussion of the cost of health care and why it's rising. Defensive medicine costs the U.S. as much as $126 billion per year. That was out of a 2003 HHS study. One-third of the orthopedists, obstetricians, trauma surgeons, emergency room doctors and plastic surgeons can expect to be sued in any given year. The data for 2006 shows 71 percent of the medical liability cases are dropped or dismissed. Only 1 percent of the cases result in a verdict.

Mr. DENT. I thank the gentleman for yielding. In Pennsylvania, of course, we have been in a crisis state for some time with respect to medical liability. In fact, my colleague Tim Murphy remembers the great debates we had in Pennsylvania about the need for joint and several liability reform, to make sure that the award would be basically proportional to the degree of fault. We felt that that was something that was absolutely essential. Caps on noneconomic damages, another area we were greatly in need of reform in Pennsylvania. Also the notion of a periodic payment as opposed to one big lump-sum award. One could pay those payments out over a period of time. Something that, again, was absolutely essential. In the city of Philadelphia, in particular, we had a very real crisis. In fact, at the time a group called Jury Verdict Research had done a number of studies about the jury awards and settlements coming out of the city of Philadelphia. The average jury award at that time was somewhere around $1 million. The rest of the State, on average, was a bit less than $500,000. In fact, it got so bad one year that there were more awards and payouts out of the city of Philadelphia than in the entire State of California; and the city of Philadelphia has a population of about 1.5 million people. So what we had to do was find ways to get cases out of the city of Philadelphia, out of those courts. So Congressman Murphy and I actually passed legislation that would have essentially required the cases be heard in the county where the alleged malpractice incident occurred, and we supported it in Harrisburg. So that made complete and total sense. Consequently, we tried to pass it legislatively, but we ended up having the Supreme Court establish a rule to essentially provide that kind of a remedy. What happened is, we saw the number of cases heard in Philadelphia drop dramatically as a result of that. So that was just another example of the problems. Also, we have many people in this country who must go to an emergency room for care. They go to the emergency room, and oftentimes emergency room physicians and staff are the subject of lawsuits. But those same physicians must provide care under Federal law, something called EMTALA; and essentially what that means is that they must provide care. So I think what we should do is provide medical liability relief to those emergency room physicians by treating them as Federal employees, not that they're going to be on the Federal payroll. But for tort purposes, in the Federal Tort Claims Act, they would be relieved from those types of lawsuits. Because we've had situations across this country where trauma rooms have been forced to close down. It's dramatic. We also had a situation where we met an obstetrician recently from one of the hospitals in the city of Philadelphia who actually said, The only reason why we deliver babies is to train our students. We lose money. There are many doctors who choose not to deliver babies these days because of liability. And in Philadelphia I know one hospital, I think it was Methodist Hospital, stopped delivering babies. One of the teaching institutions only delivers just so that they can train their residents. They lose money, and it's very costly to them. But they do it as a service and as a way of training physicians. But that's a very sad state of affairs when we can't deliver babies because of the high costs.

Mr. DENT. Just in conclusion, I just think we want to say a few things. I think in our health care system we certainly want our system to be focused on prevention, not maintenance. We want cures, not treatments. The system should be about doctors, not lawyers. We want patients to be treated like they want to be treated, like human beings. They want to be treated like people and not some number, something abstract. They want to be treated like a human being. And so, because at the end of the day, we all want our loved ones to be cared for. You don't want them to have to wait. You don't want to see your mother, like mine, who's 80 years old be told that she's contributed her whole life, relatively healthy, we don't want to tell her, I'm sorry, we're going to discard you now that you've reached a certain age. That's what we are concerned about. So we're going to try to work, I think, in a bipartisan manner, try to work in a way that embraces a lot of ideas that we can all share. And short of a government takeover of our system, I think we can do that. We have the capacity to do it. The American people expect it of us, and I look forward to working with all my colleagues to come to that kind of result.

Mr. DENT. 165 million Americans.

Mr. DENT. Well said. And I think we should focus on solutions. We've talked a lot about the challenges and the problems and the costs, but it does come down to solutions. And I think to sum up what we've been talking about tonight in terms of our solutions, you, Congressman Kirk, have been a great leader on the Medical Rights Act. And to make sure that that sacred relationship between doctor and patient is not violated, we have to protect that principle, and that notion must be protected up front. As we lower the cost of insurance, we've talked about some ideas about making sure that businesses can reach across State lines, they can reach across State lines, realize greater discounts so they can provide more affordable coverage to their employees. That's a cost issue. Medical liability reform, and we've given some specific examples of things we can do on medical liability reform to help lower the cost of care. Absolutely critical. We want the States to be innovative. We want them to be innovative. And many States, I believe 34 States, have high risk pools, some of which work reasonably well, and others are not very effective. And so how can we help States innovate, to provide ways to make sure people receive coverage, particularly that uninsured population I think we're all generally concerned about. That's that population that is chronically uninsured, and maybe it's about 10 million people. I don't have the statistics in front of me, but somewhere around 10 million people are chronically uninsured. They're not that under-35 population, but people who really need help and may have a preexisting condition that prevents them from getting picked up. Or a person, right now, let's face it, a lot of people are more--what they're afraid of more than losing their jobs is losing their health care coverage. And I think we have to make sure that we take care of that population, uninsured who have a preexisting condition. We need to help them, particularly if they're high risk. And that's where we can use the States, I think, to be very, very innovative. And the other thing that we have to talk about too, and we don't talk enough about it, but I think people want to see medical breakthroughs in the United States. They want quality and they want innovation, and they don't want an average system. And I've always been struck. I visited the country of Ecuador once with my family a few years ago, and I was struck. The tour guide was telling me about their national system, and then we drove by the hospitals. They're right next to each other, the public hospital and the private hospital, and you could tell which was which visually. The private hospital looked like a hotel, a very inviting place. The public hospital, unfortunately, looked like a building that was somewhat dilapidated. And that's what just frightened me, two tiers of care. Now, this is a Latin American country. Some might call it a third world country. But nevertheless, that's what I saw, and I would never want to see that happen in America.

Mr. DENT. Thank you, Congressman Kirk, for your leadership on health care. As you know, we have been working diligently to come up with some alternative ideas. And the chart that you have just identified in terms of cancer survivability rates as well as health care costs, I think really drives home the point that Americans all across this country understand: that we have a health care crisis, we particularly have a crisis in cost. And they understand, too, that depending on how we engage in health care reform could impact the care they receive. Americans are concerned about medical breakthroughs, innovation, and quality. They're also concerned about the ability to get the care they need when they need it because they understand that if care is delayed, care is denied. And you pointed out some interesting cancer survivability statistics from Canada. Interestingly enough, an anecdote: there is a member of Parliament in Canada, I believe she was a member of the Liberal Party. She is a great proponent of the Canadian health care system. And what happened is that she contracted breast cancer, and for whatever reason, she decided she needed her care in the United States. It created quite a controversy in Canada because it really spoke to the issue in Canada, which was that the Canadian system was good enough for all the Canadians, but not for this particular member of Parliament. And it spoke to the issue of two tiers of system, one for those who are in Canada, and those who, when they can't get the care that they need when they need it, they simply go south--because much of the Canadian population lives within 50 miles of the American border. So the second tier of Canadian health care can be provided across the border, and people pay top dollar. So I think that's something that we have to talk about quite a bit as we engage in this discussion: that we understand that care delayed is care denied, that people understand that the costs are rising, and that we have to come up with solutions. I am going to be, at some point tonight, talking about medical liability reform, why we need that. And that is a major cost driver. Defensive medicine costs have gone up significantly because of the tort system in the United States. We understand that there is just too much money being spent in the courtroom and not in the operating room. I think we all understand that. We are also joined tonight by our friend and colleague from western Pennsylvania, Tim Murphy, Dr. Murphy, who has a background in psychology, and also has a great deal of interest on this issue. At this time, I would be happy to yield to my friend and colleague from western Pennsylvania.

Mr. DENT. That would be Medicaid and SCHIP.

Mr. DENT. That was the point I made a few moments earlier about equalizing the tax treatment. That is a point we are stating; that the 165 million Americans--I think that is about 60 percent of our population--has insurance through their employers, but those individuals who cannot afford insurance, and there are a lot of them out there, unfortunately, cannot afford their insurance, but they get no favorable tax treatment themselves. Their employer receives it, as they should, that treatment, but the employee, the worker or the self- employed individual should get that same favorable treatment. That is a way to really help particularly the younger population, some of whom have some capacity to purchase insurance. They may be relatively healthy, but they choose not to purchase it. Some use the term ``the invincibles.'' Obviously they are not. But they need insurance, and we can help that population afford a reasonable, comprehensive plan. And that's one of the major parts of the reform that you and I have worked on. And I think we can do this in a bipartisan manner. I think there are plenty of people in this room, on both sides of the aisle, that would be willing to vote for this type of commonsense reform that's going to help people get access to care and coverage.

Mr. DENT

Mr. DENT. I thank the gentleman for yielding. Just very briefly, I wanted to say about this whole matter, the offending countries tend to be about eight countries, China, India, Vietnam, Laos, Eritrea, and I am probably neglecting one or two. But there are a handful of countries that are responsible for these 147,000 individuals who have valid removal orders against them. They should be removed. I thank the gentleman, Mr. Castle, and I thank the gentleman from California for working with us to provide an amendment that I think sends a very strong message that it is unacceptable that we have to expend our limited resources to hold people who should have been returned. So, again, I thank you for your courtesy and again urge adoption of the Castle-Dent amendment.

Mr. DENT. I thank the gentleman from Delaware. Madam Chair, I rise in support of the Castle-Dent amendment to the Foreign Relations Authorization Act. As of May 2009, just last month, over 147,000 citizens, residents and nationals of foreign countries remain in the United States because the governments of their home nations are delaying or even refusing repatriation, according to U.S. Immigration and Customs Enforcement. It's simply unacceptable. The disconcerting detail regarding the situation is that over 17,000 of these individuals are criminal aliens who have been released into our communities and neighborhoods because U.S. courts have ruled that our system cannot legally hold them in custody for longer than 180 days, or 6 months, following their sentence of imprisonment if their home country refuses or unreasonably delays repatriation. Detainment will only be extended if an individual has been proven to be especially dangerous by a court and a psychiatrist. This extension has only been exercised a handful of times since being instituted in 2004. Releasing dangerous criminals back on to our streets is just not fair to our citizenry and the families and individuals who have legally immigrated to America. That said, the Castle-Dent amendment requires quarterly reports, reports every 90 days, to Congress from the Secretary of Homeland Security publicly listing the countries that refuse or unreasonably delay repatriation, including information on the total number of criminal aliens in the United States. Furthermore, the Secretary of Homeland Security will have the power to facilitate the repatriation process by denying the entrance to the U.S. of those holding diplomatic visas of the offending country. The administration can exercise discretion regarding diplomatic flexibility with an affected nation if necessary. Under current statute, the Immigration and Nationality Act provides that the U.S. State Department has the authority to discontinue the granting of immigrant or nonimmigrant visas to nationals from foreign countries that unreasonably delay or deny accepting an alien who is a citizen, subject, national or resident of that country. Although State has threatened to deny visas in this capacity, it has never enforced this authority. Additionally, the Congressional Budget Office has indicated this amendment has no significant impact on PAYGO. On the other hand, drawn- out repatriation negotiations divert scarce Federal and State resources. As an example, in one case, the U.S. Government paid $197,000 to fly an alien convicted of assault with a knife back to his home country of Somalia, only to be denied and sent back to the U.S. where he was released and fled to Canada. I don't understand the logic here. We cannot spend taxpayer dollars to remove a dangerous individual from American soil only to discover the nation is refusing the reentry of their citizen. Congressional action on comprehensive immigration hangs in the future.

Mr. DENT

Mr. DENT. Thank you, Congressman Petri, for your part of this legislation. On May 15, 2009, the Aircraft Owners and Pilots Association, or AOPA, celebrated its 70th anniversary. Since its inception on the eve of the Second World War, AOPA has grown to be one of the strongest voices for general aviation in the United States. Throughout its rich history, AOPA has developed and maintained close working relationships with Federal Government agencies including the Department of Transportation, Department of Homeland Security, Federal Aviation Administration, and the Transportation Security Administration. By working closely with these agencies, AOPA has helped us create the safest and most efficient aviation system in the world. For the last 7 years, AOPA has also fostered a dynamic relationship with Congress, and specifically the members of the Committee on Transportation and Infrastructure on which I serve. The association's first political activity was to urge the U.S. Senate to pass legislation establishing the civilian pilot training program which allows thousands of American pilots to gain their certification through Federal Government support. Decades later, AOPA remains a key actor in the development in our Nation's aviation policy having played a vital role in the crafting and passage of this year's FAA Reauthorization Act. Today, AOPA's membership exceeds 400,000, including seven out of every 10 pilots in this Nation. I'm confident every Member of Congress currently has a valuable relationship with the general aviation pilots flying in their districts. On a personal note, AOPA members from the Lehigh Valley area serve on my aviation advisory board proved to be some of the most informed and influential participants. Their expertise has truly been a great resource for me as I serve on the Transportation and Infrastructure Committee and the Aviation Subcommittee. Madam Speaker, I believe the passage of this resolution congratulating AOPA on its 70 years of service is a fitting way to salute the many pilots who help make our aviation system the safest and most efficient in the world. And at this time I would like to encourage everybody to support this legislation and urge its adoption.

Mr. DENT

Mr. DENT. Real quickly, I just want to say that individuals with Top Secret Security Clearance go through an extensive background check and investigation every 5 years and friends, family members, coworkers and even neighbors are interviewed during this process. This amendment recognizes the expansive nature of the top secret investigation and the reduced risk individuals with these clearances pose. For these reasons, I strongly support this amendment and urge its adoption.

Mr. DENT. Mr. Chairman, I yield 4 minutes to the distinguished gentleman from the State of Georgia (Mr. Broun).

Mr. DENT. I yield an additional 30 seconds to Dr. Broun.

Mr. DENT. Mr. Chairman, I yield 2 minutes to the distinguished gentleman from the State of Alaska (Mr. Young).

Mr. DENT. Mr. Chairman, may I inquire as to how much time I have remaining on this side?

Mr. DENT. Mr. Chairman, I yield 2 minutes to the distinguished gentleman from the State of Delaware (Mr. Castle).

Mr. DENT. Mr. Chairman, I rise to claim time in opposition to the amendment.

Mr. DENT. Mr. Chairman, I yield 90 seconds to the distinguished gentleman from Beavercreek, Ohio (Mr. Austria).