Ernie Fletcher

Mr. FLETCHER

Mr. FLETCHER. Mr. Chairman, I yield 30 seconds to the gentleman from Indiana (Mr. Pence). (Mr. PENCE asked and was given permission to revise and extend his remarks.)

Mr. FLETCHER. Mr. Chairman, I yield myself such time as I may consume. Mr. Chairman, as we look at the problem facing America and health care, the most daunting problem we have are the 43 million that are uninsured. The majority of those uninsured are working individuals. The majority of those working individuals are in small businesses. What we do with association health plans is allow those small businesses to come together, to insure themselves across the Nation. Mr. Chairman, this last year when I was going across my district, I talked to farmers that were paying on the individual market for their family up to $800 and 900 a month. That was unaffordable for them. Now, imagine if the American Farm Bureau could provide a plan and pool across the Nation and offer that individual farmer a policy for his family that was 30 percent, maybe more than that, reduced from what he is paying now; what impact would that have on the farmers across this country? Or the other 81 or number of organizations, associations that we have supporting this bill, because their associations should be able to offer their members a plan just like unions do, multi-employer plans now. So I think in addition to that, when we combine this to the Ganske- Dingell bill and hopefully the Norwood amendment, we provide all the patient protections that ensure that patients get not only this pooled health care plan that will reduce costs, but we provide them the patient protections that everyone will get across this Nation including the accountability. I want to encourage my colleagues to vote for this measure to improve the health care in America and provide more insurance for Americans.

Mr. FLETCHER. Mr. Chairman, as a practicing physician, the possibility of malpractice was always there in the back of your mind, because you wanted to make sure you delivered the most quality care you could to your patients. I can think of generally, probably a day did not go by when there were things that you felt like, well, I do not really think we need this, but because of the way malpractice is, we are going to order a specific test. A patient that comes in with a headache, you may not see them again for a while, and you order an $800 or a $1,000 MRI just to make sure that if something happens way in the future that you do not incur some sort of frivolous lawsuit. But let me talk about a couple of things. One, according to Daniel P. Kessler, an associate professor at Stanford Business School, when he looked at direct costs, he said they may be relatively small, the direct costs of liability. I think clearly we can say they are fairly significant. But they are small relative to the indirect costs which he estimates five times. For that reason and for the quality of care, to make sure that we do not promote defensive medicine, I urge my colleagues to support this, as most of the physicians across the country would agree.

Mr. FLETCHER. Mr. Chairman, will the gentleman yield?

Mr. FLETCHER. Mr. Chairman, would the gentleman please explain to me why MSA expansion is in your bill, and why the patient protections in that bill will not protect those patients in MSAs?

Mr. FLETCHER

Mr. FLETCHER. Mr. Chairman, I certainly appreciate the work that has been done by the gentleman from Ohio (Mr. Boehner), the chairman of the Committee on Education and the Workforce; and as he has excelled in education, now he has certainly excelled in this issue of protecting patients. Yesterday was a very fine day for the patients across America. After months and months of negotiating, the gentleman from Georgia (Mr. Norwood) agreed that it was time to strike a very good compromise, something that was focused on patients. I certainly appreciate the work of everyone that has been doing a great deal regarding this issue over the last 6, 8 years. But one thing I think we must realize is that we need to have a patients' protection bill that will be signed by the President, one, that makes sure that we stress the quality of health care; two, that we protect access to health care and consider the uninsured; and, three, we hold HMOs accountable. We do that with the Norwood amendment. It is surprising the respect that the gentleman from Georgia (Mr. Norwood) has across this Nation. According to the majority leader in the Senate, he is the most respected voice on patient protection across this Nation. Now because of political reasons, the other side would change their tune because they are more concerned about politics than they are the health of patients. We have 43 million uninsured in this country, 10 million more than a decade ago. Nearly 40 percent of uninsured adults skipped a recommended medical test or treatment, and 20 percent said they did not get the needed care for a serious problem in the last year. The uninsured are more likely to be hospitalized for avoidable conditions such as pheumonia and uncontrolled diabetes, and are three times more likely to die in the hospital than an insured patient. That is a striking, a very striking statistic from the Journal of the American Medical Association. It is beyond me how the other side, who has always talked about the most vulnerable in our society, low income and minorities, how they could show such a flagrant disregard for the uninsured, willing to drive up the costs with the frivolous lawsuits to favor the personal injury lawyers over the patients. It is striking to me how they can ignore this particular fact and the impact of having more uninsured in this Nation will have on the health of Americans. We need to come together, lay aside politics and make sure we cover the uninsured. That is the reason why I am glad we provide some access programs in the amendment through association health plans to allow small businesses to come together to be able to reduce the cost of premiums from 10 to 30 percent and allow some medical savings accounts. Again, I appreciate the work that is been done on this by a number of individuals. I certainly want to thank the President for his passion of making sure we get patient protection. I want to encourage everyone to support the Norwood amendment to the Ganske-Dingell bill.

Mr. FLETCHER

Mr. FLETCHER. Mr. Speaker, I just wanted to rise and discuss some issues regarding patient protections. As we know, this is a piece of legislation that is anticipated to come before this body next week. It is a piece of legislation that has been debated for quite some time for a number of years here. Yet, unfortunately, we seem to be at somewhat of a logjam. Let me say that we have been able to reach quite a compromise position in the bill that we have put forth, myself along with the gentleman from Minnesota (Mr. Peterson), a Democrat, as well as the gentlewoman from Connecticut (Mrs. Johnson), who have worked very, very hard to really come together with a piece of legislation that is a very balanced approach. Mr. Speaker, we have come a long way. However, there are some Members who did not want to increase the liabilities of HMOs at all. There are some people who wanted to open up unlimited lawsuits that would have driven up the cost of health care and increased the number of uninsured in this country. Yet, Mr. Speaker, we have reached a good balance in this piece of legislation, the Fletcher-Peterson-Johnson legislation, that does three things particularly. One, it increases the quality of health care in America. How does it do this? It does that by establishing the right of every patient in America that has insurance to be able to appeal to a panel of expert physicians. These are practicing physicians that are trained in the specialty to be reviewed. So if a patient has an HMO that questions their ability to get a particular treatment, they can go to this panel. What we do is set the criteria of that panel to make sure that it is the highest standards of medical care in this country, state-of-the-art care. We establish that based on a consensus of expert opinion and what we call referred journals. Those are those medical journals like the New England Journal of Medicine, the Journal of the American Medical Association, that are reviewed by peers to make sure that the information in those journals is accurate and substantiated by scientific research. We make sure that every patient in America has that option of coming and asking that expert panel whether or not they should receive this treatment. If they are not given that treatment, then we hold the HMOs liable. We hold them liable. Actually, if the HMO refuses to give what the experts say, we hold them just as liable as any physician is held liable in this country. Yet the other side says that is not enough because they want to allow trial lawyers to sue no matter what the case is, even if the plan is offering the care; or if the plan actually is saying that the experts say this is not the appropriate treatment, then they want an opportunity, a right, to be able to sue that managed care facility. What is that going to do? This is unlimited lawsuits. We have debated this for years. As a family physician, I know the extra costs of what we call defensive medicine, what the costs are. It is not thousands, it is not millions, it is billions of dollars of tests that are run, procedures that are performed, that are only done because of fear of frivolous lawsuits. That does not improve the quality of health care. It actually has just the opposite effect on the quality of health care. There have been some studies done to show that frivolous lawsuits do not improve the quality of health care. As a matter of fact, they impair it. Under the Democrats' bill, and again, they have been unyielding and lack the ability, it seems, to be able to yield or to compromise at all on this issue. Even though we have opened up liability tremendously, making sure that we punish bad players, they are unwilling to compromise. What has that done? That has made us unable to get a bill passed here. Now I would hope they would be able to compromise some, because I believe all of us truly want to get a bill signed by the President that can help patients in this country. Why will we not support the bill that has unlimited frivolous lawsuits and has no provisions, substantial provisions, for access? Because we know it will increase the uninsured in this country. Some estimates say from 7 million up to 9 million people will lose their health insurance. What effect does that have on a patient? Patients that do not have insurance have poorer health. Disease progresses further along before they are actually diagnosed of the disease. If they are hospitalized and they do not have insurance, they die at three times the rate of a patient that has insurance. So it is very troubling to me when I see the flagrant disregard for the uninsured that the Democrats have expressed in their unwillingness to compromise with us and reach a real solution for patients in this Nation. When I talk to constituents, Mr. Speaker, the number one concern I hear about, and I have been through many factories and small businesses and talked to workers, I ask them, ``What are several of the things that are important to you?'' They talk about the education of their children. But when we get down do it, just as important to them is the health care of their children. Under the Democrat bill on this Patients' Bill of Rights, they will be threatened with losing their health care through many small businesses, and maybe even large businesses, because of the added burden of liability. I have letters that have come, a number of letters from small businesses that say, we are not going to be able to offer health care to our employees under the provisions of the Democrat bill because of the liability that exists there. That is not helping patients. That will result in people losing the health care they get through their job, and that is one of the most important aspects about many individuals' employment. I can think of a young lady on the line of Toyota Manufacturing Company. She installs the bumpers on Avalons and Camrys. I asked her about the benefits she gets through Toyota. She mentioned one of the major benefits she gets is the health care through her employers. Yet, that may be threatened under their plan. It would require that they look and ask, is it going to be possible to withstand the liability? Are they going to end up giving the money to this young woman, and having her have to go out and buy her own insurance? Many companies will find out some way to make sure that does not happen, but inevitably, it will raise the premiums that that young lady is going to have to pay. That means there is less money for her to take care of those children she is so concerned about. That means there is less security that she is able to provide for her family. That means there is less peace of mind that she has as she is working to take care of those children. Mr. Speaker, I want to cover a few more things about our health care bill. As we look at the guiding principles for our health care bill and this Patients' Bill of Rights, and again, this is a compromise that has been developed over a number of years, it is to improve the quality of health care. I spoke about that. It is making health care more accessible, more affordable, especially to the uninsured. I mentioned that their bill does very little to do that. Actually, it will result in millions probably losing their health care. But we provide something called medical savings accounts. That means we can set aside money, much like an IRA, through our jobs, and we can use that money for health care. We can use it for routine health care that we all get to prevent diseases and to detect diseases early. We might use it for eyeglasses or other things that are important for health care and well-being. This will allow more individuals to get insurance because in some of the pilot programs we have done with medical savings accounts, almost one-third of the people that get insurance through those did not previously have health insurance, so that certainly makes it more available to the uninsured, and helps us reduce the problem of 43 million Americans uninsured. As we look at holding health plans accountable, we talked about if a health plan does not follow that external review, then they are held accountable, just as accountable as any physician. That is very important, and so we want to make sure that there is accountability. When we look at the number of uninsured, just to kind of give you an idea of what the magnitude of the uninsured are in this country, look at these cities: Portland; Bakersfield; Phoenix; Denver; Dallas; Atlanta; Orlando; Lexington, and then that is my home city; Charlotte; Hartford; Syracuse; Cleveland; Chicago; Des Moines; Minneapolis; Salt Lake City. If we added the population of all of those cities, that would equal the number of people in this country that have no health insurance. The last thing we want to do is to drive up the cost of health insurance. Now, as we look at the provision, another provision I want to talk about, that is association health plans. We talked about MSAs, or medical savings accounts. But association health plans, what that does is allow small businesses to come together to self-insure and to offer a product nationally. So, for example, my farmers are paying $800 or $900 a month for premiums to buy their health insurance on the individual markets. What this would allow is the American Farm Bureau Association to offer a national plan that is self-insured, much like the large companies do. It is a fairness issue. Why can we not have small companies coming together and offering insurance products just like large companies do? If we do that, it is estimated that it will reduce the premiums by 10 percent to 30 percent. That will possibly allow us to insure as many as 9 million Americans. If we look at that, it is equivalent to the people living in the following cities that are highlighted in black: Salt Lake City, Phoenix, Des Moines, and Atlanta. That is a number of people, an equivalent number of people of several cities in this Nation that would be able to get insurance through these association health plans. Let me just close by saying there is a lot of. I think, demagoguery going on and criticism of the plan saying that we do not allow direct access, for example, to OB-GYN and pediatricians. In fact, that is just not true. We have the equivalency of 400,000 physicians in different organizations that endorse this bill because it does exactly what they know it needs to do to ensure that they can deliver the treatment they need to their patients. It allows direct access to OB-GYN physicians. It makes sure that if a young lady is being cared for during her pregnancy, if the plan and the physician no longer have a contract together, that she can continue to get that care through that same physician: a physician whom she trusts, especially trusts for the delivery of a newborn child; and not only that, but post-partum care. We also allow for clinical trials; that if there is a treatment that provides hope and it is approved by the FDA or by the National Institutes of Health or by the veterans' programs, that we can actually guarantee that the plan would cover that treatment. It may be the only hope that that child has left, or that individual has left, ensuring that they get the treatment that would offer them a hope of health and well-being. We also have been criticized, saying that we do not provide emergency care for neonatal care. This criticism is most laughable, and there is certainly a tremendous degree of demagoguery from the Democrats because of this reason. We actually improve the provision they have, and say that not only a layperson's definition, but if even in the opinion the health professions, and even if the mother was not aware of the condition of the child, but if, under the opinion of a health care professional, the mother needed to bring that child in, that we guaranteed that that child would get treatment. I can recall a child that needed treatment. The mother was in our practice and gave me a call. This happened to me on several occasions. I asked her to bring that child in. I can even recall one situation where the child was in very critical condition when that child arrived. Yet, young mothers sometimes do not know all of the precautionary signs, so it is very important to have this access provision. We offer better access and better cover for neonates and those young infants, the newborns, than the other side does. They are also talking about preemption of State laws. Yet our provisions make it easier for States that have equivalent patient protections to be able to use their laws, instead of having to use the Federal mandate. So we actually do less to supersede State law than the other side does, because about 33 States have passed patient protections at this time, and we think it is important that we allow that. The bottom line, the Democrat plan is a bad plan for the most vulnerable in this Nation. Who are those? They are the low-income minorities, those right on the border. I know they speak a lot about this constituency, but when it comes down to the bottom line, they are putting politics before the most vulnerable in this society, because their plan will disproportionately affect low-income and minorities in this Nation and cause a disproportionate number of those to lose their insurance. It threatens the health care they get through their job. Ours provides several plans to ensure that we can cover more individuals with health insurance, up to 9 million more. It has been estimated under their plan that several million will lose their health care, as we have shown. So Mr. Speaker, I appreciate sharing this time on the Patients' Bill of Rights. I would hope that the Democrats, as we come back next week into session, that they would be willing to reach a compromise that is good for the American people; to stop this logjam and be able to pass a Patients' Bill of Rights that we can lay on the President's desk, because he has spoken very passionately about this issue, and wants very much a Patients' Bill of Rights for the American people. I would hope they are willing to reach a compromise. We have compromised tremendously so we might get a patients' bill of rights passed.

Mr. FLETCHER

Mr. FLETCHER. Mr. Speaker, I thank the gentlewoman. I certainly appreciate all the work that we have done together and the gentlewoman's help in making sure that we have a piece of legislation that truly is focused on patients and focused on getting patients the health care that they need. Mr. Speaker, all of us have heard the tragedies of HMOs, and there are many out there, and I think we can all relate to that. As a practicing family physician, I remember many episodes where I had a conflict with the HMO, trying to get the treatment that the patient needed. So I think all of us agree that there are tragedies out there where patients did not get the treatment they needed, or where they were misdirected to a distant ER and something happened. We want to make sure that we correct those problems and that we get patients the care that they need. That is why when the gentlewoman from Connecticut (Mrs. Johnson) and the gentleman from Minnesota (Mr. Peterson) worked on this bill, and a number of others who have worked very hard on it, we focused primarily first on patients and getting the care. We wanted to make sure that we no longer saw a system where insurance bureaucrats made medical decisions but rather physicians made medical decisions. We also did not want to go to the extreme of other folks saying, let us let lawyers and judges make the medical decisions. That is not right either. First off, the ability to get that treatment is impaired. It may take years to get a settlement, well after the medical treatment is needed. Secondly, judges and lawyers are not trained to make those medical decisions. So we established a bill that focused on getting the care patients need. Now, let me compare, because I have a chart here that compares the basic elements of the patient protections in the two bills. Our bill, which is the Johnson-Fletcher-Peterson bill versus the Ganske bill, or the Kennedy-McCain bill. First, emergency access. We both ensure that the patient can get the emergency room care that they need. We also ensure something called point of service. What that means is that one has an option of going to any physician. If one wants to get that plan, one can go to any physician out there. They may not be a physician that is part of even that network of the HMO, and a company will offer a plan that you can purchase that will allow you to see a physician that you trust that may not be a member of that network. You can see your OB-GYN doctor directly. You can take your children, and I know that this is very important for families, to ensure that their children have access to that pediatrician that has been trained especially to take care of the problems of children. We provide direct access to pediatricians. Specialty care. To make sure that there is an adequate coverage of specialists out there to bring the latest, the state-of-the-art of medicine, to the patient's bedside. We want to make sure that there is continuity of care, that if, all of a sudden, the contract is removed from the physician, that there is a solution. For instance, if you are a young lady and you are being covered by a physician or he or she is your attending physician and you are about to deliver a child, we make sure that you can continue that continuity of care, that you can continue to see that physician, and that you get the care that you need throughout, even though they are no longer working with that HMO, that they can do that until the delivery is completed and postpartum care is completed as well. We do not allow any gag clauses. We do not allow HMOs to tell physicians, you cannot tell your patients what medical treatment they need. So we stop all of that, just like the other bill. Clinical trials. We make sure that if there is a clinical trial that is out there that may give someone a hope of a cure for a disease that we make that available. We make sure that you get plan information, just like the other bill. We make sure that there is an appeals process; that if an HMO says, we do not think that is covered, that you can get an internal and external appeal. What does that mean? That means that you can appeal it to a panel of experts. We have set quality number one in this bill. We have established a criteria for this external review, the highest standards in the country, a consensus of experts of national opinions and what we call the referee journals, those medical journals that drive the state of the art of medicine. So we establish the highest quality of any bill. Actually, our quality of care standards are higher than any other bill here. We make sure that the prescription drugs that you need are there, that if it is not on the formulary and you cannot tolerate the drug that that is on the formulary, that there is access to a drug that may not be on the formulary, but because you cannot take the medication that is on the formulary, you get another medication. We make sure that there is the liability, that there is the redress so that one can hold HMOs accountable. Now, one way we hold them accountable is we make sure that if an insurance company does not comply with this panel of expert physicians, this high gold standard, that if they do not comply with that and give the treatment that one needs, we hold an HMO liable in exactly the same manner that a physician is liable. The other side has about 19 pages of criteria that have to be met. Nobody knows how the States are going to respond to that. We are seeing a decision from the Department of Justice saying that we are not sure how the States are going to respond to 19 pages of Federal mandates on State courts. That is unprecedented. But we make sure that the HMO is held accountable if they do not comply with those panel of expert physicians, the same way a physician is held accountable. There is no difference in our bill. We make sure that there is tight, focused accountability. We also provide, and let me talk about it, immediate access and instant remedy. When we focus on patients, that is what we want to see. We also provide the opportunity for small businesses to come together and to offer a national health plan. That will save an estimate of 10 percent to 30 percent on premiums. I have not talked to anyone out there, Mr. Speaker, that is not interested in the cost of health care and of seeing that going up double digits this year. So being able to decrease the cost of health insurance, make that more accessible, allow more small businesses to offer health insurance is one of our goals. I believe we accomplished it. It is estimated that 8.5 million Americans will be able to get insurance that do not have insurance today. We hold HMOs accountable; and we weed out bad players, as I have said. We make sure that the medical decisions are made by doctors. The Kennedy bill and the Ganske-Dingell bill, what they say is that if one does not get the treatment immediately, if they just allege harm, they can go to court. What does that do? That does not, first, get the patient the treatment they need, and it also increases the number of junk or frivolous lawsuits. We will talk about that in a minute and what effect that has on patients' ability to get affordable health care. We make sure that one does not have to go to a judge, that one can go to a doctor to get an opinion. Then if the HMO is a bad player, we hold them accountable. We enable small businesses, as I said, to offer health insurance. Most importantly, when we talk to the American people, Mr. Speaker, what we find out is that the American people are very, very concerned about the health care they get through their job. I have some farmers in my district whose spouses go to work simply so they can get that health care. The other bill may impact that to the point where individuals will lose the health care they get through their work. In Kentucky, that estimate is 40,000 to 80,000 Kentuckians will lose their health insurance because of the Ganske-Dingell bill. Again, we protect the health care Americans get through their jobs. We provide all patients with patient protections. By setting that gold standard by that independent review of panels, we raise the standard of the quality of health care. When we look at insurance premiums, ours, when we figure the total bill with those association health plans and something else called Medical Savings Accounts, where one can set aside some money to use for health care expenses, ours shows that we will have a net decrease, if we look at the premiums. Theirs will increase by about 4.2 percent. We do not think we will increase lawsuits. Actually, we will get the care and have less lawsuits than they will, but yet we will weed out bad players. We estimate that we may decrease totally by 7 million the number of uninsured. They may increase it for some up to 9 million. Health care quality, we believe we can actually increase health care quality with this bill, which is a primary concern. We want remedy, we do not want retaliation. We know there is a lot of emotion. As a physician, I can say there are many times when HMOs angered me. But the motivation for passing a good patients' bill of rights is remedy, not retaliation. We want to make sure one gets immediate help, not unlimited or frivolous lawsuits. We want to make sure one has access to State courts if the managed care company refuses to give what the experts say. There are no caps on many of their decisions, and that means premiums are going to go up. We have access also to Federal courts if it is a coverage decision. Why is it very important to make sure that we provide health insurance? Why are we so concerned about the uninsured? I am disappointed in the other side. I think we both have a very similar motive, but their bill has what I call truly a flagrant disregard for the uninsured. When we look at the simple fact, and this comes out of the Journal of American Medical Association from November 19, 1997, this was an article that said that a patient without health insurance is three times more likely to die than patients with health insurance. So when we talk about driving up the number of uninsured, we have a tremendous impact on the health and well-being of Americans. That is why it is so important to focus on the uninsured. Look at this map. We currently have 43 million Americans uninsured. If we look at, under the Ganske bill, there are 4 million more uninsured. If we look at the blue States and if we were to take the population of all those blue States, that is equal to the population of the number of people in the United States that have no insurance. That is where we should be focused. That means that 43 million Americans now are not able to go see their physician, not able to get the preventive health care they need, so when they do arrive in the emergency room their disease is further along. It is more advanced and less curable. If we pass the Ganske-Dingell bill, it is estimated that those red States, a population equal to the population of those red States would lose their health insurance. I do not think that is something we can afford in America. Let me say this, as we look at the differences, I think both of us have the same goal. That is to make sure we provide good patient protection. I think in their liability portion they are very misguided in the sense they turn decisions over to judges and lawyers instead of physicians. I think it is bad legislation, particularly for those that I call ``near-uninsured.'' Who is it going to impact most? Low-income and minorities, that is who it is going to impact. I am surprised that the Democrats would take up this issue, because that is a constituency they always speak about having compassion for, yet their bill will impact them worse than any other portion of our society. Low-income and minority people are the ones that stand to lose the health insurance, those who are barely getting along, those families who are having to decide between putting food on the table and providing health care for their children. Under their bill, they may end up having to say, I am not going to take the food off the table, so I will have to drop health insurance. That is not right for America. That is not good for those most vulnerable in our country. I appreciate the opportunity, I say to the gentlewoman from Connecticut (Mrs. Johnson), to speak with her, and I thank her for all her work on this bill. I think we have an excellent bill. I thank the gentlewoman for the opportunity to share this time with her.

Mr. FLETCHER. Mr. Speaker, we wanted to make sure that the access there to the emergency was available to everyone, regardless of their age and regardless of their ability to be able to define what a layperson's definition is. So we make it very clear, and I think that is one of the reasons that, when we talk to the emergency room physicians across this Nation, they prefer our provisions, so that no patient is without access to the emergency room. I mentioned in the beginning that some of the problems have been that a patient may call the HMO and they send them to a distant emergency room. We have eliminated that problem. We have solved that problem. We make sure that if one has an emergency, if one has severe pain or something where one feels or a layperson feels like it could threaten their health, they can go to the nearest emergency room, get that treatment from those physicians and health care providers, and they can be assured of being reimbursed for that.

Mr. FLETCHER. Let me address this. A young mother sometimes is not sure whether an infant needs to come. I recall a situation where a young mother came and she gave me, after a few questions, a short history of this infant. She was not sure whether or not that infant needed to come in. At that point, I told her that, no, I think you need to come in immediately. When that child arrived there, it was very, very ill. The gentlewoman is absolutely right that it is very difficult sometimes on a layperson's judgment to define whether a young infant, a very young infant, is truly at a great deal of risk with their health care, and yet it requires health care professionals. So our provision for that gives a lot more protection to those young mothers and young infants.

Mr. FLETCHER

Mr. FLETCHER. Mr. Speaker, today I rise to recognize Hugh Lee Grundy, a man who has devoted a lifetime of hard work and dedication to America's Armed Forces in Southeast Asia. Mr. Grundy is the retired President of Air America, an organization that served a special and undercover purpose for our nation's Central Intelligence Agency and allied countries in Asia and throughout the world. Hugh Grundy of Crab Orchard, Kentucky spent 50 to 60 years in the active world of aviation, and I am truly proud to stand here today and honor him here in the U.S. House of Representatives. Mr. Grundy was born at Valley Hill, Kentucky on the Grundy family farm, which he now owns and operates. Mr. Grundy raised and showed saddle horses at state and county fairs while growing up. Throughout his schooling, he worked at a local Ford dealership, rising to the position of assistant General Manager. He learned to fly light planes in Central Kentucky in his teenage years. Mr. Grundy attended Aeronautical School in California and eventually became a teacher there. He then worked for Pan American Airlines. Mr. Grundy faithfully served his country in various capacities for more than 30 years. During World War II, Mr. Grundy served his country as an Engineering Officer and Air Crew Member. He reached the rank of Major in the United States Army in 1946. At the close of World War II, Mr. Grundy exchanged active duty for the reserves and returned to Pan American. Later he was transferred to Shanghai, China to work for the China National Aviation Corporation. Mr. Grundy served concurrently as President of Air America, Air Asia, and Civil Air Transport from 1954 to 1976. As President of Air America, Mr. Grundy commanded over 10,000 men and women serving in Vietnam, Cambodia, Laos, and Thailand. Mr. Grundy came out of retirement twice in order to return to preside over Southern Air Transport, a company based in Miami, Florida. In June of 2001, the CIA presented Mr. Grundy with two citations, one in his capacity as President of Civil Air Transport and Air America, and one to him personally. This was the second time Mr. Grundy was given recognition by the CIA, the first being a medal for Honorable Service upon the occasion of his retirement from Air America. Today I rise, Mr. Speaker, to salute Mr. Grundy for his commitment to aviation, his service to our country, and his patriotic leadership throughout the years.

Mr. FLETCHER

Mr. FLETCHER. Mr. Speaker, I rise today to acknowledge and thank a community leader for his 50 years of dedicated service to medicine, many of those years spent serving and impacting lives in Central Kentucky. Dr. Charles Sachatello has been a member of the Lexington Community since 1970 and has dutifully served as a surgeon, neighbor and friend. He has recently retired and it is my honor to tell you about his life and accomplishments. Born in Connecticut, Dr. Sachatello received his undergraduate degree from Yale University and medical degree from Yale Medical School before attending Vanderbilt University to receive his surgical training. While at Vanderbilt, Dr. Sachatello published several papers regarding a new surgical treatment detailing techniques to remove blood clots. After attending Vanderbilt University, Dr. Sachatello joined the staff of the Roswell Park Memorial Institute in Buffalo, NY. During his tenure, he recognized the Juvenile Polyposis of Infancy syndrome and established a working classification of intestinal polyps. Dr. Sachatello became a Professor of Surgery at the University of Kentucky, Chandler Medical Center in 1970 and was actively involved in teaching, patient care and surgical research until his departure in 1985. During his tenure, he conducted detailed studies of patients with intra-abdominal injuries and helped popularize the technique of diagnostic peritoneal lavage. Additionally, Dr. Sachatello worked with Arrow International Inc. to develop a Diagnostic Peritoneal Lavage Kit, which has been used in tens of thousands of patients and is still widely used today. In 1985, Dr. Sachatello left the University of Kentucky and entered into private practice. He established the Bluegrass Surgical Group and was instrumental to the group's merger with the United Surgical Associates in 1998, which is one of the largest surgical groups in the nation. Over the years, Dr. Sachatello has authored over 80 papers and several chapters in surgery textbooks. He also established the Charles and Suzanne Sachatello Endowment Fund at the University of Kentucky to purchase books on trauma. He was also instrumental is establishing the Grove Memorial AOA lectureship endowment. Today, I rise to salute Dr. Sachatello for his commitment to medicine, to the Lexington Community and to me personally. Throughout his lifetime, he has touched thousands of lives as a teacher, physician, friend and neighbor improving the lives of people throughout Kentucky.

Mr. FLETCHER

Mr. FLETCHER. Mr. Chairman, I appreciate the opportunity to speak on this very important subject. I think we all would probably agree that the education of our children is one of our greatest responsibilities. Let me say thanks to the gentleman from Ohio (Chairman Boehner) for all of his work, an amazing accomplishment as we pass this bipartisan bill out of the House Committee on Education and the Workforce. Folks have said, well, it is not perfect. Of course it is not. But it is a very, very good product and a great step in the right direction. Does it please everyone? No, but I think it does an outstanding job to change the direction of education in this country, the first change we have had in probably about 30 years. The President has established the principles, and I think this bill meets those principles. There are a few things that we might work on as we amend it to try to give students more choice. But right now, the focus that I think we need to look at, too, is particularly on the educational gap that we have in this country. When I look at minorities and look at only 36 percent of minorities being able to read on grade level by the fourth grade, we have a problem, a serious problem, an unacceptable problem. I believe this legislation, this initiative by the President, will help address that problem, a problem that I would say has been largely ignored over the last several decades. The gap has not decreased. We have not offered the kind of help in education to empower minorities in this country that we should. I think it is a reflection of some soft discrimination that lowers expectations, that we need to make sure that that is stopped and that we raise expectations, the accountability, the focus on literacy which is needed in this country greatly to make sure that the minorities close that gap. We have seen that happen in Texas under the President's leadership. I believe it can happen nationally, and I think that is one of the strengths of this bill is to say let us stop that soft discrimination. Let us provide the kind of educational opportunities we need to provide to the minorities in this country so that we give them the kind of freedom for those children to be all that they can be. Let me say this, with the flexibility it offers, it is the very thing we heard on our education hearing we had in Lexington, Kentucky. We had a hearing on minority education in Lexington, Kentucky, at Booker T. Washington. One of the things we heard from a teacher, Richard Greene, was that give us the flexibility locally that we need to take these children to mentor them, to provide the kind of education that they need, because he does that. He has seen lives turned around. I believe this education bill will give greater opportunities to make real differences in the lives of those students and allow that teacher, Richard Greene, to provide that mentoring and opportunity to those students to give them the opportunity again to reach their full potential and be all they can be.

Mr. FLETCHER

Mr. FLETCHER. Mr. Speaker, I thank the gentleman for yielding me this time. I appreciate the opportunity to rise and speak in support of this conference committee, the budget conference committee. As we can see, it helps us set the priority of paying down the national debt at record levels to ensure that we do not leave our grandchildren and children in debt. Tax relief for every taxpayer. Improved education. It gives us the opportunity to not just put more money into education, but actually make some structural changes that will improve the education for our children. Stronger national defense, health care reform and modernization of Medicare, with up to $300 billion for Medicare reform, including prescription drugs which is needed for our seniors. Last year in the House, we passed the first prescription drug bill for our seniors out of this House, and we are going to continue to work to make sure that happens so that no senior has to choose between their food and medicine. We are going to save Social Security in the sense that we are setting aside Social Security and Medicare and making sure we are keeping that in a lockbox. The other side talks a lot about putting more money into priorities. What does that do? We have held the spending at 4 percent. They would like to increase it 5, 6, 8 percent, we have heard, depending on who speaks. What is that? Now we have heard they want tax relief; but let me tell my colleagues, any increase in spending as it goes above inflation is a taxation on the next generation, because that becomes the baseline for next year. We have all heard in our accounts of compound interest and how that works, how we can double our money over a period of years. Well, what I call the increased spending above inflation, what the other side would like to do is compound taxation on our children and grandchildren, because we require future revenues to be increased in a compounded way to increase the spending, or to fund the increased spending that they want every year. Mr. Speaker, that is not good for America, it is not good for our children, and it is certainly not the kind of tax relief and freedom that we need to return to our American families.

Mr. FLETCHER

Mr. FLETCHER. Mr. Speaker, I ask unanimous consent that the Committee on Education and the Workforce be discharged from further consideration of the concurrent resolution (H. Con. Res. 110) expressing the sense of Congress in support of National Children's Memorial Flag Day, and ask for its immediate consideration in the House.

Mr. FLETCHER. Mr. Speaker, I thank the gentleman for yielding. Mr. Speaker, I rise in support of National Children's Memorial Flag Day and encourage national, State, and local agencies and private organizations to recognize the Children's Memorial Flag. This year all 50 States, plus the District of Columbia, will either fly the flag or recognize it in an appropriate manner. Mr. Speaker, every year in the United States, thousands of children die unnecessary deaths. Of these children, three a day die from physical abuse or neglect, and unintentional accidents are the leading cause of death in those children ages 1 to 14. Of children who died of abuse and neglect in 1996, 86 percent were under the age of 5, nearly 40 percent were less than a year old. Our children are our future. Mr. Speaker, this is the reason that I support the National Children's Flag Day and would encourage my colleagues to do the same and hope that this raises the recognition that we should take as a Nation to ensure the safety of our children.

Mr. FLETCHER

Mr. FLETCHER. Mr. Speaker, I ask unanimous consent that all Members may have 5 legislative days in which to revise and extend their remarks on House Concurrent Resolution 110.

Mr. FLETCHER

Mr. FLETCHER. Mr. Speaker, I appreciate the opportunity to speak on this very important measure. We have two quite diverse views here. We have a side that presents here a substitute bill, and while we are glad to see that they are finally coming around to realize that the death tax is wrong, unfortunately they have not quite seen the fact that our bill is based not just on how much money are we going to be able to keep in Washington, but, rather, on the principle that taxing someone twice, and their families after they have passed away, is wrong. What we see on the other side is not a sincere interest, I believe, in whole of relieving this problem that we have, this unfairness in the Tax Code, but rather posturing themselves politically. Unfortunately, there is a lot of that done here. But, Mr. Speaker, though it is not a perfect bill that we have, H.R. 8, I would like to phase it in more quickly, we are working on a responsible way of phasing it in. What is it about? It is, as the gentleman said, about jobs, and it is also about green space. We have a lot of beautiful farms in Kentucky, and every time one generation passes it on to the next, there is a large tax that requires them often to sell that farm for development. There is a small family in a county that is a small county, a poor county, Nicholas County in Kentucky, where the community has lost half their industrial jobs this last year. A small Democratic family started a small business a few years ago with computerized lathe technology and machinists and has developed quite a company. What will happen to that company, if we keep the death tax the way it is, is that when he tries to pass that on to his children Lynn and Lee, they will have to sell the assets of that company. That company will then probably be moved to where most of the machinist work is done, in Cincinnati or Cleveland. Please, vote down this substitute. Vote for H.R. 8 so we are able to keep the jobs, the green space, and to promote the politics of fairness.

Mr. FLETCHER

Mr. FLETCHER. Mr. Speaker, I thank the gentleman for yielding me this time. What this bill does very clearly, first, is double the child tax credit from $500 to $1,000, increases standard deductions for married folks, joint filers, twice that of single filers; expands the 15 percent tax bracket for married joint filers to twice that of single filers; and increases the earned income tax credit; protects child tax credit from the alternative minimum tax. What is this bill really about? I say it is truly about family values. I know that expression has been abused over the years, but it is about the value of the institution of marriage; something that transcends faith and transcends culture. We are saying let us not tax that institution because there are enough pressures on that institution already. Let us make it fair. Let us give them the opportunities. One of the leading causes of a breakdown of the family is financial pressure, and we want to relieve that. That is what this bill does. We had from the far left a welfare system that did not recognize the value of the family and said, Dad, you are not welcome here. We truly need to recognize the value of the institution of marriage. Because why? It is about children. It is about their future, making sure that we can do everything to recognize the importance of its institution and its impact on children. That is the reason I recommend that you oppose this partisan bill and support the bipartisan bill H.R. 6.

Mr. FLETCHER

Mr. FLETCHER. Mr. Chairman, as we look at the budget that we have passed out of the Committee on the Budget, I think it is a very balanced budget. It is not a perfect budget. I do not think there is a perfect budget that comes out of this body. There is always room for improvement or tweaking here and there. One of the first things that I think is most important out of this budget is we find that it does give a tax refund. It understands that principle that it is not the government's money, it is the people's money. I asked some of the Blue Dogs, where were they 2 years ago when we wanted to pass a tax bill, that we would have given tax money back to citizens? Where were they when we tried to override that veto? We would have been able to give that money. It would have been in the economy now, and possibly would have really ameliorated some of the decline we have seen in the economy thus far if they would have acted then. I say that the tax relief they are talking about, they are about 2 years late. We have a tax relief plan that takes only 25 percent of the surplus and refunds that to the taxpayers. We also provide substantially for education, not just throwing money at education, but reforming the way education is done so we can leave no child behind, and make sure that we give every child in this country an opportunity to learn and take away that barrier from economic prosperity. It modernizes Medicare and sets aside money. We can throw more money at prescription drugs or whatever, but we certainly budget a good amount for prescription drugs. Not only that, but we have some flexibility to modernize Medicare to meet the modern needs of health care, which include disease prevention and chronic disease management, which is not part of the Medicare system now. It needs updating. Medicare spending will double over the next 10 years. If we do not reform the system, we are not really going to be able to provide the health care we need. Our budget addresses the uninsured, and provides several programs to make sure we can cover the uninsured. This increases the funding for community health centers to make sure those folks who fall through the cracks can get the help they need. It allows families people who are disabled or have disabled members to buy into Medicaid. It allows increased funding for NIH and research. I encourage Members to vote for the committee's budget.

Mr. FLETCHER

Mr. FLETCHER. Mr. Speaker, it is my honor to recognize J.B. and Gerry Amburgey on their 50th Wedding Anniversary. They have been a vital team in Montgomery County since they were married in Camargo on March 13, 1951. The Amburgey's have served the Jeffersonville/Means community for over 50 years through their family business, civic duties and church- related activities. For the majority of their 50 years together, J.B. and Gerry worked side by side at W.J. Amburgey & Sons. With the local Post Office housed at the same location as the family business, Gerry also dedicated 27 years to the community as its PostMaster. It is a great honor to provide a tribute for a couple who have committed themselves to each other for so many ears. That is why it is a privilege for me to rise today and honor J.B. and Gerry's 50th Wedding Anniversary. I wish them many more years of happiness together.

Mr. FLETCHER

Mr. FLETCHER. Mr. Speaker, as we look back over the history of this body for 40 years, since the mid sixties we have been spending the money that individuals have paid in their payroll for Social Security and for Medicare. We have been spending it on other government programs. I remember 2 years ago, my first year here in Congress, the gentleman from California proposed this and we began the first lockbox to set aside Social Security. I can remember some Members were making light of it and saying it was not a real lockbox, and it had a hole in the bottom of it. That first year I was here 2 years ago we did not spend one penny of Social Security money. The lockbox worked. It kept us disciplined so we did not spend that Social Security. We did it last year with Medicare, and we are repeating it again this year. Some folks are concerned that we have allowed the use of this Social Security money and Medicare money to be used for reform. We have to face the fact that if we do not make some changes in improving and modernizing these programs to meet the needs of an aging population, we are going to run into serious problems. Sticking our head in the sand does not work. Using rhetoric for political reasons does not solve the problems we are going to be facing in the future. I am proud we can support and hope we have bipartisan support for this bill to lock up both the Social Security trust fund and the Medicare trust fund for our future generations, and allow us to begin to look at improvements that will preserve these great programs for future generations.

Mr. FLETCHER

Mr. FLETCHER. Mr. Speaker, on rollcall No. 541, I was detained by an accident which forced me to miss my flight to Washington, DC. Had I been present, I would have voted ``yea.''

Mr. FLETCHER

Mr. FLETCHER. Mr. Speaker, it is my honor to recognize a distinguished member of the medical community of Central Kentucky. Dr. Juliann Sebastian is an Associate Professor and Assistant Dean for advanced practice nursing as well as the Director of Graduate Studies for the MSN degree program of the College of Nursing at the University of Kentucky. Dr. Sebastian is a dedicated medical professional who has educated countless students during their journey through nursing school. Recently, Dr. Sebastian was honored by the Robert Wood Johnson Nurse Fellows Program at the Friends of the National Institute of Nursing Research's Annual Gala. This honor will allow Dr. Sebastian to embark on a three year self-study program while continuing her current duties at the University of Kentucky. It is a pleasure to recognize Dr. Juliann Sebastian in the United States House of Representatives today, on her prestigious achievement. It is clear that the Fellows program recognized Dr. Sebastian's many talents and abilities to contribute so much to the medical community. As a fellow member of the medical community, I salute you, Dr. Sebastian.

Mr. FLETCHER

Mr. FLETCHER. Mr. Speaker, due to my wife's illness and emergency surgery, I was not present for rollcoll votes No. 504, and No. 505. Had I been present, I would have voted as follows: H.R. 4049--Privacy Commission Act--``yea''; H.R. 4147--Stop Material Unsuitable for Teens Act--``yea''; and H.R. 3088--Victims of Rape Health Protection Act-- ``yea''.