Jim Greenwood

Mr. GREENWOOD

Mr. GREENWOOD. Mr. Chairman, on rollcall No. 362 I was inadvertently detained and failed to vote. Had I been present, I would have voted ``no.'' Amendment No. 4 Offered by Mr. Kolbe, as Modified, to Amendment No. 2 Offered by Mr. Hyde, as Amended

Mr. GREENWOOD

Mr. GREENWOOD. Mr. Speaker, I support this new, innovative Medicare prescription drug benefit, and commend Energy and Commerce Committee Chairman Tauzin and Health Subcommittee Chairman Bilirakis for developing a proposal that is fiscally responsible, modernizes the Medicare program, and delivers a sound prescription drug benefit. A prescription drug benefit in Medicare is the most important social policy that Congress can deliver this Congress. Period. My home state of Pennsylvania has the second highest number of seniors in the country, and these seniors are living longer, healthier lives, thanks in part to modern medications. Death rates from heart disease, cancer and stroke are going down, and hundreds of new medications are now being developed to combat diseases of aging, including Alzheimer's, Parkinson's, and arthritis. Unfortunately, along with these new drug therapies comes a higher price to those that need them. Seniors without adequate access to these drugs will not be able to benefit from the stunning advances in health care resulting from the newest pharmaceutical products. Society will spend more money on their health care, because many new drugs actually serve as preventive measures and often prevent costly hospitalizations. Medicare in its current form does not cover most prescription drugs. When it was created in 1965, it was a good program for its time. President Johnson, on signing Medicare into law on July 30, 1965, said, ``No longer will older Americans be denied the healing miracle of modern medicine. No longer will illness crush and destroy the savings they have so carefully put away over a lifetime so that they might enjoy dignity in their later years.'' But with advancements in drug treatment, modern medicine has grown increasingly expensive, as Medicare does not pay for these wonderful outpatient drugs. We need to modernize Medicare. As long as Medicare does not cover outpatient drug benefits, seniors will not be as healthy as they could be, and they will pay more out-of-pocket costs for preventive medications. Nearly two-thirds of seniors have some insurance coverage that helps pay for prescription drugs through private employer plans or supplemental (Medigap) coverage; however, the remaining third has absolutely no coverage for prescription drugs. This is not good enough. Seniors, living on limited income, should not be the last payers of retail prices for drugs in our great country. But we should not impose price controls so that seniors can afford their prescriptions. Instead, we need to use the tools that the private sector does, using leverage and bargaining for discounts. Medicare needs to take advantage of reduced prices that we can achieve using the tools that are used by private entities, operating in the employer- provided health care market. We need to be careful about how we reform Medicare. Those two-thirds of seniors who have drug coverage are pleased with what coverage they have and don't want a big government solution that could increase their costs. Congress passed the Medicare Catastrophic Coverage Act in 1988 with the intention of easing the cost of catastrophic events for Medicare recipients. However, instead of helping, it made things much worse for seniors who already had catastrophic coverage. They ended up paying more out-of-pocket for fewer health benefits. It was so devastating that Congress was forced to repeal the legislation the very next year. Mr. Speaker, this bill finds the right mix. It establishes a generous prescription drug benefit, using the private sector tools that provide significant savings for seniors when they purchase prescription drugs. And, it reforms and strengthens the Medicare program in the right way. This bill also provides significant relief to seniors in Pennsylvania by strengthening the Medicare+Choice program. Over the past few years, seniors who have enrolled in Medicare+Choice have seen programs increase their premiums, decrease their benefits, or leave the program altogether. For example, in the largest plan in my district, seniors have seen their premiums rise from $0 to $94 per month. This bill stabilizes the Medicare+Choice program. And, it fundamentally reforms the program by creating the ``MedicareAdvantage'' program. This program provides for significantly more stability by allowing for competitive bidding by the plans. The MedicareAdvantage program will help these plans so that they remain a viable option for millions of seniors, and continue to provide a variety of health services, such as vision, hearing, and preventative care that are not offered through the traditional Fee for Service program. Mr. Speaker, let me talk for a minute about the reforms in the bill. It provides for the creation of a new enhanced fee-for-service program that gives beneficiaries new options and choices for services. Finally, the Medicare program will incorporate the most popular option in private health insurance (and the health insurance offered in the federal employees health benefits program), preferred provider organizations (PPO). These new PPOs will create significant new options for services for seniors. Furthermore, this bill will not only include improving access to prescription drugs, but will modernize the Medicare program by increasing the availability of wellness programs and streamlining the often cumbersome paperwork that seniors face in getting Medicare benefits. Finally, I am pleased that H.R. 1 has included provisions to reform the payments for the drugs that Medicare does cover in part B. These reforms represent the culmination of a multi-year investigation by the Energy and Commerce Committee. Presently, providers are reimbursed for the cost of these drugs at 95 percent of the average wholesale price (AWP). Congress and Medicare officials have wrestled for years with the difficult issue of how to set a fair and appropriate Medicare reimbursement rate for prescription drugs covered by Medicare part B. The reimbursement benchmark we have used since the early 1990s has been the AWP, which is reported by drug companies and price reporting services. prior to that, providers were reimbursed on a cost basis, which is cumbersome and inflationary. Over the past decade, what we have learned is that the AWP is a fictitious number that must be changed. Rather than an accurate barometer of the price at which physicians purchase the drugs used in their practice, the AWP benchmark is more like a car's ``sticker price,'' which is usually much higher than the actual acquisition cost. Under competitive pressure, manufacturers and wholesalers will routinely discount drug prices to physicians, lower their cost, while maintaining a higher AWP. In a competitive spiral, these discounts grow, increasing the net profits on the drugs, while the Medicare program continues to pay the higher AWP. Unfortunately, due to the 20 percent copay that all beneficiaries pay for part B services, Medicare beneficiaries presently pay $200 million more than they should in inflated co-pays. What's more, the Medicare program itself pays over $1 billion more than we should. The new system, based on competitive bidding and choice, pays appropriately for drugs and reimburses physicians appropriately for services. Under this new model, we provide physicians a choice--either continue to do business as they have or enter a new program that provides drugs to physicians for administration on a replacement basis. These reforms are fair, sound and must be enacted. Earlier this year, Congress set aside $400 billion for the development of a prescription drug benefit in Medicare. This is a significant and meaningful commitment by Congress for our Nation's seniors. Some may quibble about the size of the benefit. However, I am convinced that we can pass legislation so that every senior has access to the latest prescription drug products and has catastrophic coverage for very serious, very costly medical conditions. We owe it to our seniors to pass and have the President sign into law, a prescription drug benefit this year.

Mr. GREENWOOD

Mr. GREENWOOD. I thank the gentleman for yielding me this time. Mr. Speaker, my parents, my mother and father, are 81 years of age, alive and well, and I would like to dedicate all the work that I have put into this bill to them and I know it will benefit them immensely. My father used to say when I was a young lad, ``Jim, there are three kinds of people in this world. There are shirkers, there are workers and there are jerkers. The shirkers are the people who just don't do anything. They don't contribute. They don't help. The workers are the people who roll up their sleeves and get the job done. The jerkers are the ones that all the time the workers are working they keep tugging at them, pulling at them, jerking them around trying to interfere with the work.'' I would submit that the Democratic Party, in all due respect, between 1965 and 1994, when they lost control of the House, were shirkers when it came to the issue of a prescription drug benefit, for they did nothing. They did not provide a big plan, a little plan, a medium-sized plan, they did not provide a plan with a doughnut, without a doughnut. They did not provide a plan of any kind. They did nothing. We have been the worker party. We have passed a prescription drug bill in this House year after year since we have had control. That is hard to do. That is hard to do because mature legislators have to figure out how to strike a balance. We have people in this House who do not want to vote for this bill. They do not want to vote for this bill because they think it is too liberal. They think it is a big new entitlement program that will bankrupt the country. They are against it because it is too liberal. There are a whole lot of people in this House who cannot vote for this and will not vote for it because it is too conservative; it does not spend enough money; it is not big government enough; it uses private sector factors, influences to curb prices. If you want to get 218 votes for a bill to provide a prescription drug benefit to the elderly and the disabled in this country, you have to work very hard with very complex issues and strike a political balance down the center through the eye of the needle to get the job done, and that is what this bill before the House of Representatives stands for. That is what it results from. Now we have got the jerkers. We are trying to get this carefully balanced, incredibly complicated piece of work that our staff on both sides of the aisle have labored over for years to get done, want to try to move it through the House today, get it over to Senate, we have got some bipartisan support here, we have got some bipartisan support in the Senate, and we are going to get it done. And at the end of the day when the little old ladies and the little old men in my district and your districts who have been writing us letters and saying, with tears rolling down their cheeks, I have got a prescription for cholesterol drugs, I have got a prescription for antidepressants, I have got a prescription for my arthritis, I have got a prescription for this and for that and I can't afford them, what am I going to do. We have all been getting those letters for years and years. And when this year is over and when we stand with the President of the United States and he signs these bills, we will say to the little old men and the little old ladies and the disabled people of all ages in our district, we got the job done, when nobody else could or nobody else would. Whether the shirkers did not do their job or the jerkers tried to get in the way, the workers will get the job done and this will be an historic year for the Medicare program of this United States. I am proud of everyone on either side of the aisle who actually rolled up their sleeves and contributed to the product.

Mr. GREENWOOD

Mr. GREENWOOD. Mr. Speaker, I thank the chairman of the committee for yielding me this time. The gentleman from Michigan (Mr. Dingell) and others have presented a chart earlier that purported to show that somehow our plan was too complicated. It is a complicated issue to provide prescription drug benefits to millions of Americans who have never had them. Let me show another chart that describes our plan and it is not complicated at all. Today a senior citizen walks into a drugstore and wants to buy Lopressor, 100 milligrams. She has to pay, for 30 tabs, $45.99 right out of her pocket. Under our bill the price first comes down because of the group purchasing power to $36.79 and then what does she pay? She pays $7.36 and if she is low income she pays $5. That is a big difference from $46. Let us look at Lipitor. An awful lot of Americans take Lipitor every day to keep their cholesterol down. I do. It costs $108.65 today because for 40 years the Democrats did not do anything about prescription drugs and for 8 years President Clinton did not do anything about prescription drugs, but under our plan Lipitor goes down to $86.92 because of our purchasing power, but the beneficiary pays, his/her share, $17.38. Pretty straightforward. Pretty simple. Nothing complicated about that. Celebrex, an important anti- inflammatory drug for arthritis that so many seniors suffer from, a very popular drug, $86.28 today to get 30 tablets of that for 1 month. We bring it down to $69.02 because of our power of purchasing, but the beneficiary pays $13.80 for a month's supply and if they are a poor senior citizen, $5. $5, down from $86.28. Zoloft, 100 milligrams, 30 tabs for a month, it is an antidepressant. A lot of elderly suffer from depression, unfortunately, at their age in part because they do not have good health care. We bring the price down to $63.17. The beneficiary pays $12.63 a month and, if she is poor, $5 a month. This chart is pretty straightforward and pretty simple. This demonstrates what happens when good-minded people do very hard work with very smart staff, employing very good ideas. We get the job done for the elderly, a job that I am sorry to the gentleman from California (Mr. Stark), I am sorry to the gentleman from Michigan (Mr. Dingell). They have been here for a long time and they have done nothing. A lot of talk tonight. A lot of good talk, a lot of bogeyman talk, a lot of scare-the-seniors talk tonight, but we will get this done. It will be very simple. It will be very straightforward. The senior citizens will love it, and as a measure of that you are all going to be voting for it next month.

Mr. GREENWOOD

Mr. GREENWOOD. Mr. Speaker, I thank the gentleman for yielding me time. Mr. Speaker, I do think it is unfortunate that when we are here to debate a bill on child abuse prevention, that we get into a debate about a legitimate difference of opinion as to tax policy. I think that that is unfortunate. But, be that as it may, I also would say ironically I think it is unfortunate to hear the minority party constantly talking about their hatred of deficits, when every single subcommittee markup of any kind I have been in for the last several months, it is the other party trying to spend more money, more money, more money, and us trying to hold the line. Let us talk about the rule before us. I rise in support of the rule, which I think is a fair rule, but I also rise in strong support of the bill. I would like to talk about a particular provision that I worked very hard to get in in the Committee on Education and Workforce, and which I think will do a tremendous amount to actually prevent child abuse, which is what we want to do. What it does is it says that we look at the causes, the root causes, of child abuse. When you look for the root causes of child abuse to try to prevent it, you find this constant association between abusers of children and abusers of substance. We find it over and over again. Parents who are caught in abusive cycles with drugs and alcohol bring their problems to bear on their children, with often very devastating results in terms of physical brutality against children, sexual abuse of children and psychological abuse of children. What we noticed, and I bring to bear on this experience my own time spent as a child protective service worker in my home of Bucks County, what we find is that children are born in hospitals every day in this country, and it as clear as can be they are born to mothers who are addicted. These are women who come to the hospitals and bear children who either suffer from fetal alcohol syndrome or they suffer from the systemic presence of a drug or actually have what is called neonatal abstinence syndrome. The child is in withdrawal from the drug. It is a pretty good indicator that this child may be returning to a home where it is not safe. We have wrestled as a society with how do you protect these children. We do not want to necessarily deem the mothers as having abused the child by virtue of their abuse of the substance. We want to provide intervention, but how do you do that? What this underlying conference committee report says is that when children appear in a hospital and are delivered and have these symptoms of substance abuse apparent, that the mandated reporters, the health care providers, must notify the child protective service agency, and that child protective service agency then must come in and make sure that there is a safe plan of care for the child. It does not say that it finds abuse necessarily, it does not say that it finds dependency, it just says we need to intervene, we need to talk with the parents of this child and find out how they intend to overcome their own personal issues so that they can be prepared to nurture this vulnerable child. I think this provision will go in a tremendous way to provide intervention for young children before they are ever subject to abuse, and help not only that child, but help the mother certainly and the father involved as well. Mr. Speaker, I want to commend and thank the staffs of the committees that worked with us in the House and Senate, and the Committee on Rules for providing a rule under which this conference report can be considered.

Mr. GREENWOOD

Mr. GREENWOOD. Mr. Speaker, I yield 1 minute to the gentlewoman from Connecticut (Mrs. Johnson).

Mr. GREENWOOD. Mr. Speaker, I yield myself such time as I may consume. Debates as the one we are having today always focus on the differences between us; and there are, in fact, differences between us. We who offer this substitute amendment believe that the 90 percent of abortions that occur in the first trimester of pregnancy should be private and legal. The proponents of this bill do not. We believe that the 99.6 percent of all abortions performed in the country that are not affected by this legislation at all should be private and legal. They do not. But there are points of agreement. We all believe that abortions that might be performed post-viability, that are not done to protect the life or preserve the health of the woman, should be illegal. We agree on that; and now let us see which of these bills, theirs or ours, actually accomplishes this goal. Proponents of the underlying bill claim that their legislation will stop a particular type of abortion. They are wrong. It will not. Thirty-one States have passed this legislation and the United States Supreme Court in the famous case of Stenberg v. Carhart deemed those bills, which are essentially identical to this bill, unconstitutional; and fundamentally, they said that what was wrong with those bills was that they made no exceptions for when the woman's health was a serious issue. Our substitute, not the underlying bill, complies with the Court's requirement that there must be a health exception. Secondly, proponents claim that they want this dilation and extraction procedure, which is what it is actually called, they say it is being performed on healthy women. Yet their bill makes no exceptions for sick women. We have heard over and over again this procedure is done on healthy women with healthy babies. Then put a bill in, as we have, that talks about making the procedure illegal for women who are healthy, but allows it for those who are sick and need it. Third, the proponents of this legislation claim that they want to eliminate late-term abortions. Yet their bill fails to accomplish this not once, but twice. First, it does not limit itself to post-viability pregnancies, late-term abortions; but it reaches way back into the early second trimester. Secondly, it fails to ban post-viability abortions by other means, as has been said repeatedly. So women who seek post-viability abortions for important medical reasons, who would be denied access to dilation and extraction procedures under this legislation, would still be perfectly free to use other, albeit more dangerous, procedures. Our substitute bill bans all post-viability abortions by any means, not just one means but all means, unless the woman has a serious medical reason for needing that procedure. Our substitute substitutes policy for politics, and I urge its passage. Mr. Speaker, I reserve the balance of my time.

Mr. GREENWOOD. Mr. Speaker, I yield myself 30 seconds, and our theme song is ``We Trust the Women of America to Do What Is Right.'' But to respond to my friend, the chairman of the Committee on the Judiciary, who argued that our health exception is too broad and allows loopholes. Their response is to have no health exception whatsoever. If the issue here is that we want to make sure that this procedure is only used where health requirements demand it, then we should be working together to create a very tight health exception not eliminating one entirely. Mr. Speaker, I yield 3 minutes to the gentleman Illinois (Mr. Kirk). (Mr. KIRK asked and was given permission to revise and extend his remarks.)

Mr. GREENWOOD. Mr. Speaker, I offer an amendment in the nature of a substitute.

Mr. GREENWOOD. Mr. Speaker, I ask unanimous consent to yield 15 minutes to the gentleman from Maryland (Mr. Hoyer) for the purposes of control.

Mr. GREENWOOD. Mr. Speaker, I yield myself such time as I may consume. Mr. Speaker, I would state that the gentlewoman from Pennsylvania (Ms. Hart) indicated that the people of this country are calling for this kind of a law. In the three States where this has been on a referendum, it has been defeated in each case. Mr. Speaker, I yield 4 minutes to the gentlewoman from Connecticut (Mrs. Johnson).

Mr. GREENWOOD. Mr. Speaker, I yield myself 1\1/2\ minutes. Mr. Speaker, the previous speaker used very good words. Unfortunately, the bill that he advocates will not ban the procedure he abhors. Our amendment will. The previous speaker talked about the broadness of our health exception. If the proponents of this legislation wanted to make sure that no healthy woman could ever get a late-term abortion, they would be advocating legislation that would require a second doctor's opinion, a clearly defined definition or list of medical conditions. That is what they would be doing if they were serious about that. But because they are opposed to abortion under any circumstances virtually at all, they cannot go there. Now, they are very good at describing the gruesome details of abortion. Let us talk about the gruesome realities that sometimes make abortion necessary. In March 1995, Tammy Watts from Arizona and her husband Mitch made the agonizing decision to end a wanted pregnancy at 28 weeks gestation. It would have been their first child. The fetus, however, had extensive, ultimately lethal, anomalies related to a genetic condition known as trisomy-13. The Watts daughter, which they had already named McKenzie, was missing chambers in her heart, her brain was severely damaged and her skull had not formed in the back. Her liver and kidneys were oversized and already failing irreparably. Her bowel, bladder and intestines were formed on the outside of her body and had grown into a non-functioning mass of tissues. Doctors also told the couple that Tammy's health was at risk from a continued pregnancy, especially if the baby died in utero. They decided to terminate the pregnancy, and Tammy and Mitchell were able to conceive again and announced the birth of their daughter, Savannah Whitnee, last July. These are the realities that American women confront with their physicians, and that is why, in cases where their life or their health is at risk, this is none of our business and we do not belong in this decision.

Mr. GREENWOOD. Mr. Speaker, I yield myself the balance of my time. Mr. Speaker, why are we here? Are we here because we are about to vote on a piece of legislation that will become law? No, we are not. It will not. It has been abundantly clear. The Supreme Court has voted on this issue. It has nullified every identical state law, and, as sure as God made little green apples, if this bill goes to the United States Supreme Court, by a vote of 5 to 4 it will be discarded. So we have engaged in a political issue. I know what the political issue is. The political issue is to try to make those of us who are pro-choice appear to be extreme. Good politics, lousy use of this Chamber. It is a lousy use of this Chamber. If Members who propose this legislation were serious about limiting late-term abortions and joining us in that effort, what would they do? They would help us create a tight, tight law that makes it clear that healthy women with healthy fetuses cannot get late-term abortions. We would all be in agreement. We would get something done. We would make sure all of this talk of a loophole big enough we can drive a truck through would be gone. We would settle that. But they cannot go in because they do not believe in a woman's right to choose at all, so they cannot craft reasonable legislation that would take care of the late-term issue. They cannot do that. So all they can do is go to the extreme, create the most exaggerated circumstances, and point to the most gruesome photographs and drawings. I submit that this is an exercise in futility and urge Members to support the Greenwood-Hoyer-Johnson substitute.

Mr. GREENWOOD

Mr. GREENWOOD. Mr. Chairman, I thank the gentleman for yielding me this time. I agree with my colleague from Pennsylvania on the value of abstinence. I would be opposed to a penny of this money going to any program that did not preach and teach abstinence. It is absolutely necessary. My concern with the amendment is it would allow money to go to programs that do abstinence only. The problem with that, and I have friends from Africa who are with us today who have just explained to us, if we take a woman whose husband has contracted HIV and she needs a condom and the only program in her community is a program that simply does abstinence and nothing else, then we have done nothing for her and it will cost her her life, and it will cost the lives of the children that she bears. If every program provided abstinence, I would be for the Pitts amendment completely. But the Pitts amendment, by allowing a third of the money to go to programs that provide abstinence, will allow programs that provide abstinence only and that certainly is insufficient, as everyone has agreed.

Mr. GREENWOOD

Mr. GREENWOOD. Mr. Speaker, I thank the gentleman for yielding me time. I also thank him for his splendid work on this very important piece of legislation. Mr. Speaker, I also thank the gentleman from Texas (Mr. Hinojosa), the gentleman from Ohio (Chairman Boehner), and the ranking member, the gentleman from California (Mr. George Miller), for their work, because they truly produced a bipartisan product here. If there was ever a reason to come together across the aisle, Republican and Democrat, to come to agreement, I cannot think of one more vital than that, of protecting children from child abuse and responding to children who have been abused. Mr. Speaker, before I entered politics, I was a caseworker. I worked with abused and neglected children. And it is painful work to do. We all know about child abuse, the immediate consequences of child abuse. There is nothing more pathetic and pitiful than to think of a young child, a newborn, a child of any age, who looks to his or her mother, his or her father, for the kind of guidance, the kind of love, the kind of nurturing that all of us want to give to our children and all of us were fortunate enough to have in our childhood, and instead receive rebukes, receive blows, to be tortured, to be sexually abused. The pain of that is unimaginable and anguishing for the child. Then, of course, it produces long-term consequences that the gentleman from Texas (Mr. DeLay) and others have referred to. It is the cause of so many people turning to lives of crime, it is the cause of so many individuals becoming abusers themselves of their children and of their spouses, it is the cause of substance abuse in so many cases. So many of the ills of society that are costly in terms of human suffering and costly in terms of tax dollars have their origin in the abuse of children. One of the things that frustrated me as a caseworker was that we know how to respond to abuse. We know how to get it reported now. We have hot lines. We know how to do interventions and investigations. We know how to prosecute child abusers. We know how to seek custody of children who are dependent and not safe at home and place them into foster care. We know how to place children in adoption. We even know how, in some instances, to bring families together again and heal the parents and provide them the services that they need so that they do not have to be abusive. But the thing that we have the most difficulty in doing is preventing the abuse in the first place. That is so hard, so difficult to get to. That is why I take such great satisfaction in the fact that the members of my committee, the ranking members of the subcommittee and the full committee and the chairman and the gentleman from Michigan (Mr. Hoekstra) and the staff helped me to put language in this bill that I hope will do a great deal to prevent child abuse. If we look at the precursors to child abuse, if we try to predict child abuse and see where we can intervene before it occurs, what the experts will tell us, and those of us who have been in the field know, is that substance abuse is a great predictor of child abuse. When you have a mother and/or a father or others in the house who are addicted to alcohol, who are addicted to drugs, you find so frequently in, I think, 35 percent of the cases, you find that because they are inhibited, they break awful taboos; because their nerves are ruined, they become short-tempered and abusive to their children; because they are out of touch with reality, they do things they do not even know that they are doing. We know that substance abuse leads so frequently, almost invariably, to child abuse. So what do we do about that? The opportunity to intervene is best found when a child is born. When a child is born in a hospital and it suffers from fetal alcohol syndrome, if it is clear that the mother is addicted to drugs because either she is showing the signs or the child is in neonatal abstinence syndrome, which means they are coming off of drugs at the time of birth, if we can see the systemic presence of a substance, a controlled substance in a child, if it has done neurological damage to a child, we know right there and then at that moment of birth of this child that if something does not happen there is an extraordinarily high chance that that child, after its neurological conditions, its physiological conditions are healed in the hospital, will then return home to a situation in which it is incredibly likely to be abused. The problem we have had heretofore is there is no legal way to intervene. People have tried to pass laws at the State level and at perhaps the Federal level to make it a child abuse case. Well, that is problematic, because we do not want to necessarily prosecute the woman for child abuse because she has a substance abuse problem. We may even drive her away from the hospital if she knows she is going to face that, and she may choose to deliver at home in a dangerous situation. So it seems that the thing to do is to intervene with social services. What the language that is in the bill says is that when these children appear under these circumstances is that the hospital personnel, the medical personnel shall be required to report that information to the child protective services specialists who then will come out to the hospital right away and intervene and get with that mother and hopefully the father, if the father is there, and say, look, you have a problem here. You have struck bottom. Look what your problem has done to your child. Here is an opportunity to get help. For the sake of your child, are you willing to receive nursing care at your home, in-home nurses? Are you willing to get treatment for your drug abuse? Are you willing to get social services? We can bring to bear a whole host of intervention services so that your problems are solved and you do not put your child at risk. It is a wonderful opportunity. All of the substance abuse treatment experts will tell us that it is a bottoming-out experience when the mother and/or the father look and say, what have we done here? This is as low as it gets. We have hurt our newborn baby, that they are most ready for help. By bringing these services to bear, we can help these children and these families. We can prevent child abuse. In the cases where the mother and the father just refuse to accept services, then that may be the trigger for the caseworkers to take that case to court and seek custody of the child and provide protective custody. But hopefully, in most cases, it will result in a happier ending than that and one in which the child is protected, the family is healed, and good is done all around. So I want to thank the gentleman from Michigan (Mr. Hoekstra), the gentleman from Texas (Mr. Hinojosa), the gentleman from Ohio (Mr. Boehner), the gentleman from California (Mr. George Miller), and the staff on both sides of the aisle for helping me get this language in which I tried for years and years in my State legislature of Pennsylvania to get it in; and I am so happy to have it as part of this bill this evening.

Mr. GREENWOOD

Mr. GREENWOOD. Mr. Speaker, I thank the gentleman for yielding me time. The gentlewoman from Texas (Ms. Jackson-Lee) showed me a picture of Nathaniel, a young boy tragically brain damaged. I want my colleagues to understand that this bill of ours is modeled after California law. And in California law just last May under the same kind of law, a little boy who was brain damaged at a very young age because of malpractice was awarded $43.5 million. And our bill would do nothing to prevent this young man from getting what they need, and that is probably a lifetime of round-the-clock medical care, a lifetime of lost wages. All that would be recoverable in full, as it should be, and on top of that at least a quarter of a million dollars in pain and suffering; and if the State from which the child comes wanted to, that State could raise that level to whatever it wants. We have a flexible cap. This is a question of balance. This is a question of balance. We have to figure out how do we properly pay for medical liability claims in a reasoned way that still allows us to retain our doctors and hospitals.

Mr. GREENWOOD

Mr. GREENWOOD. Mr. Speaker, I thank the gentleman for yielding me this time. I would like to respond to some of the arguments made by the opponents. First off, there has been this constant drumbeat of accusations that somehow this legislation does not provide the care and the coverage for those who are harmed. Let us say it for the 15th time: this bill allows anyone who is injured by a doctor or a hospital or any other health care entity the ability to recover every single penny of economic damages, all their medical care, all their lost wages, lifetimes of lost wages. There are cases over and over again in the State of California that has this legislation in place where there are awards of $50 million, $80 million, et cetera. Plenty of money for the victims to cover their needs. Secondly, there is this drumbeat that this is really about the insurance industry. Why are we not regulating the insurance industry? Listen carefully. Sixty percent of the physicians in this country buy their medical liability insurance from physician-owned companies. Those companies exist for one purpose, and that is to keep the price of medical liability insurance low. They do not gouge their customers; they do not collude with one another, because they are the doctors. They are not doing anything to raise rates or to hold rates up high. They are doing everything to push rates down. Guess what? They cannot offer lower premium prices than commercial insurers. So if your whole thesis here is, oh, those insurance companies, they are overcharging, they are gouging, they are colluding, explain to me, I beg you, stand up and explain to me why it is that the physician-owned companies are in the same boat and are not able to provide affordable coverage? The gentleman from New Jersey (Mr. Pallone) talked about shielding pharmaceutical companies, shielding HMOs, device companies from lawsuits. This bill does nothing of the kind. If a pharmaceutical company is guilty of making bad medicine or overcharging medicine, they will be liable for millions of dollars, untold millions of dollars for economic damages. There is no shield whatsoever. Then finally let me say this. We have heard over and over again from the opponents of this legislation, it does not really help doctors. Let us see who supports it: the American Medical Association, the American Association of Neurological Surgeons, the American Association of Nurse Anesthetists, the American Association of Orthopedic Surgeons, the American Association of Thoracic Surgery, the American Association for Vascular Surgery, the American College of Cardiology, the College of Chest Physicians, the College of Emergency Physicians, the College of Nurse Midwives, the College of Nurse Practitioners, the California Medical Association. Every doctors' group in America supports this legislation. So do not stand up with a straight face, opponents of this legislation, and tell us that the doctors are not smart enough to figure out that this is exactly the prescription that they need.

Mr. GREENWOOD

Mr. GREENWOOD. Madam Speaker, I thank the gentleman for yielding and I thank all of my colleagues for this special order. It is very important and I did not hear the special order given by opponents of the bill earlier, but I am told that there are some corrections to the Record that might need to be made, and I would like to do that. There is no one who is debating that there is a crisis in this country. The worst opponents, the most fervent of the opponents of the bill, the trial lawyers, are not arguing we are having a crisis in the States, including my State of Pennsylvania and many others. That is accepted. The question is what is the solution. The key point that the opponents seem to make is that the insurance companies, the problem here is the insurance companies. It is not the legal system. It is not what goes on in the courtroom. It is that the insurance companies are overcharging for these liability premiums. If I thought that were the case and that the evidence substantiated that and if we had testimony to that effect, then I am not the least bit shy about going after the insurance companies. I know my colleagues are not. We would do what is necessary there. The fact of the matter is that the National Association of Insurance Commissioners asked point blank, testified, not once but repeatedly, to the fact that there is no evidence that the insurance companies are colluding; that they are price gouging; that they are doing a market sharing plot; that they are scheming in some ways to overcharge for these premiums. We do not have to take anyone's word for it. What we have to simply take a look at is the fact that 60 percent of the physicians in this country acquire their medical liability insurance from physician-owned companies. Think about that. These physician-owned companies are basically mutual companies. They are set up by doctors for the sole purpose of trying to enable doctors to get affordable medical liability. So they do everything in their power to get that premium as low as possible. They are certainly not colluding. They are certainly not price gouging. They are certainly not ripping off the doctors because they work for the doctors. They are owned by the doctors. They are the doctors. The fact is that they have not been able to provide premiums at lower costs than the commercial insurers. So what does that tell us? That tells us that if, in fact, the commercial insurers were guilty of price gouging, were guilty of colluding, were guilty of overcharging, that their prices would be here and the physician-owned companies would be here. That is not the case. What is the case is that they are at right about the same place and that leads us I think to the inescapable conclusion that the problem is with the judicial system and not with the insurance system. Another argument that we have heard throughout this debate and we have heard at the hearings, we will hear certainly tomorrow a lot, is that $250,000 is just too low, how can we have such a low cap when noneconomic damages should be higher than that. So why did we pick $250,000? Picked it, first off, because that is what California did in 1975 and it has worked. While the rest of the country has seen medical liability rates go up by 505 percent since then, in California only 167 percent. So it has worked. Secondly, the California Congressional delegation did not want us to set a cap that is higher than theirs because they are happy with theirs. They do not want that to change. So what we said, being respectful of other States and being respectful of the concept of States rights, we said, well, we will have a flexible cap, which means we set it at 250 as a floor and then any State that wants to can raise that cap to $500,000, to $750,000, to $1 million. They can put inflaters in there, they can revisit it from time to time, and I think that is fair, and that is reasonable, and that is contained in this legislation. So the fixation on the $250,000 I think is a bit of a red herring. I have heard opponents of this bill say this bill does not do anything to stop frivolous suits. That is the problem. The problem is frivolous suits. What this bill does is stop frivolous suits. What it does is this. When we have no cap on the noneconomic damages, and we said we do not put any cap on economic damages, we think if we have the case of a child that has been terribly injured and is going to require round-the-clock care for the rest of its life, we are talking about judgments on the order of magnitude of $50 million, $75 million for the health care and for the lost wages, a lifetime of lost wages, and we are for that. This bill allows that. When we have no cap on the noneconomic damages, the sky is the limit. So what happens when the sky is the limit? A frivolous suit is filed, a relatively weak suit is filed without much merit. The insurance company that is insuring the doctor or the hospital looks at the facts and says, well, this plaintiff is particularly pitiful, this plaintiff is an especially pathetic plaintiff, we have got a very strong attorney here on this case. We better not fight this because we go out into the courtroom and fight this and try to defend against this case, the jury could decide to give one of these jackpot awards and it is not worth the risk. So, given the fact that we have got this huge risk, what we are going to do is we will just settle, and every time they settle one of these cases, that gets built into the premium, and it increases the incentive for more cases to be filed. Finally, what we have heard over and over again and what we are certainly going to hear tomorrow is what about these tragic cases, what about the poor 17-year-old girl in North Carolina, the Mexican girl who died from the organ transplant error. In North Carolina, where that occurred, they have a law that allows for wrongful death suits. They will go into the court under that suit, as they would even if our bill becomes law, and they will be able to sue for and they can do it either pursuant to other State laws or pursuant to our law, get a claim and receive awards equal to a lifetime of lost wages. The California Plaintiff's Bar has been extremely successful in figuring out how to raise those economic damages, as they should be. If somebody is paralyzed, they go in and they get not only all of their lost wages, all of their medical costs covered, but they say now he is going to have to pay for someone to do household chores, and he is going to have to have his car altered, get a special automobile, and he will have to have ramps in his house. All that gets covered, and it gets covered well, and we think that is the case in the most egregious examples. I think, and I think a majority of the Members of Congress will vote that way tomorrow, that the crisis is real, the crisis is upon us, and the crisis is severe. We have the best health care system in the world, but people will and have already died because they could not get to a trauma center, because the trauma center did not have the docs there because the docs did not have the insurance. And those people who are injured because they cannot get access to health care are just as hurt and just as damaged and just as dead, unfortunately, because the system is not working. We can solve this problem with this legislation. It is fair, it is balanced, and I thank my colleagues again for this excellent opportunity to tell America about this.

Mr. GREENWOOD

Mr. GREENWOOD. Mr. Chairman, I offer amendment No. 3 in the nature of a substitute.

Mr. GREENWOOD. Parliamentary inquiry, Mr. Chairman.

Mr. GREENWOOD. Mr. Chairman, do I need to designate a portion of my time to the minority?

Mr. GREENWOOD. Mr. Chairman, I yield half of my time to the gentlewoman from Colorado (Ms. DeGette).

Mr. GREENWOOD. Mr. Chairman, I yield myself such time as I may consume. Mr. Chairman, it has been a good debate so far. It was a good debate last year. This is about ethical and moral issues. The proponents of the gentleman from Florida's (Mr. Weldon) bill have argued the ethical and moral issues against reproductive cloning; and on that issue, my friend, the gentleman from Florida (Dr. Weldon) and I are in perfect agreement. It is wrong to create a human being through cloning. It is probably physically cruel to do that, because of the likelihood of defect; and it is emotionally, I believe, cruel to do that because no one should be brought into life as a duplicate of another. Each of us has the right to be the product of a mother and a father. So we agree on that. Now let us deal with the moral and ethical issues that have to do with somatic nuclear transfer. Because what is at stake is well over a hundred million Americans today suffering from diseases like Parkinson's, like Alzheimer's, like cancer, and like diabetes; and as this chart shows, the millions of people suffering today from those diseases and the millions more expected to be suffering from those diseases over the next 10 years. Now, none of us in this room is an expert on the science of nuclear cell somatic transfer. But those who are the experts tell us this, that with this technology simply requires a limited number of eggs donated by women, denucleated, enucleated. And then the cells, the DNA from something like a cheek cell placed in that nucleus, electricity is applied and then the cells divide. Why do scientists want to do that? They want to do that because we want to observe the miraculous occurrence inside that egg as those cells become first pluripotent stem cells and then divide into specialized cells. Why do they want to do that? They want to do that because they need to understand the biology and the chemistry as to how that happens. And when they have understood the biology and the chemistry of that process, there is no more need for women to donate eggs in order for the cures for these diseases to come about. Because then doctors in hospitals around the world will be able to take these patients suffering from not only these diseases but from juvenile diabetes, from Alzheimer's, from spinal cord injuries, from head injuries, and take the somatic cells from that patient, combine them with the growth factors that they identify in this limited amount of research, process healthy cells from our own bodies and use those healthy cells to cure our diseases, to fix our injuries, and to reduce human suffering by amounts that we cannot even imagine. So the ethical and moral issue here is are we or are we not willing to allow that science to go forward so that we go through this transient phase where we use this relatively small number of ova contributed by willing women to understand how to do this so we can bring about the cure. Now the argument that is presented by the exponents of my substitute, which again bans reproductive cloning, allows this research to continue. The argument that is proposed is, well, once that cheek cell divides in an egg in a petri dish, it is a potential human being; and, therefore, if it is going to be destroyed after it divides a certain number of times, after the observations are finished that that is immoral. Now, if that is the case, if that is what you believe, then we should ban in vitro fertilization because in vitro fertilization has produced 100,000 embryos in this country right now that will be discarded, 100,000 of them. Far more order of magnitude than will ever be created through this technology and they are going to be discarded, and that is apparently okay with the proponents of this legislation because it brings beautiful little children into the world to couples who otherwise could not have them. So that is the trade-off we make. And nobody here is arguing, in fact, to the contrary. They are preserving the need for in vitro fertilization, and yet the number of embryos created and destroyed by in vitro fertilization orders of magnitude is more than we are talking about here. And if we want to get totally philosophical about this, every single day millions of eggs are fertilized in the womb that do not adhere to the uterine walls and are flushed away and somehow that is the way God does it. That is the way nature does it. And we do not hear a gnashing of teeth about that by the makers of this amendment about this bill. Ladies and gentlemen, this is a turning point in our history. This is a question about whether or not we are going to go forward with the most promising medicine of our time. The ability to stop the suffering, to heal the sick, to cure the injured of diseases that have plagued us for centuries or whether we turn our back on this science in the name of ethics and morals and kill an opportunity to do something that is ethically and morally correct, and that is to prevent this suffering. Mr. Chairman, I reserve the balance of my time.

Mr. GREENWOOD. Mr. Chairman, I yield myself such time as I may consume. I want to quickly make observations about two contradictions that I think my friend from Florida made. Number one, he said that our substitute cannot be enforced. That does not make any sense. If we can enforce the Weldon law, we can enforce the Greenwood law, and if people are going to make clones in violation of the law, they are going to do it under the Weldon law or the Greenwood law. So that is an argument we should discount immediately. The second contradiction, which I think is more severe, is that I heard the gentleman from Florida (Mr. Weldon) talk about we are going to have shelves of embryos, we are going to have embryo farms; we are going to create all of these embryos. He just told us how extraordinarily difficult it is to get one ovum. We have to superovulate a woman. It is very difficult. It is painful. Women are not going to line up to have this procedure. So there is absolutely no chance whatsoever that we are going to have this huge multitude of eggs. We are going to be lucky to have enough to do the research. Mr. Chairman, I yield 2 minutes to the gentleman from Illinois (Mr. Kirk).

Mr. GREENWOOD. Mr. Chairman, I yield myself such time as I may consume, and ask my friend from New Jersey how we would wind up with a cloned embryo stockpile? How would that happen?