Tim Murphy

Mr. MURPHY

Mr. MURPHY. Madam Speaker, if the gentleman will yield, one of the things that is in this Medicare bill we passed a while ago now, that many people are forgetting, has to do with the entry physical that people get, but there are also elements in there that have to do with some patient management, the pharmacist is working more monitoring the medication, and communication. I would ask my colleague to speak on that, because that may be a thing that we really are not quite used to, physicians and pharmacists working more closely together as part of that Medicare bill so that there is less hospitalization. I know one hospital in my district, Washington Hospital, really found that by doing careful patient management of those with heart disease, they reduced rehospitalizations by 50 percent. That is a massive savings in costs and certainly much better for the patients, in many cases saving some lives. I wonder if the gentleman could comment about that.

Mr. MURPHY. Madam Speaker, I would like to shift to a couple of areas of health care here and some other things that we are moving on and we need to continue to push for. One has to do with some mental health issues. I mentioned earlier about Hurricane Katrina and some of the folks who had psychiatric illnesses, and as the hospitals were emptied, people did not know their medications; and I mentioned how those problems occurred. We also have to pay attention not only in terms of using electronic medical records so people can find their record when they need to, but making sure we have the security so that people cannot get into the record when they do not need to. Part of what Dr. David Brailer, who the White House appointed to work on this issue, along with many companies, such as in Pittsburgh, the University of Pittsburgh Medical Center, and there are many private companies trying to come up with solutions, so we have a great many other aspects that we are working towards in order to make sure that these records are secure and confidential. I want to ensure my colleagues that this is something that I am in complete agreement with, what Secretary Leavitt is working on in HHS and also Dr. Brailer, that these electronic records need to be secure and confidential so people can always trust that their records are not going to be viewed by somebody who should not get into them. In the Committee on Energy and Commerce, we are working on some other technological aspects. We are working with the committee to offer some amendments to make sure we also have reporting. Interestingly enough, one of the areas we find loopholes as we are moving forward on issues is that right now if there is a breach in security of some kind of records, health records, unless someone reports that there is not something that is done and what we really want to make sure is happening is hospitals are regularly scanning their records as many of them do now and look for any sort of attempts people may have to get into those computer files. Similarly when we have our own paper records in our own office, we have to keep those under lock and key. We have to make sure that those who are not authorized to see them don't get in there to see them. In the mental health area, I want to talk for a few minutes about a couple of aspects and again give my colleague time if he has some issues he wants to get into, but I want to talk about mental health care treatment for chronic diseases and how they can lower health care costs. For many individuals with chronic diseases like asthma, arthritis, heart disease, cancer, diabetes, lupus, and many other areas, interestingly enough, the incidence of depression can be double that of the general population. Whereas in any given life span, perhaps about 16 percent of the population may suffer from some severe depression, when you have a chronic illness like heart disease, those rates can double. And some cardiologists tell me that the numbers would really be even much higher than that. After all, when you are told you have a debilitating disease or something that can be life threatening, it is expected that a person would have a severe reaction. Many times it is overwhelming stress. Sometimes that can move into a sense of depression. Depression is not just a sad feeling as we all feel at times. We have a bad day, the loss of a loved one, job stress. Depression is part of life in terms of having some sense of sadness. It reaches a point, however, in some folks where it really becomes a wall around them. It affects them physically. It affects them mentally. Thoughts are sluggish. Oftentimes they have a hard time getting out of bed in the morning but then a hard time sleeping once they are there. They may find themselves with no appetite. They may find themselves overeating. They may find themselves seeking other things to alleviate their depression such as drugs and alcohol. And I am not talking about prescribed drugs. It may be things where they are angry, they are edgy, they are moody. It may be that they are withdrawn. All sorts of things can happen. What is interesting is how this really becomes not just a mood and an emotional reaction and this is not something that is just a sign of weakness, it is a real chemical, neurochemical reaction that occurs in the brain then that becomes debilitating. For someone who has heart disease or diabetes, I was mentioning, double the incidence, think of this: That the stress can be so prolonged on their body and their system and it depends on the individual, it is almost as if there is a point at which the body says, We can't handle the stress anymore and depression begins to overcome. Why does it increase so much with things like heart disease? Perhaps because of the stress, but here is an interesting factor. Patients diagnosed with depression have higher rates of chronic medical illness and use health care services more often. Patients with chronic medical illness and untreated depression have higher health care costs in several categories of care: primary care, regular doctor visits, medical specialty care, medical inpatient care, pharmacy, lab costs, all increase, when compared to those with chronic medical illness and treated or with no depression. Much higher. As I said before, clinical depression affects about 16 percent of the population at one time or another in their lives. Unlike the normal experience of sadness or loss or mood states, it becomes much higher. For example, 31 percent with diabetes have depressive symptoms. Interestingly enough, the increased psychological stress or depression increases platelet reactivity to thrombosis, or blood clotting. In other words, when you have heart disease, untreated depression in ways we are not quite clear yet can actually lead to an increases in clotting of those little blood cells, the platelets that we have. This can in turn lead to almost doubling the cost of health care for folks with heart disease. Again, you have folks with and without heart disease. Those with heart disease may have double the incidence of depression. And those with untreated depression or not responding to treatments can have double the health care cost. Some are intuitively obvious: Perhaps the person is not following up with doctor visits; perhaps they are not following the treatment plan; they are not going through and taking medication; maybe they are not seeing the doctor; exercising; all the things they should be doing. But even in that case if they are doing that, there is something physical that is taking place in those patients that may actually contribute to increased medical complications. Very often treatment for mental illness is not provided by a mental health professional. A person does not see a psychiatrist for their medications, maybe does not see a psychologist for other behavioral therapies that may go with that. Actually psychiatric medications are prescribed by nonpsychiatrists 75 percent of the time, most frequently by primary care, general and family physicians. But when we combine medical and behavioral health services to coordinate the diagnosis and treatment of the full spectrum of diseases, we can see some huge changes in that. When you have, as I said before, untreated depression, it has been found to increase health care costs by complicating symptoms and treatments of such things as back pain, diabetes, headache and heart disease annually from $1,000 to $3,000 per patient. Very, very important when you are dealing with someone, for example, who is an employee who has some of these problems, when you see this untreated depression in them, increased costs. Untreated depression costs employers more than $51 billion per year in absenteeism and lost productivity, not including higher medical and pharmaceutical costs. When we use information technology and much of what we have been talking about this evening, it can be used to track diseases and intervene with appropriate care. So now with a physician seeing a patient with a chronic illness and into that computer he types in or she types in the diagnosis, up in the screen should not only appear, here is confirmation of the diagnosis of this disease but up also arise some questions as prompts to the physician. Again if he types in coronary heart disease, what may also show up is, ask the patient the following questions: Ask about mood, ask about appetite, sleep problems, problems in their relationship with their spouse, to see if there is any indication of other psychiatric or psychological disorders for which that patient could be referred over for help. This information about provider system performance will be extremely valuable to have this. But unfortunately in many cases a physician may not have those prompts available and if they may only have a handful of moments to see a patient, it becomes very, very difficult. If we saw depression as a medical condition for what it is and other psychiatric illnesses for the medical conditions they are, we could reduce health care costs and save lives. Unfortunately, and I know our colleagues as well, there are some folks here who believe there is no such thing as mental illness and I have heard such statements made, saying, oh, it's just a chemical reaction in the body, or there really are no other emotional components. We have heard Hollywood stars talk about this with an incredible amount of prejudice and ignorance. But it is true. There is such a thing as mental illness. As much as we want to pretend it is not there, as much as we want to ignore it, it does not make it go away. It does not help if we continue to treat mental ilness with the same level of insight and ignorance as the Salem witch trials. There are times that we have not advanced much beyond that. But when on the other hand we recognize this incredible integration between mental health treatments and other medical treatments, I say other medical treatments because they are both medical, we can see with those patients huge changes and huge cost savings. Increased psychological stress or depression increases platelet reactivity, as I said, thrombosis. But there are also aspects, too, with treatment here that we find really can save a great deal of money. A 2000 report by the Office of Personnel Management for Federal health employees provides an example of several major employers who through managed care programs have discovered they can offer mental health benefits to their employees in order to maintain a higher quality workforce. These employers included companies like AT&T, American Airlines, Eastman Kodak, General Motors, IBM, Massachusetts Group Insurance Commission, Pepsico. The list goes on. The most important finding of this report was that employers who provide generous mental health and substance abuse benefits to their employees and their families are committed to providing these benefits because they are convinced that doing so is essential to the corporate bottom line. What they indeed found was the mental health coverage put on par with physical health coverage only costs employers about 1 percent or $1.32 per enrollee per month according to a 2004 analysis by Price Waterhouse. But they also found it actually saves a great deal of money for individual businesses. As we are proceeding through efforts to save money through Medicaid, as we are looking at such things as Medicare, I call upon our colleagues to make sure we are saying, you don't just save money by cutting rates of growth. It is important we do that. It is important we work with States to reduce that. But it is also important we work with States to help them understand and employers to understand that when you deny an aspect of critical care, and that is mental health care, you can actually be harming the patient. And so it is vitally important that we look in all these areas now and other bills that may be before us in the future, that we use them in such ways, this huge amount of spending the Federal Government gets involved with health care, but also encouraging employers to do the same thing. Congress budgeted $20 million for the development of comprehensive State mental health plans to improve the mental health services infrastructure in 2005. The amount we need to, however, spend is probably much more than that. Unfortunately, the way the Congressional Budget Office works in this Federal Government, it only tells you what you spend. It does not tell you what you saved. It would be much like if we looked at how much we are going to spend in immunizations but did not see what we saved in lives and money for flu. It would be ridiculous if we did not say that that indeed would be a savings. We have to keep working at these aspects here. We have to look at how Medicare and Medicaid reimburse. We have to look at pay-for-performance incentives to help physicians and mental health professionals work together in a comprehensive and integrated way. We have to make sure we are helping businesses understand that these Medicaid transformation grants, for example, that I mentioned earlier are, I believe, going to be $100 million invested, but when we use these for such things as county nursing homes, skilled nursing facilities, federally qualified community health centers and similar facilities and inner city hospitals, we will see tremendous savings come through this whole system here. Just to wrap up my comments and I will turn back to the gentleman from Georgia if he has some other thoughts he wanted to say in wrapping things up tonight, it is so vitally important that we work together, not only the handful of health care professionals that are here in Congress but it is so important that as Members of Congress we work together to understand that health care is not just about what you spend, it is also about what you save by your spending. If we are ever going to get control of this juggernaut of health care costs, it is not just going to be by having the discussion go in terms of who is spending; it is not just a matter of saying we are going to have health care savings accounts so people can pay more attention to what they are spending, that is important; and it is not just in terms of saying, nobody can afford health care so let's have the Federal Government take over. It is about not just who is paying but what we are paying for. That is why the comments we have made tonight about what we are spending money and how we are going to spend it on dealing with the concerns about the avian flu be done in a careful and thoughtful manner. That is why other aspects I mentioned before about medical records, electronic medical records and also integrated health care and other aspects we can get into, too, about prevention, et cetera, it is so important we deal with these in a comprehensive manner to look at those savings. I wish that we could get the Congressional Budget Office to do more aspects of looking at how we can save money in this, but that is going to be something that we are going to have to carry the torch on. I know my colleague has carried the torch on many of these aspects here. I think we have about 7 or 8 minutes left. I know you have a number of other aspects you would like to talk about. I always enjoy these colloquies with you about looking at this. It is an important aspect that we team up together on here to get this Nation thinking about other ways of saving lives and saving money by, and I will leave with this chart here, about the health transformation. We cannot just make reforms within the current framework. We have to look at our current health care system and if we fail to change, it will decay into a system we cannot afford anymore. If we work toward real change to a 21st century health care system, that is where we should be going. I believe our Nation, whether it is private employers or the Federal Government, will see tremendous changes that save tens of thousands of lives and tens of billions of dollars. I thank my colleague for being such an adamant supporter of moving this health care system forward.

Mr. MURPHY. Madam Speaker, I thank the gentleman. One of the ways that our Nation needs to be dealing with this potential and other issues is to have a better health care system overall. The gentleman mentioned Hurricane Katrina, and I would like to use that as a stepping-off point to talk about some of the work this Nation needs to be doing in some of the things we are doing. When Hurricane Katrina hit and, subsequently, Hurricane Rita, we saw something we had not really been prepared for, not only the huge devastation of 90,000 square miles, almost double the size of Pennsylvania, but we also saw hospitals were closed, records were destroyed, physician offices were inaccessible and patients were inaccessible. Patients by the hundreds of thousands traveled around the country, many without their medications, without their medical records, and in some cases not even knowing what their medications were. We had to essentially reinvent for many of them a system of health care. Now, let me take this on another smaller role here too with regard to individuals. When a person goes to their own physician, many times you have what I refer to as 21st century medical technology kept track of in a 19th century system, and that is paper and pen records. Now I have seen these myself through many years of working in hospitals and in my own practice settings where you write your notes down, and when lab results come, you stick them in the chart, and it could be for a typical patient perhaps the pile of papers could be much thicker than this. Yet, when a person goes to the hospital, it is not unheard of, for example, I was talking to someone at one hospital; and I would be interested to hear if my colleague's experiences are the same. But say a woman showed up in an emergency department in labor. Some notes may be made there. She then may go up to the delivery area to deliver. After that, she goes to recovery and her baby goes to pediatrics. And each time separate mounds of medical records are made, which may not really be collated together for hours, sometimes days afterwards simply because of what is happening there, not to mention her own medical records from her own obstetrician back home. That is the way the system operates every day. Let us take another scenario. Take a single mom who has a son who has asthma. And perhaps because of whatever housing, perhaps she is on Medicaid, low income, and she finds a situation where she has to move to a different part of town and it becomes difficult for her to get across town to see her other doctors, so she goes to a new doctor. And they have to essentially reinvent what has been done for this child or call for those records and have them shipped over. Now, if one has the luxury of days, sometimes that can be done, with the situation of establishing new relationships with new physicians and new nurses. But you also have the situation, if the child goes into acute distress with something like asthma, of showing up in an emergency department and having to have all the medical staff there trying to track down what is the child's medical history, what prescription drugs is he on, are there any particular allergies he has, if he is on other medications will there be drug interactions, what is his blood type. Even the most basic information is important to have, but they do not have it. Now, in some hospitals around the country we see some changes being made. University of Pittsburgh Medical Center, where I am from, is one that is doing this, but there are other centers, at Northwestern, and other States have this, where they are emerging towards the technology of electronic medical records and electronic prescribing. I want to talk a little about how that is done and show some things that are being done on Medicaid. Imagine going to a medical office and filling out a clipboard with your name, address, phone number, your medical history, and allergies, if you can remember it all. Very often, it is tough. Certainly my colleagues in Congress, I think we would all be hard-pressed to remember every doctor we ever saw, every medication we ever took, or every diagnosis that was ever placed in our chart, but it is important information. Add to that every x-ray we have ever taken, every lab test that has ever been done. Those are oftentimes lost to the ether. Some studies have indicated that perhaps as much as 14 percent of medical records are missing, some important information, important enough that it would change the direction of what the provider would diagnose or call for treatment in those cases, and in some cases, physicians say major changes in how they would diagnose. Perhaps a patient was set up for a blood test and they never showed up for the blood test. Or perhaps they did show up, and the information was never forwarded to the physician's office. Or if it was forwarded, maybe it was misfiled or placed somewhere else. A whole host of things can go wrong when you are dealing with reams and reams of paper filings. Then the moment of truth comes when the doctor needs it, where is the information. If it is missing, they may have to call for repeat tests or write a prescription and then find out that it causes problems with the patient, which can cost lives as well as money. It is estimated that 150 million times a year pharmacists call physicians to double- check medications. Perhaps they cannot read their handwriting, or double-check the decimal point on the medication dosage level, or perhaps to say Mr. Smith is on another medication from another doctor which is identical, or it is one that would have a bad drug interaction with this other medication. That is a grave concern, how do we fix this. Well, by using electronic medical records, the medical record could actually be placed on a computer, perhaps in the physician's office. In some cases, individuals can carry their own. I brought a sample, smaller than a stick of gum. This is a 64-bit memory chip. It happens to be on a key ring. It is quite possible in the near future we may be seeing individuals who carry their own extensive medical records that can fit into their wallet or on a key ring. If an emergency came up and if something came up, they could, at a moment's notice, hand it to a doctor. They plug it in and pull up the records right away. This is critically important for those with complicated cases. That involves a huge investment in the medical infrastructure in America, but if we use a situation like Hurricane Katrina or an outbreak of a pandemic in this Nation where the medical system of this country would be taxed beyond anything we can imagine. Again with Hurricane Katrina, hundreds of thousands of patients moving about, many psychiatric patients let out of hospitals with no recall of their medications. People had to start from scratch and diagnose them. What if we had medical records on file that people could use in a secure and confidential way and could tap into. Or what if some individuals carry their own medical records in their wallet. It would be incredibly valuable in moments of need and help reduce health care costs. This is not something that should just be in the best of hospitals or in the hands of those who can afford it. If we are going to lower health care costs, we need to put it in the hands of every American. RAND Corporation released a study a few weeks ago that said if our Nation switches to electronic medical records, we could save in the nature of $160 billion-plus per year. $160 billion per year. In a health care system where we are so concerned that costs are moving completely out of control, where people cannot afford health care, where businesses can no longer afford the double-digit increases in costs, we need something major, something comprehensive, something that completely shifts how we provide health care in this Nation. And electronic medical records is just that treatment. Not only does it save money in terms of doctors not having to take time to review the chart, worry about mistakes they may have made, call for new MRIs, X-rays, CT scans, blood tests, not only that reduction in costs, and not only the savings of lives, because a mistake has not been made or a delay has not occurred in care; but Rand goes on to say you save massive amounts of money in terms of jobs, people not losing work because of complications or having to go back to a doctor to have tests done again. Think of it this way: If a doctor asks for an X-ray and it is done, and he says did you bring the X-ray, no, they did not give it to me. The doctor says, we will take another one. You pay for that X-ray, the person's time who has to have another test done, all of that is duplication of work. But what if, again, that individual carried the X- rays, films of their surgeries, all of those details on a chip, or if it was on a computer screen in the physician's office. Not only would the doctor have instant access, but he would not be going page by page through the medical records, what did I prescribe before, because nobody can possibly remember the details of all of the patients they see. But in an instant, tapping a button could call up those X-rays. Added to that, if the physician had questions and needed a consultation, he does not just call his old mentor in medical school, I need to call Dr. O'Hare and get his consult and mail him the X-ray and ask him to comment back. Literally, at the stroke of a key, he can have another doctor look at the X-ray, consult with him, and provide valuable information back in time faster than the speed of light. It saves valuable time, critical information, and saves lives. But how do we get that into Medicaid, is my question. Well, first of all, let us look at what Medicaid has done here and look at some costs. In 2006, the Federal Government is spending in billions, about $190 billion. This is going to increase by $66.4 billion, or 34.8 percent, over the next 5 years. We are up to $200 billion in 2007; 2008 to $217 billion; 2009 is $237 billion; and by 2010 it is $257 billion. The Federal Government general increase in what it is spending on Medicaid is going to increase 7 percent over the next several years. The budget package that Congress is putting together now to try to reduce some of the deficit is going to do some things that the Governors of States have asked for. The Governors of States have said that Medicaid spending, in some cases, is almost 20 percent of the State budget. They need some mechanisms by which to control this. I was pleased that a bill I introduced has been put into the Medicaid package of our deficit reduction package, which will put $100 million in grants to go to hospitals that have high Medicaid populations, perhaps inner-city hospitals, perhaps community health centers, and nursing homes and other centers that have high Medicaid populations so they can partake in electronic medical reports. Basically, a hospital has to convert their files into computer programs and be able to pull those up. There are a couple of nuances that go on. You have to make sure that different offices of doctors and hospitals can all speak to each other on this because otherwise there can be a medical Tower of Babel, that is, one hospital may use one type of computer program for their records and another hospital another type of record. But I want to call upon my colleague and ask the gentleman from Georgia (Mr. Gingrey) from a physician's standpoint on what he says our Nation can be doing to assist this transition, how it helps medical practice, and perhaps some experiences of your own work. I believe you have delivered 5,000 babies or so in your time, so how it makes a difference from being able to have information instantaneously as opposed to waiting for files or trying to make a best guess on a patient.

Mr. MURPHY

Mr. MURPHY. Mr. Speaker, nearly all Americans' personal health information remains at some risk. More than one in four health insurance plans and almost one in three care providers have indicated that they experience data security breaches of personal health information. The problem is that only 43 percent of health care providers comply with Federal laws that protect an unauthorized disclosure of health information. As the U.S. slowly expands its use of electronic health records, Congress needs to shift from the current complaint-driven approach to enforcing privacy standards to proactively defending patients' personal information. Every American should be able to know that their medical records are secure. My legislation, H.R. 2234, would keep electronic medical records safe, ensure that patients have access to their own records, and notify them when information is accessed by an unauthorized user, thus reducing risk. Ensuring health data security is important for all Americans to have confidence in their hospital. I would urge my colleagues to learn more about protecting patient privacy for the 21st century by visiting my Web site at murphy.house.gov.

Mr. MURPHY

Mr. MURPHY. Mr. Chairman, the Private Property Rights Protection Act would hopefully, once and for all, prohibit Federal, State and local use of eminent domain to take private property for economic development. The Fourteenth Amendment's due process clause gives eminent domain authority to States and localities if seizing property for a ``public use.'' However, in the Kelo decision, the Supreme Court ruled that New London, Connecticut's redevelopment plan was constitutional and, in fact, for a ``public use''--largely ignoring the reality that the property, as part of the plan, would be turned over to private developers. The Fourteenth Amendment also contains what's known as the equal protection clause, which states: ``No State shall make or enforce any law which shall . . . deny to any person within its jurisdiction the equal protection of the laws.'' But the Kelo ruling deliberately declares that heretofor, certain persons and their property will in fact be protected UNequally. Or, in the case of Kelo, not at all. In addition to prohibiting any level of government from using economic development as a reason for exercising its power of eminent domain, H.R. 4128 would also provide assurances that those who are victimized by eminent domain property seizures will get their day in court. Eminent domain victims suffering injuries from a violation of the protections in H.R. 4128 will be allowed access to State or Federal court to enforce its provisions. Mr. Chairman, the home ownership rate is at the highest level in our Nation's history. Owning one's home and property is the cornerstone of the American Dream. The Kelo decision sets a precedent that can turn the American Dream into a nightmare for victims of eminent domain. I salute Chairman Sensenbrenner and Chairman Smith of the Judiciary Committee and Chairman Goodlatte of the Agriculture Committee for developing this strong, bipartisan legislative defense of private citizens. I am proud to cosponsor the legislation, and urge all Members to support this prudent bill.

Mr. MURPHY

Mr. MURPHY. Mr. Speaker, Medicaid waste, fraud and abuse is literally wasting billions of health care dollars and taking them away from elderly, blind, disabled and low-income Americans. For example, in California they found illegal billing for over $20 million for tests never authorized by physicians. The State of New York identified some $18 billion worth of fraud. Practices like this are unacceptable. Yesterday the Committee on Energy and Commerce provided $100 million in grants for health care providers who adopt electronic medical records. These advances in health information technology will help providers with large Medicaid populations, like community health centers and inner-city hospitals. A Rand study reported that if we use electronic medical records throughout the Nation, it could save $160 billion-plus in medical costs. The expansion of health IT promises to reduce errors and streamline Medicaid administration. Mr. Speaker, health IT is the future. It is where we are going and applies this significant technology to save money, and, most importantly, lives. I urge my colleagues to visit my Web site at murphy.house.gov for more information.

Mr. MURPHY

Mr. MURPHY. Mr. Speaker, I thank the gentlewoman from Ohio (Mrs. Schmidt) for yielding me time and for her work and the work of the Committee on Government Reform on this bill. We are here to remember and consider a Congressman beloved in the hearts of those in southwestern Pennsylvania, James G. Fulton. Now, there were two things you were not allowed to say in the congressional office of James Fulton. The first was, ``I can't,'' and the second was, ``I don't know,'' this according to Congressman Fulton's long-time aide Richard Beeman, who wrote these words in the eulogy that were included in the Congressional Record on October 21, 1971. Consistent with these simple mottos, warm-hearted, thoughtful, plain- spoken James Fulton represented the Pittsburgh area in Congress with great charm and distinction and a vibrant can-do spirit for 27 years. James Fulton was born in Dormont Borough in Allegheny County in March of 1903, and it was the elected officials in Dormont who recommended that we consider him for naming this post office. He graduated from Pennsylvania State College, now known as Penn State University, and later from Harvard Law School. He pursued many diverse interests in his young adulthood; went on to private practice in Pittsburgh; as it was noted before, became the publisher of the Mount Lebanon News; earned a seat on the Allegheny County Board of Law Examiners; and then served 2 years in the Pennsylvania State senate in 1939 and 1940. At the relatively advanced age of 39, he enlisted in the United States Naval Reserve in 1942, and heroically served in the South Pacific as a lieutenant. What is perhaps most remarkable about Fulton's service was that he actually ran for Congress while still fighting the war abroad. Indeed, in November 1944, while still in the service, Fulton was elected as a Republican to the 79th Congress to represent the Pittsburgh area. When he was honorably discharged in early 1945, he began what became a nearly 27-year career in the U.S. House of Representatives. His primary interest in the House was to facilitate U.S. innovation in science technology. He rose to become ranking member of the House Committee on Science and Astronautics. Sadly, he died in office on October 6, 1971, at the age of 68. But among his accomplishments is something that is still remembered today in our region. He worked tirelessly in dealing with some of the many flood control issues in the hilly areas of southwest Pennsylvania. Still today when we are beleaguered by huge storms in our area, people note that it was his work on flood control projects which to this day have a lasting legacy of saving many homes in the region. In the years following his death in 1972, the James G. Fulton Fellows Program was established as a living memorial to Congressman Fulton. This program remains today open to undergraduate students who permanently reside in Allegheny County who want to work for a Pennsylvania Member of Congress. The program reflects the fact that Congressman Fulton mentored more than 100 college students during his tenure in Congress. Mr. Speaker, last but not least, I thank my good friends from the Committee on Government Reform, the gentleman from Virginia (Mr. Davis), the gentleman from California (Mr. Waxman), for helping me to honor such an esteemed former Member of this body as Congressman Fulton. I also want to recognize Sara D'Orsie on the committee's majority staff and Denise Wilson of the staff of the gentleman from California (Mr. Waxman) for their important efforts. Mr. Speaker, with enactment of this legislation, this post office building will stand as a prominent tribute to the public service career of a Pittsburgh icon, Congressman James Fulton. I urge my colleagues to join me in support of this measure.

Mr. MURPHY

Mr. MURPHY. Mr. Speaker, 80 percent of the Nation's total medical care costs, including Medicaid expenditures, are spent in the treatment of chronic conditions such as diabetes, arthritis, and cardiovascular disease. Chronic disease often involves multiple diagnoses, hospitalizations, tests, and treatments. All of this is expensive and complex, and as health care costs soar we can save lives and money using better patient management. Under patient care management plans, patients are monitored by nurses to coordinate their complex care, monitor prescription use, watch out for problems, and empower patients to get involved in their own care. Money spent up front dramatically lowers health care costs and, most importantly, improves patient outcome. A patient management program at the Washington Hospital in southwestern Pennsylvania taught patients to self-manage their disease through diet, lifestyle changes, medication monitoring, and depression screening. The result has been a remarkable 50 percent decrease in hospital readmission rates. I urge my colleagues to learn more about reducing costs in Federal Medicare and Medicaid spending through better patient care management programs by visiting my Web site at murphy.house.gov.

Mr. MURPHY

Mr. MURPHY. Mr. Speaker, reclaiming my time, I thank the gentleman for his learned information for our colleagues to be aware of not only Head Start but about prenatal care. One program I want to mention, the National Nurse-Family Partnership, is a great example of success. It is a public-private nonprofit center. I believe it is centered in Colorado, with over 700 nurses delivering in-home prenatal care and early infant care to more than 13,000 low- income families throughout the Nation. Interestingly enough, they were able to demonstrate they could return $4 savings for every $1 invested in these services by the time the children reach age 15 by reducing expenditures for such things as special education, emergency room visits. Again, when we use a more comprehensive patient care model, we look at the whole family and not just the individual disease, we can save money and provide care. Secondly, I also applaud my colleague for bringing up those aspects about Head Start and Early Head Start, so critically important for families who are struggling to make ends meet to have this system that really puts the parent at the center of the child's care, making sure they are involved in all the decisions, making sure they have the information they need to have, making sure that they are, in essence, put into the role of parent and not government in the role of parent; and that makes all the difference in the world. Let me shift into another area here, however, that is also critically important and something we dealt with today. At any point if my colleague has comments he wants to make, I certainly would encourage him to do so. But this is the area of childhood obesity. Today, we passed a bill out of the House that said that we cannot just be blaming restaurants and fast-food companies and food manufacturers when someone has obesity problems. Indeed, it is something we all have to work on and have responsibility for because whether they are healthy snacks that a person eats too much of or unhealthy snacks, whatever that is, we have to make sure that we watch our diet and have proper exercise. Unfortunately, what has happened in this Nation, I believe it may only be the State of Illinois that still requires gym class in school, and as such, children spend much more sedentary time at home, playing video games or in front of the television, less active, and eating more during that time. This is a major contributor to childhood obesity. And what has happened in the last 10 years, and look here, the proportion of obese children has tripled since 1970. It has doubled in the last 10 years, tripled among teenagers actually during this time period, and increased incidences of disease associated with that, including such things as now we see adult onset diabetes showing up in our children. We also see heart problems showing up. We see the risks that take place with blood pressures that are showing up in children who really did not have these problems before. This is an estimated annual cost of obesity-related diseases in the United States: $100 billion. $100 billion annual cost of obesity- related diseases. This is not something that is cured by simply having government come in and tell people what they can and cannot eat. Something has broken down in our families and our communities where we are no longer telling kids they have had enough to eat or they are not going to eat any more of that or they need to get out and play. The annual hospital costs for obesity-related disorders in children ages 6 to 17 years of age increased from $35 million to $127 million between 1979 and 2000. It is a lack of physical exercise; 38.6 percent of United States adults report they have no leisure-time physical activity at all. The annual estimated cost for diseases associated with this physical activity in 2000 was $76 million, but we know that daily participation in physical ed classes by high school students has dropped from 42 percent in 1991 to 29 percent in 1999 and continues to decline. Even though we have data that continues to tell us physical exercise is critical and important, not just for a child's physical health, but really, as we are looking at ways of managing this, we cannot continue to just pump money into the Medicaid system and into our insurance systems to cover the costs of the outcome at the end of the line. We need to go upstream and work on some basic prevention, and that means, quite frankly, mothers and fathers across America have to work on these issues of teaching their children to be responsible for their own bodies, making sure that we, as Members of Congress, are talking about these issues, but making sure as we monitor how money is spent we are much better off looking at ways that funding could be given to communities, programs, to schools, to hospitals to help make sure we are working on prevention of obesity rather than paying the high costs at the end of the line for so much of the increases in health care because obesity has continued to climb. Now, with obesity often comes behavioral disorders as a matter of fact. Many a child I saw in my clinical practice as a psychologist oftentimes came in a child who was well overweight, teased by their peers, struggled with this on top of their other physical problems. They oftentimes got in this downward spiral, less activity, more socially isolated. Perhaps they were teased by other kids, the butt of jokes, a sad condition, and many of these children also suffered problems with mental health. What happens in the area of mental health is sometimes in this Chamber and our Nation, we look down upon it from a couple of different angles. We see perhaps mental health problems are some sign of softness, that perhaps people should be a little tougher, take it on the chin, not be so sensitive. Sometimes I am not sure we have advanced from the days of the Salem witch trials, and blame those who suffer from mental illness and say somehow you should have done more. Sometimes we ridicule those who are on medication. Jokes still abound on television calling people crazy, loony, out of control, retarded, in derogatory terms, for something that we continue to see in this Nation as a sign of weakness instead of a real disease. Again, if we are going to deal with things in the health care area, to truly reduce costs and deal with patients, we have to understand in the area of children's mental health psychological disorders are real. They are not made up. They are not indications where someone is weaker and ineffective. There is a very strong and consistent scientific basis to say that the myth of psychological disorders and psychiatric disorders has to be debunked. Kids do have real problems. Adolescents have more problems. Adults have even more problems, and all these grow when we do not deal with these problems at an early level. There are biological and environmental causes. It is interesting, you can have some children face tremendous difficulties in their life and they do not seem to show problems in mental outcomes, but that does not mean that those who do have problems are simply weak. Just like some of us may be exposed to the flu, some of us may eat different, and be around those who smoke and never develop any symptoms at all, where others are susceptible to them as part of their own biological genetic makeup. Again, it does not mean they are weak or ineffective. It means a combination of the biological and environmental factors that caused this. You cannot simply say if we take care of these environmental causes it will never occur. Sometimes people say, well, maybe it is poverty that causes some of these difficulties with mental illness, and that is not the case at all. Depression, bipolar disorders, attention disorders, anxiety disorders occur at all lines of children. Boys sometimes have more than others, but there is this link between biological and environmental causes. Boys have more problems, for example, with attention disorders. Girls may have different symptoms with depression, but in all cases we also see there is a commonality between parents and grandparents having some of these diagnoses that I mentioned for anxiety, bipolar disorder, attention disorder, depression and their children. Not always children, but certainly some where you have significant environmental stresses and reactions which interact. We may see, for example, as the outcome of the hurricanes in the gulf coast that there will be some children who live through tremendous trauma, and they may have some post-traumatic stress reactions, but it may never reach the level of post-traumatic stress disorder. It becomes a longer term debilitating factor, exhibited, for example, as such things as depression, trouble concentrating, nightmares, et cetera. It may never reach that level because they may in their own biological factors have resilience, but their family may be there to support. The other things here is to understand that psychological disorders do respond to treatment. This may be pharmaceutical; that is, medication, and it certainly is also matters of counseling and therapy. This is not just a matter of talking to someone, giving common-sense ideas. This is a matter of very strategic, scientifically based things such as cognitive behavioral therapy to work with patients. We know, for example, that children with depression respond fairly well, pretty well, to some of the talk therapy or counseling to help them understand strategies to deal with problems in their life, recognize the symptoms and do their own intervention themselves to change those symptoms. But we also know when people move from moderate to more severe levels of depression, medication, it is pretty darn helpful and sometimes almost necessary for them to have that. It does not help when we have movie stars out there saying there is no such thing as mental illness, an irresponsible statement. It does not make things go away just because you wish it to be so. I do not want situations put upon our country where we see that, again, people from Hollywood are saying, well, there is no such thing as mental illness, and therefore, we do not treat it. That is wrong. We do know that they can respond to treatment, and it is important we continue to fund in areas of Medicaid and everywhere else, Medicare, psychological, psychiatric treatment because it is helpful. We also need to, however, carefully evaluate the treatment, the planning and follow-up assessment of these. I will give you a couple of examples. Last year, there was a lot of discussion about some anti-depressant medication, and when some children took it, there was a higher risk for suicidal thinking, suicidal ideations we call it. What did not come up in those discussions are a couple of important factors. One, 75 percent of psychiatric medications are prescribed by nonpsychiatrists. They may be highly qualified physicians. In many cases, they may be general practitioners, pediatricians, family doctors, obstetricians. Seventy- five percent, however, and they may or may not be doing the other follow-up that is necessary. What anti-depressant medications do is they can change a person's mood. They can help change the chemical, biological reaction that a person's central nervous system and brain of how they process stresses that can lead to the debilitation of depression, but it does not change the way a person thinks. That is why it is so important that we make sure we are funding programs that also provide the psychological therapy for children to help them understand what these thoughts are, to help them change the way they are thinking about the world so as they start to feel better they do not have more suicidal risks. Interestingly enough, one of the things we oftentimes taught medical students in medical schools is once patients start getting better with symptoms of depression, the risk for suicide may increase because the support systems back off and they say Johnny's feeling better, we do not need to have him in the hospital or do not need to be around him as much. Perhaps people are no longer monitoring the person 24 hours a day. They start to go back to school, face more stresses. As they are getting their energy up, as they are back in the world and thinking if we do not change the way they think with depressive thought patterns, if we do not interrupt that and change it, you can actually increase the risk for suicide. That being the case, we have to make sure that as we are looking for more effective ways of spending money, the taxpayer dollars in Medicaid and Medicare and Head Start that we are working comprehensive care with the patient, with mental illness as well, such problems as I said before about bipolar; that is, manic depressive illness, attention deficit disorder, anxiety disorders, all of these with a strong genetic component and elements where we can make huge changes in people's lives. It is something that we need to make sure we are no longer just criticizing about overprescribing or perhaps saying that too many kids are getting stimulant medication with attention disorder; we should or should not do this. Here is the crux of this. It really is a matter of having accurate diagnosis and treatment and making sure that we are not overmedicating or undermedicating our children. Somehow in this Chamber we politicize this to somehow think we are doing something wrong in both areas of the conservative far right, the liberal far left, somehow accuse maybe there is some conspiracies involved in this, and there is not. It is a matter of making sure the physicians have the training to deal with this. They are interacting a comprehensive care model, a patient care model, disease management model, together with people of various professions and working closely with the families. We see this in the area of children's health when you start to look at so many aspects here that you really can make some huge differences. I would like to point to a couple of things here and then call upon the gentleman from Georgia (Mr. Gingrey), my colleague, on a couple of questions. But one of the things to keep in mind about depression, which is one of the most common mental illnesses affecting more than 19 million Americans each year, that it can cause longer lasting forms. You can lose pleasure in life, complicate other medical conditions, can lead to suicide, but it is also associated with many other medical issues. For example, cancer has a higher incidence of depression, stroke. Diabetes, people with diabetes have a 25 percent chance of having depression. That is higher than the rest of the population. Depression also affects as many as 70 percent of patients with chronic diabetic complications. People with heart disease, 40 to 65 percent of them will have depression, and what is interesting is untreated depression in these patients can lead to complications, such as the health care costs can double. Now, I ask the gentleman from Georgia (Mr. Gingrey) on this, he certainly treated many a patient who had medical complications as well as some of the psychological ones, and I would like to ask him, in looking at some of these more comprehensive chronic care models, of how we need to be moving forward in a modern system of health care and not be just looking at individual disease, but how looking at more advanced forms of bringing technology and changing the system, how he sees that affecting the patient in a cost-effective way.

Mr. MURPHY. Mr. Speaker, I am joined by my colleagues this evening to talk about Children's Health Month. It is very important for all families in our Nation, and certainly an issue that concerns all of us on both sides of the aisle. While the rhetoric of the House often echoes through these walls about cuts and people being harmed, it seems to me that is the only part of the discussion that we are taking away. Little offers are made in terms of what is needed. What we do often hear is discussions of who is paying. Should individuals pay, insurance companies be taxed more, businesses be given tax cuts, perhaps health savings accounts, association health plans, or just have the Federal Government take over? But this should not just be an issue of who is paying, for although that is important, and how much we are paying is important, really much of this comes down to what we need to have is an open discussion of what we are paying for. According to the National Center of Health Statistics, 83 percent of children in this country under 18 years of age have excellent to very good health. That is good news. Now 17 percent of America's children are in less than favorable health, either to mild or severe levels. We have to make sure we do all we can to help these children have a better health future and help the rest remain healthy. According to the American Academy of Pediatrics, 6.3 million uninsured children, over two-thirds of all uninsured children in America, are currently eligible either for Medicaid or for the State health insurance programs, but they are not enrolled. There are many opportunities. I know the State of Pennsylvania, where I represent the 18th Congressional District, really has very good services and insurance for children of a low income level but we need to make sure that we expand enrollment and get those kids beyond. For those who are uninsured or underinsured but beyond the level of Medicaid, there are several things that we should be looking at to make sure that they get the health care they need to maintain their health to prevent higher expenses for emergency care. But what this means is not just more discussions on we are cutting money out of Medicaid or other aspects. Look at what has happened to the growth of Medicaid. In 1995, and this is for all ages, Medicaid spent $150 billion. We are now up to $300 billion. About half of Americans are covered by some level of Federal insurance or health care. But the system is growing, and the concern is it is growing out of control. While we are looking at such things as how do we pay for Hurricane Katrina's outcome in this devastated gulf region, how do we take care of so many needs, is it fair to just continue to say to the American people we are going to continue to spend more without finding ways of eliminating waste and fraud and abuse? Let me give an example. The New York Times wrote recently about an amount of some $4.4 billion in Medicaid fraud in that State. One dentist billed for over 980 procedures in one day. Clearly these were patients that were actually being seen. Another company used van rides for supposedly disabled people, billing those rides to the government. But these people when followed by a reporter clearly were not disabled. They walked around just fine. There is example after example after example. I believe the American taxpayer wants to make sure that this waste, this fraud, this abuse is removed from the health care system. But it is not just a matter of that. When it comes to our children, we also have to make sure the system works with these programs in ways that optimize the health and outcome. One of the things that I want to talk about today, along with the gentleman from Georgia (Mr. Gingrey), is transforming our health care system. We oftentimes use a tongue-in-cheek quote around here that says one of the definitions of insanity is doing the same thing over and over again and expecting different results. Indeed, in the health care system where so much money is used inappropriately and wastefully, we ought to have some changes. From the Center of Health Transformation, they say we have this current health care system and we are trying to come up with some reforms within the network. We try things like so much money is going to pay for diagnoses. We ask for some procedures to be done inpatient and outpatient, all within that system. What happens is if this system does not change, it will lead to some decay. The system cannot continue to go the way it is. Anyone who owns a small business or a household cannot continue to operate the way our health care system operates. When we go into hospitals, inpatient/outpatient, you will see the latest equipment, the greatest skilled personnel, MRIs, PT scans, CT scans, but very often we also see that data is kept on patients on pieces of paper. We have 21st century health technology kept on 16th century monitors. What happens, people slip through the cracks. The wrong prescriptions are ordered. Tests that are done have to be repeated because someone cannot get them. I was talking to one of our colleagues today and he was telling me how a sonogram was done of his wife who is pregnant, but he cannot get it from here back home to his wife because he has to carry it manually. It cannot be e-mailed. We take e-mails for granted, but doctors have to wait for papers to transfer locations. What happens? Can we come up with some real changes to really help our children? Yes, if we switch to an intelligent health system that uses electronic prescribing, electronic medical records, real patient care management for our children rather than having a system that gets bogged down and collapses of its own expense and weight, we can come up with success for our children and no longer be mired in failure. Let me describe a little bit about what we mean by managing the whole patient. A lot of what people think happens when they have an individual or chronic disease is something common, like diabetes or asthma in a child, the doctor will examine and make sure that the child has the right medications, watches their diet and the environment around them, and hope all goes well. As long as the parents are monitoring that carefully and there is communication between doctor, nurse, patient and child, you can have a pretty good system. What happens if the information does not get to the parents, the patient education is not quite there? Maybe they skip a prescription, maybe they did not pick it up on time, maybe they do not fully understand all the elements of diet and medications for complicated diseases. What does that mean? You can end up with chronic diseases, repeat tests, many hospitalizations, emergency care may be required, increasing medications, going from doctor to doctor who may not know the other medications the child is on, leading to further risks, and all of this costs unnecessary money, unnecessary time in hospitals, increases the risk for harm, and what happens, we end up paying for it. About 10 percent of the cases that show up in an emergency room are someone who has no ability to pay, but it is estimated that 60 percent or more, 60 percent or more of patients who show up in emergency departments are nonemergencies. If in such cases the care was given ahead of time, whether it is through a community health center, a clinic, direct patient care with a physician, if we monitored and kept a careful eye on those children with chronic conditions, we could save massive amounts of money. This is not cutting care, it is improving care. Emergency care can cost five to eight times more than outpatient care, and we can actually save billions of dollars in the system. This is where we can find savings, and in so doing we save lives as well as money. But this means we use a chronic care model and not the inefficient going to a doctor, another disease, go to another doctor. What this involves is not just the health system, it really involves the community, the resources. What takes place, the support systems, the families, the individuals helping to make sure they are watching their children, they are educated and they know what to do. It is making sure we have a delivery system involved with making sure doctors are notified if someone does not pick up their prescriptions. A lot of this can be done with electronic prescribing notification. It is making sure that clinical information systems are there so that if X-rays are done, procedures and tests are done, that information is communicated back to the doctor. One study I looked at said something like 14 percent of the charts reviewed the physician found that they were missing some important data. Perhaps the physician referred the patient on to have some testing done, and it was never done. In the majority of these cases, the doctor said it would affect what diagnosis they had and future tests called for. This is not a matter of just saying we are going to cut care, this is improving care. But this also means that clinical information systems must be there. They are a critical component of health care, of having the physician and nurse and family work together. What does that do? It is a matter of having productive interaction between everybody involved. You have an informed, active patient and you have a prepared, proactive practice team. No longer the passive system, the doctor says here is your diagnosis, here is your prescription, good luck, call me if there is a problem. If that prescription is not filled, there is a call from the doctor. It is a system of interaction between the patient and doctor to make sure they are going back and forth. Mr. Speaker, I am not talking about things that take place only in families that have access to computers and finances to do this. A lot of this is done in areas of low income levels, of high risk populations where we really find it is much more affordable. What we need to be looking at here as Congress is when we are reviewing such things as the Medicaid system, it is not just saying we are going to lop off $8 billion or $10 billion and see what happens. It is a matter of doing more effective work. Much like a household that says our spending is going out of control, they do not just say let us not spend any more. Every small business and family does this. They look at what they are spending, but you have to change some of your habits and make habits more effective. The system that seems to be adapting the slowest is our health care system, perhaps because we just keep doing the same thing over and over again and expecting different results. What the Federal Government is going to do and what we are doing here in the Republican Conference is asking those questions and demanding some answers of changing some of that system. What I would like to do is call upon the gentleman from Georgia (Mr. Gingrey), who as an obstetrician has worked with many families, particularly in the area of prenatal care. One of the critical areas in cutting costs and being more effective in health care is dealing with prenatal care in an effective and positive way. Mr. Speaker, I yield to the gentleman from Georgia (Mr. Gingrey) to talk about these aspects of prenatal care, and he can tell us about some of the elements of saving money by doing more effective patient care management.

Mr. MURPHY. I am reminded of the story of the fellow who was on his hands and knees late at night under a streetlight in the city, probably had too much to drink, and a police officer sees him and says: Excuse me, sir, what are you doing? The gentleman says: I am looking for my car keys. And the police officer says to him: Well, where did you lose them? He said: I lost them down at the end of that dark ally down there. And the policeman says: Well, why are you not looking for your keys at the end of that dark ally over there? And the gentleman says: Because there is more light over here. Sometimes I think the way we look at these medical issues, instead of looking at the cost savings involved with prevention, we simply are able to look at how much it costs us up front because it is easier to find that data. It is tougher to pay attention to prevention. My colleague brought up some great points. Prenatal care, Early Head Start, Head Start, what that contributes to in helping save problems. We talked about community health centers and spending money. I like the President's plan of a community health center in every county in America where there is poverty and an uninsured, can help reduce emergency visits by four-fifths, the cost of the emergency visits. It is an incredible amount of savings, but not one that we can get those scores for. And it is one of those things where, unfortunately, the political rhetoric comes through in this Chamber, and I do not know of anybody who has ever been cured by a floor speech, but it certainly is one where there is just so much talk that continues on, spending too much here, spending too much there. We need to pay attention to spending too much. The problem is not what we are spending, but what we are spending it on. And if we are continuing to spend on wasteful or fraudulent or abusive or simply health care issues that are not taking care of the disparity of outcomes between, for example, low socioeconomic families, families that are struggling to make ends meet and feel they do not have the money to pay for their doctor visits, and those that may be in poverty, we need to work on those disparities of outcomes and make sure that we take care of those children early on; and that is why the issue of community health centers for our kids is so critically important. But, again, some will say we are spending too much, causing the budget to go up, and we cannot get the proper numbers. Now, some of the public that may be listening is wondering why we are even talking about the CBO. But that is, unfortunately, the way this Chamber operates now and that people oftentimes look at those numbers. We have seen tremendous inaccuracies in those numbers. My colleague from Georgia spoke about those inaccuracies when it came to looking at things such as the death tax and them being off over $1 trillion in their estimates. But also it is one of those things in health care, too. Think about this: if you take a medication that costs you $50, but it may prevent you from having a heart attack and further hospitalizations, surgery, disability, workers comp, losing your job, having the family require other care, that is a massive amount of cost savings. But, instead, we may focus on only that aspect of the cost of that medication, instead of all the other costs that are saved there. When we look at what we are doing with children's health, it is so critically important that we look at the big picture here as well. Now, I am going to see if my colleague has any final comments to make in this area of health care. Barring that, I just want to mention a couple of final comments here. We are certainly the stewards of the people's money, and although we are not here to take the place of the family, we are here to do sometimes what Abe Lincoln said. President Lincoln said, ``Governments should do that which the people cannot do for themselves.'' Now, in the areas of such things as food and consumption, people and parents ought to be watching what they eat. Well, what we also ought to be doing ourselves is working along with physicians and schoolteachers and people in the community to make sure our kids are healthy and safe and exercise and eat right. But we also have to make sure we are working at comprehensive care, real patient care models, that involves nutrition and exercise and prevention and mental health, and integrated care of all of those things together. If we are truly going to do what is right and decent and honorable for the next generation, it is a matter of doing what is right in health care. It is a matter of pooling our resources together and looking at the answers, to be science-based and not emotion-based on this. The science tells us we have things we can do, but we are not yet doing. The science tells us when it comes to managing the disease it is not appropriate to just look at that individual disease, but to see how it operates in the context of the child and their family. This is true compassion. This is where we will save lives. This is where we will save money. This is where if we do things like looking at electronic medical records, and make sure that every hospital around the Nation has this, and providers and pharmacists have these, you can find out these things and work on them together. That is what takes place in States like Nebraska and other hospitals around the Nation. We have here an opportunity to make a huge difference, to save lives by the hundreds of thousands, and to save money by the hundreds of billions of dollars. We have that opportunity before us. The question is, will we have the courage to work together in a bipartisan manner to do it? My hope is that our colleagues drop the gloves on this, put down the swords, stop looking for opportunities to send out sound bytes and to have people make phone calls and use it as political fodder, but instead to be able to look our constituents in the eye and say when we were all here, when we were all granted the authority to do something about America, we took an opportunity to save lives and save money, and we ought to start with our children. I thank my colleagues.

Mr. MURPHY. Also, it is related to, my understanding is yet so many other aspects come from this that you may find in such children also eating disorders and diabetes and cancer risks even if that child never themselves smoked cigarettes. But the risks are huge. I believe a direct and indirect medical cost of smoking in this Nation is about $138 billion per year. Of course, another reason why I believe it is so important not only for the government but really for individuals and businesses to focus so much on helping to change that is the State of California, for example, estimates that their statewide tobacco prevention program during the 1990s resulted in overall cost savings of $8.4 billion in health care. That is pretty remarkable. Again, unfortunately, the way the Congress scores things with the Congressional Budget Office, when we talk about starting programs that would actually save money, my colleagues are aware of this, we never can get an accurate measure of what it actually saved because of the way the CBO, the Congressional Budget Office, scores things. It is not how much you save, but how much you spend. So if we would do similar things that would lead to a smoking cessation during pregnancy, and it might cost X number of dollars, the CBO would score that but never tell us how much money it would save over time. That is something that frustrates all of us because the things we are talking here tonight really require some expenditures to get these savings. Businesses are picking up on this. A recent review of health promotion and disease and management programs in businesses that provided health education to their employees, including exercise, health-risk screening, weight control, nutrition information, stress management, disease screening, and smoking cessation, found a significant return in investment, saved about $1.50 to about $5 for every dollar spent in the program. For example, Motorola, their wellness program saved the company about $4 for every dollar invested. Northeast Utilities' program in its first 24 months reduced some of the claims by about $1.4 billion. Caterpillar Company, they had a program that saved about $700 million. Johnson and Johnson's health and wellness program saved about a couple hundred dollars per employee per year. What is interesting here is how much we can save and what we have to look at here. And I call upon my colleagues, we need to make some fundamental changes in how CBO scores these things. We have got to stop just looking at how much it costs up front and look at how much it saves in the long run. Again, I look at such things as if we are able to have more people go to federally approved health centers, community health centers in their community instead of showing up in the emergency departments, yes, it may cost money; the President called for a couple billion dollars to put into those community health centers. But if it is one-fifth of the cost of going there rather than the cost of going to the emergency departments, that is a massive cost savings. Certainly I call upon my colleague, too, it is one of those things you have seen as well, how do we get these prevention issues begin to be scored. It is of fundamental importance to health care.

Mr. MURPHY. I thank the gentleman. I asked about another issue, too, which is one that is so critically important for children. My colleague from Georgia had mentioned before, during pregnancy, smoking being one of the risk factors. I believe that the sad statistic is that the Pittsburgh region has some of the highest maternal smoking rates during pregnancy in the Nation. My understanding is a lot of complications can come when you have a mother who smokes during pregnancy. Certainly an important part of prenatal care for our children is understanding the importance of helping a mother to stop smoking during that time. I wonder if the gentleman can comment on some of the complications that might come for that mother and that baby not only during labor and delivery but the long-term effects for that child when the mother smokes during pregnancy.

Mr. MURPHY

Mr. MURPHY. Mr. Chairman, I thank the chairman for yielding me this time. Mr. Chairman, opponents of this legislation have said we do not need this bill. They said, we need a debate on health care, and I am pleased to engage in that debate. I am reminded of the book that talks about everything I need to know in life I learned in kindergarten. I have learned a few things here. Lawsuits do not lower obesity rates. Lawsuits do not improve the nutrition habits of children. Lawsuits do not reduce the $127 million annual medical costs that our Nation incurs on obesity-related conditions in children and the increase in obesity rates. Mr. Chairman, parents need to teach their children at early ages to eat healthy meals and to establish exercise routines for their families. School districts need to make sure they have gym classes and serve the right kinds of food as an option. Proper diet and exercise will help reduce medical complications that are increasingly common in children, such as hypertension, diabetes, high cholesterol, and heart disease which were once found almost exclusively in adults. In my years working as a psychologist and oftentimes consulting with courts, I have yet to find a court that can replace a parent. When will we learn we cannot litigate compassion, we cannot mandate common sense, and we certainly cannot legislate personal responsibility. H.R. 554 will do more than restrict lawsuits against food and manufacturers for weight-related cases. It forces us to take personal responsibility for ourselves and our families and put a priority on establishing healthy lifestyles. Here are the facts. If you touch a flame, you are going to get burned. If you eat a lot and do not exercise, you are going to gain weight. We need to take personal responsibility for that. The bill before us directly protects individual freedoms of all Americans from a tiny minority who try to exploit the legal system for personal gain. I strongly support H.R. 554, and I commend the chairman for his work.

Mr. MURPHY

Mr. MURPHY. Mr. Speaker, failure to take prescription medications properly accounts for approximately 125,000 deaths, and an additional $100 billion per year in preventable hospitalizations, emergency department and repeat physician visits. Twenty-three percent of nursing home admissions and 10 percent of all hospital admissions result from patients failing to take medications properly. Why do they skip their medications? Some forget, some want to save money, some did not believe that drugs were effective. Some doubted they needed to take them, or experienced unwanted side effects. Much of this can be solved by improving communication between doctor and pharmacist and patient. Under the new Medicare bill, pharmacists will manage and monitor medications for patients with chronic illness. These programs have the potential to save billions of dollars and thousands of lives each year. It is a welcome addition to the Medicare bill and one that will help many seniors. To learn more about the careful adherence to medication therapies and how they can save lives and money, I would encourage my colleagues to visit my Web site at murphy.house.gov.

Mr. MURPHY

Mr. MURPHY. Mr. Speaker, we find ourselves with so many things happening now. We have increased gasoline prices, increased winter heating costs, natural gas prices are up, manufacturing jobs are down, all because the cost of energy has remained high. Our demand for oil has grown, our production simply cannot meet demands, and this has caused increased prices. We have increased population, and we want more manufacturers to remain in the United States. That means that we have to do something. Mr. Speaker, we do not need another hurricane to remind us that our energy infrastructure is wholly inadequate. Had we taken action to prevent our energy problems years ago, we would not have been vulnerable to natural disasters. For 30 years, we sat back. We did not want to study it. We did not want to take inventories. We did not want to explore. We resisted drilling for oil or gas. We did not build refineries. We did not move to develop clean coal technology. We did not build nuclear power plants over those 30 years, while demand grew. And eventually the system snapped. We did the same thing over and over again and expected different results. Until our refining capacity and production capacity expands, our oil markets will remain vulnerable to disruptions. We have to have increased conservation measures. We have to have the car-pooling measures in this bill. We have to have energy-efficient cars, but we have to have more refineries. During the last 30 years, our dependence or foreign energy has increased from 24 to 62 percent. How much further do we have to go? The American people understand this, and that is why they support this. That is why labor unions support this bill. That is why we have to move this forward. The Gasoline for America's Security Act builds on the Energy Policy Act of 2005 and keeps us moving in the right direction. It addresses a great deal of what we need, the use of biomass debris, car pooling, van pooling, requirements to direct the FTC to conduct an investigation into nationwide gasoline prices, and it does include anti-price-gouging measures. The other side says repeatedly it is not in there, but it does. It has anti-price-gouging measures and enforcement for gasoline, for diesel, for home heating oil, for crude oil. It is massive. There will be a temptation to blame the high gas prices on the storms alone or to use politics to block this. But the American people understand, you cannot drive a car with politics in your tank or heat a home with politics. I support the rule and this bill.

Mr. MURPHY

Mr. MURPHY. Mr. Speaker, I thank the chairman for the time. There are two points I would like to make here. First of all, with regard to the amendment, let us understand what is in there. If there is concern for giving large amounts of money to oil companies, what they propose we do is that the Federal Government gets in the business of, quote, designing and constructing refineries and then put that into use at times in their national emergencies or sell gas to States, which this bill actually allows States and governments to have some of this gasoline now, but for the government to own and operate refineries and invest all the money in there. In the alternative, if we can provide incentives for private industries to build, whether it is something small or large refineries, that makes a lot more sense. And if we are concerned at all about the budget, let us do the more efficient thing, rather than have the government run these things, have them sit mothballed until times of emergency, and then suddenly act like there is a switch one can throw and start them up. The second thing I want to point out is that I wish we could have included some important movement forward to make some changes on new source review. What happens now with a coal-fired power plant, for example, if they want to go in and do some routine maintenance, and while they are in there maybe improve the efficiency of the plant, the EPA comes by and says, no, you are going to do something different here. Even though you are going to improve efficiencies, we want you to do everything now. The energy company comes back and says we cannot afford those larger investments; we were going to make some smaller ones, so, therefore, we will do nothing. What they have done, instead of using the abundant supply of coal, we have 300 years' worth of coal in this Nation, they will move to natural gas instead in order to meet some of those standards. Natural gas means we have more demand, the costs go up, it affects homeowners in the price of heating their homes, and it affects our chemical industry. The Unions for Jobs and the Environment have sent a letter, and I will submit this letter as well for the Record, which states the efficiency and competitiveness of our facilities and the safety of our workers hang in the balance. This is a jobs and safety issue for millions of American workers. And they go on to say that delaying the new source review issue is costly to jobs. So I want to make sure that we address this the next time when we get on to more of these energy issues. The letter referred to is as follows: Unions for Jobs and the Environment, Washington, DC, October 5, 2005. Re: Support for Section 106 of H.R. 3893 Hon. Joe Barton, Chairman, House Committee on Energy and Commerce, Washington,

Mr. MURPHY

Mr. MURPHY. Madam Speaker, I thank the gentleman for yielding back. And before I yield back to the gentleman from Texas (Mr. Carter), I just want to mention one other thing too because while we are talking about these protections and hearing the tragic story that the gentleman from Georgia (Mr. Price) mentioned, another bill that I put in, H.R. 1313, is one that would also help us with the uninsured and underinsured. One of the issues the President has committed to putting more funding in is community health centers, community health centers where people pay a sliding fee scale supported by the local community which provides more close access for people who are uninsured and underinsured. We have situations there where physicians who were paid or hired by these clinics are covered by the Federal Liability Act where they may not go in front of a jury trial, but the judge will decide what happened if there was a problem there. The sad thing about it is if a physician, if a nurse or psychologist or podiatrist or dentist wants to volunteer in those settings, they are not covered. So it happens we have a huge shortage of health care providers when at a time we could be expanding because many providers would like to volunteer their time at community health centers. A big example is the problems that just occurred down in the gulf coast with the hurricanes. Many people wanted to volunteer at community health centers, but if we do not provide some of these protections to make sure they can provide excellent health care and be there, we will not have enough. So that is another area I certainly urge my colleagues to help us pass. With that, there are many other issues to cover tonight.

Mr. MURPHY. If the gentleman will yield, there are a couple of points that I want to draw upon the judge's knowledge and experience, as well as that of the prime sponsor, the gentleman from Georgia (Mr. Gingrey). There are two elements that are important to note. One, this bill does not preempt, if States have their own caps on punitive damages, or noneconomic damages. If States have higher or lower limits, out of respect for the Tenth Amendment, States' rights, the Federal law would not preempt that in any way, shape, or form, which is very important. It also deals with the issue of joint and several liability, as I understand. That is to say that sometimes what happens is someone will go after what is known as the deep pockets. If a person is only a couple percent responsible for something, perhaps the hospital would be sued, even though the hospital had a very, very limited role in something, or a doctor with a very limited role, maybe just another surgeon who was asked to come in and check up on the patient but that may be the person who has the most coverage, so they would sue that individual. This really protects them and makes sure it is based upon their actual responsibility in the case. Am I right on that?

Mr. MURPHY. Madam Speaker, if the gentleman would yield, a question on that. Another question is what if the patient perhaps needs rehabilitation costs, other medical care, would the gentleman point out what this bill does if a person has ongoing medical needs as a consequence? My understanding is it does not limit it and the patient could get that ongoing care.

Mr. MURPHY. Madam Speaker, if the gentleman would yield, I would like to say to our colleagues, ask him to point out a couple of the issues here. In particular, let me raise one that some people say. Does this bill protect physicians who may perhaps be practicing out of their realm of expertise or really doing wrong? Does this allow these physicians to continue practicing?

Mr. MURPHY. Madam Speaker, I thank the gentleman for yielding, and I thank the gentleman from Georgia (Dr. Gingrey) as well. We are talking about medical liability reform tonight, and my background as a psychologist is one that I think it is incredibly important to support these issues, because in my career, I have so often dealt with the problems that have stemmed from difficulty with accessing medical care. Let me tell my colleagues two stories. One is a story of a place in rural Pennsylvania where a woman went into premature labor. Now, because of the dearth of OBGYNs in her town, they drove in their car about an hour and a half to a nearby hospital, taking considerable risk to get up there. The baby was born premature. It would have been best if she would have had the care in a local hospital, but she did not have that. And children who are born premature oftentimes are at higher risk for several developmental disabilities. It is a sad thing to think that children sometimes cannot get that immediate access to care, because those first few minutes of care for a newborn baby are so critically important when they are premature, high-risk, low birth weight, maybe the mother was eclamptic, pre-eclamptic, and those first few minutes can mean the difference between a child who has some severe problems, a child who has mild problems or a child who has no problems at all. As I would do developmental follow-up with so many of these infants, it is of increasing concern to me that when there is not sufficient medical care there nearby with OBGYNs, or anyone else for that matter, you cannot get the patient the care they need then, and that baby cannot be treated by a lawsuit. That does not make up for what occurred because a physician was not around and the physician is not around because in Pennsylvania, like so many other States, about 20 other States listed at risk for this, has seen such a decrease in physicians. Another story: A hospital where several cases have occurred where people have gone into that hospital suffering from a stroke, but there were no neurosurgeons on call at that hospital because of the high medical liability costs for these neurosurgeons in that State. So patients had a certain kind of clotting that needed to be broken with a line through the femoral artery or a catheter, as it were, into the carotid, and these patients then had to be life lifted to another hospital. Again, those minutes when someone is having a stroke are critical and can mean the difference between life and death. In a number of those cases, sadly, those patients died. It was not from lack of good health care that was available; it just was not available at that hospital because the doctors were no longer able to practice in that State or in that region. Bills like H.R. 5 are extremely important, and we have passed it a couple of times in the House, and we have to continue that. But what happens is that, in so many States, we are far from being able to do that on our own. Pennsylvania, for example, has a constitutional provision there that would query that State even if it started moving forward a number of years to take care of that. But ultimately our concern has to be for better patient care. And some look upon this and say are we looking at caps on punitive damages or changes of venue and other sorts of legal issues here that somehow are going to protect the physician who is not practicing well. As one trial attorney I heard say, the trouble with medical malpractice is medical malpractice. Certainly, none of us want to see situations taking place where we are protecting problems that occur. All of us, whatever branch of health care we are in, are dedicated to making sure patients have the best care. But when you cannot get a doctor, you cannot get the care, good, bad or otherwise. And so the issue is how we make sure we have the availability of that health care. Listen to a couple of these points: one in three medical residents in my home State of Pennsylvania stated in a survey they would leave the State after completing their medical residency because of the lack of affordable malpractice or medical liability insurance. In addition, 71 percent of residency program directors reported a decrease in retention of medical residents in Pennsylvania. As a result, more and more doctors are practicing defensive medicine. And only about 4 percent of our physicians in key areas, such as obstetrics, gynecology, orthopedic surgery, neurosurgery, only about 4 percent of physicians in Pennsylvania are under age 35. As others doctors retire, we are going to continue to have this; and that is why we have a crisis, no longer just brewing, but really some significant shortages. Let me mention one or two things that we are working on as part of this, because all of us in the health care field and all of us in the House have to be focused also on patient safety. Some of the issues before us are also what Secretary Leavitt and the President are pushing and that is for reform for how we keep track of medical records. Electronic medical records is a system whereby patients' charts are kept in secure and confidential electronic records and computer systems so physicians can access them. And at the moment they are reviewing these charts, it is no longer a matter of trying to find the pages in the charts which may be scattered in different places, no longer a situation where lab results never quite made it, no longer a situation where the doctor has to call for repeat tests because he cannot find the x-ray or the CT scan or the MRI. It is accessible to him or her, and thereby not only does it save money because tests do not have to be repeated, but it can call to the attention of the physician significant findings. One study that was published last year found about 14 percent of medical records are missing some data. For example, a physician may have called for lab tests, never got in the chart, perhaps the patient did not follow up and have it done. And a physician said in many of those cases it would change their diagnosis and what they would call for for treatment of those patients. Does it save money? You bet. A Rand study report published a couple of weeks ago said if we move toward electronic medical records and electronic prescribing, we could save health care in America about $160 billion a year. And with the improved efficiency and with the reduction in absenteeism in the workplace, those numbers could go up to over $300 billion a year. Now, while we are facing an era of looking at ever-increasing health care costs, where small businesses cannot afford them, or individuals and families are wondering if they are going to be able to cover those health care costs, by doing such things as electric medical records and prescribing, we can actually provide the venue whereby physicians, everybody in the health care field, could keep better track of what is happening. One of the troubles is with the fear of liability, strange as it is, many times hospitals are concerned if they start gathering more of this data to show them where the problems are, what they should begin to review, how they should change, for example, infection rates, et cetera, they are concerned that someone is going to come in and grab those records and start suing everybody before the hospital can start to make some changes. We have got to present a situation here where physicians and nurses and hospitals and administrators and patients are all working together towards patient safety. But to that end we not only need the patient safety issues; we also need the physicians practicing. And I am joined tonight by another one of our colleagues, the gentleman from Georgia (Mr. Price), who is also going to be able to speak from his own experience on these issues and how it is critically important. So I would now like to yield as much time as he may consume, if I may, to the gentleman from Georgia (Mr. Price).

Mr. MURPHY

Mr. MURPHY. Mr. Speaker, I am pleased to introduce the Wood Stove Replacement Act of 2005. I am joined in the introduction by Representative Melissa Hart. Quite simply, our bill would provide a tax credit of $500 for individuals and families who replace their old, dirty, uncertified wood stoves with new, EPA-compliant, clean-burning wood stoves or fireplace inserts. As America's cities and counties struggle to come into compliance with the National Ambient Air Quality Standards set by the U.S. Environmental Protection Agency, smaller and more diverse sources of pollution are regulated. The primary air pollution problem in many areas of the country, including Pittsburgh, is particulate matter. Particulate matter, or soot, is caused by burning fuels such as coal, as well as wood. On December 17, 2004, the EPA designated nearly two hundred and fifty counties in the U.S. as out of compliance with federal air quality standards for ``fine particulates'' (particles under 2.5 microns in diameter). EPA has concluded that wood smoke from residential wood combustion appliances, fireplaces and wood stoves, is a significant contributor to fine particulate pollution in many of the designated counties. In 1986, EPA established a New Source Performance Standard, or NSPS, that imposed strict limits on the wood smoke that can be emitted from wood burning stoves, and it implemented a program for certifying the performance of wood stoves that comply with the standard. EPA-certified wood stoves reduce wood smoke emissions by as much as 90 percent. According to the EPA, ``certified wood stoves burn more cleanly and efficiently, save [. . . .] money, reduce the risk of fire, and improve air quality inside and outside [the] home.'' It is estimated that there are as many as 10 million old, uncertified, pre-NSPS wood stoves still in use in American homes. Fourteen thousand of them are in my area in Pittsburgh. Many of the uncertified wood stoves still in use today were purchased at the height of the fossil-fuel crisis in the 1970s. Many were installed in lower income, rural residences with ample access to free or low-cost wood fuel. The installed cost of new, certified stoves can be as high as $2,000 to $3,000, which is out of reach for many users of the old, uncertified units. To encourage users of old, dirty-burning units to trade up to new certified stoves, strong incentives must be provided. Local regulations prohibiting the use of uncertified woodstoves are politically unpalatable unless financial assistance is provided to enable homeowners to abide by such prohibitions and keep their families warm in the winter with low-cost, renewable wood fuel. According to the EPA, ``Helping areas of the country reduce pollution and meet national air quality standards for fine particles is our top priority . . . By combining local programs like clean wood stove installation with tough new federal regulations on power plants, cars, trucks and diesel equipment, we can dramatically reduce fine particle pollution and improve public health across the country.'' Our legislation to provide a federal tax credit for the replacement of uncertified wood stoves is an important way to reach consumers who otherwise may never replace their old stoves. This credit would only be available to consumers who live in areas designated as out of compliance with the fine particle and total particulate standards. A $500 tax credit would give consumers living in poor air quality areas an immediate incentive and necessary financial assistance to remove their old stove now. By using the cleaner stoves, consumers will save on fuel costs by burning one-third less wood and reduce fine particle pollution in their area thereby improving their health and the health of their families and neighbors. The need to encourage consumers to burn cleaner, more efficient woodstoves is an urgent matter. The record-high costs predicted for home heating this winter will likely push many consumers to choose more affordable wood heating. With nearly 10 million old, conventional, dirty wood stoves still in use today, it is imperative that consumers have an incentive to change out their old appliances for clean, more efficient, and EPA-certified wood stoves. Representative Hart and I are introducing this bill to coincide with an EPA event in Pittsburgh on September 29. That will be National Wood Stove Change-Out Day, where EPA encourages owners of old stoves to trade them in for new, certified units. The incentives in this bill should help accomplish this goal.

Mr. MURPHY

Mr. MURPHY. Mr. Speaker, smoking during pregnancy is associated with low birth weight in babies, preterm births, and perinatal deaths. Low birth weight babies often suffer complications such as underdeveloped lungs and require special care and longer hospital stays that can cost up to $2 billion annually in increased health care costs. As the children grow up, they are at increased risk for other health problems throughout their young lives. The Centers for Disease Control and Prevention found that if pregnant women on Medicaid receive counseling that reduces smoking, millions and perhaps billions in excess Medicaid health care costs could be avoided. This extends widely as we cover other areas to help reduce smoking. Congress needs to continue to provide health care organizations with data on the cost effectiveness of cessation services to encourage private plans and government-funded plans to cover smoking cessation. By reducing maternal smoking during pregnancy, we can save not just one but two lives at a time. I urge my colleagues to visit my Web site at murphy.house.gov to learn about more ways to save lives and to save money by reducing health care costs.

Mr. MURPHY

Mr. MURPHY. Madam Speaker, 4 years after the passengers and crew of United Airlines Flight 93 gave their lives to save others, Congress recognized their heroic actions by passing legislation calling for a permanent memorial in the U.S. Capitol. The presence of mind and strength they exhibited on September 11, 2001 averted an even greater tragedy in the Pittsburgh region. As passengers and crew of Flight 93 called their loved ones and quickly learned of their fate, they knew what had to be done. Looking out the plane's windows that clear day, they saw our homes, our schools, and our communities in southwestern Pennsylvania. Valuing human life, something their hijackers did not, they waited to act until they were over an empty field, sparing our lives. Their goal of averting tragedy in our Nation's capital was realized, but in their final moments, they were also thinking of us. For their actions that day, families throughout southwestern Pennsylvania hold a special place in their hearts for the passengers and crew of Flight 93. Prayers of thanks go to them for giving their lives to save so many. I encourage every resident of the 18th Congressional District visiting Washington, DC to take time to stop by the memorial after its completion and honor Flight 93. We have our lives, our families, and an enduring example of the human spirit for which to thank them.