Allyson Schwartz

Ms. SCHWARTZ

Ms. SCHWARTZ. Mr. Speaker, finding a uniquely American solution to ensure that all Americans have access to affordable, meaningful health coverage must also ensure adequate access to health care providers and services. Primary care providers are on the front line of our health care system, treating acute and chronic problems and keeping costly conditions from worsening. Yet, despite this essential role, it is primary care where we face the most acute shortages. Since 1998, the percentage of residents choosing primary care has dropped from 50 percent to 20 percent. By 2025, America will have a shortage of 46,000 primary care providers. I am very proud that the provisions in the health care reform legislation that is moving through Congress will address this impending crisis. It provides scholarships and loan repayments to primary care providers. It increases payments for primary care services. It eliminates copayments for Medicare beneficiaries who seek preventative care, and it creates incentives for doctors and nurses to coordinate care for patients with multiple chronic conditions. These are significant reforms that will improve access to primary care, that will improve health outcomes, and that will improve health care costs. We should support better health care for Americans by supporting health care reform.

Ms. SCHWARTZ

Ms. SCHWARTZ. Almost 50 million Americans are without health coverage. Many millions more worry about the stability of their coverage, that they will lose coverage or that at a time of accident or illness their insurance will not cover critical needs. In my home State of Pennsylvania, families have seen a 100 percent increase in their health premiums since 2000. Nearly one in five Pennsylvania families pay more than 10 percent of their income on health care, and American businesses are struggling with increasing premiums, forcing them to pass on more of the cost to employees or to drop coverage all together. The Federal Government is the largest payer of American health care costs and currently paying nearly half of the $2.5 trillion health bill. And while costs keep rising at a rate faster than inflation, health outcomes for Americans are not improving. The status quo is simply unacceptable. Inaction is unacceptable. We must move forward in offering a uniquely American solution to strengthening and reforming our health care system. Health care reform means making difficult decisions. Without congressional action, there will be higher costs and greater uncertainty for all of us. It's time to act.

Ms. SCHWARTZ

Ms. SCHWARTZ. Mr. Speaker, I rise today in support of the Statutory PAYGO Act that we are hopefully going to pass today. Pay-as-you-go, or PAYGO, rules as we talk about them are fairly straightforward. Congress should pay for any new spending. There is a strong bipartisan history of support for PAYGO. In fact in the 1990s, as a result of statutory PAYGO, this country saw record deficits transformed into record surpluses. Sadly, when those statutory PAYGO provisions expired in 2002, the former administration, with support from a Republican-controlled Congress, ignored the common sense of paying for new spending and turned our surpluses into mounting national debt, doubling the debt in 8 years. But Democrats are serious about fiscal responsibility. In 2007, the Democratically controlled House set PAYGO rules, making a commitment. Again, any new spending would be budget neutral. And this year, we have reaffirmed this commitment to our rules, and we are determined to meet the President's goal of cutting the annual deficit in half in 4 years. And now with the support of the current administration, we are reinforcing our commitment to fiscal responsibility by giving PAYGO the force of law. As vice chairman of the House Budget Committee, I know how important it is to make wise, targeted investments for our future in energy independence, in health care, and economic growth; but we must do so in a deficit neutral way. To do so, we must ensure that any new spending is paid for. And that is what we have done when we passed the energy bill. That is what we're doing as we move forward on health care reform, and it is what we're doing as we move forward, of course, on spending bills. The statutory PAYGO is smart budgetary policy. It is common sense, and most importantly, it will guarantee our Nation's fiscal security. I urge support for fiscal responsibility for the future of our country and for our debt reduction by voting ``yes'' on statutory PAYGO.

Ms. SCHWARTZ

Ms. SCHWARTZ. The introduction of health care reform legislation marks tremendous progress toward meaningful health care reform for all Americans. As a member of the Committee on Ways and Means and a centrist Democrat, I worked to ensure that this legislation is built on American assets of innovation, competition, private-public choices, and shared responsibility. I authored core provisions to increase access to primary care and strengthen consumer protections in the private market, both of which are key to improving the quality, efficiency, and reducing the cost of care, while improving health outcomes. These provisions will increase the number of primary care doctors and nurses, increase reimbursement for primary care, and coordinate care for patients. Copayments for prevention and primary care will be eliminated for all Americans. Insurance companies will be prohibited from excluding coverage of preexisting conditions and will be required to explain coverage in plain language. As Members of Congress, we have a shared responsibility to contain health costs for families, businesses and the government, while ensuring that every American has access to affordable, meaningful, stable coverage. The status quo is unacceptable and unsustainable. Now is the time to act.

Ms. SCHWARTZ

Ms. SCHWARTZ. Mr. Speaker, finding a uniquely American solution to our Nation's health care challenges means expanding access to high quality health coverage, containing health care costs, improving the quality of care and achieving better health outcomes. To achieve these goals, we have to think in new ways about how to bridge the current system's fragmentation, encourage coordination and promote collaboration by health care providers. Meaningful health care reform requires that we expand delivery of care models that encourage teamwork among providers, improve efficiencies, and ensure that Americans get better value for their health dollars spent. This includes patient-centered medical homes and greater access to primary care. We should also expand opportunities for doctors and hospitals, including those based in community and academic medical centers, to design, implement and evaluate such models of care delivery. I have introduced the Health Care Innovation Zone Program Act to create and expand these innovative models of care. When we provide incentives to payers and providers to work together to improve care to communities of patients, we will undoubtedly see better health care, better health care outcomes and lower costs for all of us.

Ms. SCHWARTZ

Ms. SCHWARTZ. I rise today to address the importance of primary care and comprehensive health care reform. As we move towards creating a uniquely American solution in which all Americans have access to affordable, meaningful, stable health coverage, we must remember that insurance alone means little if patients do not have adequate access to health care providers and services. Primary care providers are on the front line of the health care system treating acute and chronic problems, preventing diseases, and keeping costly conditions from worsening. And yet, despite this essential role, it is primary care where we face the most acute provider shortages. Fewer and fewer medical students are choosing primary care. Since 1998, the percentage of internal medicine residents declined from 50 percent to 20 percent. By 2025, America will have a shortage of 46,000 primary care providers. I have introduced the Preserving Patient Access to Primary Care Act. My proposal takes a comprehensive approach to addressing this problem, bolstering our primary care workforce and improving primary care services, providing scholarships and loan repayments, increasing payments for doctors, and eliminating copayments for Medicare beneficiaries seeking preventative care. I encourage all these provisions to be included in health care reform.

Ms. SCHWARTZ

Ms. SCHWARTZ. I rise today in support of the Enhancing Small Business Research and Innovation Act. Ingenuity and innovation are key to the U.S. economy. In Pennsylvania, the bioscience industry employs more than 77,000 people in good-paying jobs. The industry develops lifesaving pharmaceuticals, medical equipment and devices that are important here at home and around the world. In order to develop these important technologies, these companies need access to early capital to move their products from the research phase into commercial development. Small business programs, particularly SBIR and STTR programs, are important tools for our country's entrepreneurs to bring their ideas to market; however, under rules established by the previous administration, companies with large investments from venture capital were ineligible to participate in the SBIR program. This ruling created an unfortunate situation where companies had to choose between utilizing these Federal business incubator resources or raising essential venture capital investment, both important to growing their business. The bill before us today overturns this prior policy and enables Pennsylvania and the bioscience companies and companies around the country to utilize these important Federal resources and seek private investment capital. Former Congressman from Pennsylvania, Jim Greenwood, and now president of the Biotechnology Industry Organization, has said this bill ``will help to ensure that small U.S. biotech companies have increased access to capital for meritorious cutting-edge, early-stage research.'' I urge my colleagues to support this legislation that will create jobs and keep American technology competitive in this global economy.

Ms. SCHWARTZ

Ms. SCHWARTZ. Mr. Speaker, on rollcall No. 492, had I been present, I would have voted ``no.''

Ms. SCHWARTZ

Ms. SCHWARTZ. Madam Speaker, during an absence yesterday, I regrettably missed rollcall vote No. 426. Had I been present, I would have voted in the following manner: rollcall No. 426: ``no''

Ms. SCHWARTZ

Ms. SCHWARTZ. Madam Speaker, I rise today in support of the American Clean Energy and Security Act (ACES). This historic initiative will create jobs in new renewable energy industries and energy efficiency, reduce American dependence on imported oil, and decrease the greenhouse gas emissions that are causing global climate change. The growth of these new industries will enhance the ability of the United States to produce its own energy and reduce the need for oil imports from foreign countries. We currently import nearly 60 percent of our energy needs from abroad. This imbalance makes our country dependent upon foreign countries for the fuel that keeps our economy running. It is estimated that ACES will reduce U.S. oil consumption by 2 million barrels per day by 2030. Growing our domestic clean energy industry and reducing our use of foreign oil will have an important tangible benefit--reducing the greenhouse gas emissions that are causing global climate change. The Nobel-Prize winning Intergovernmental Panel on Climate Change has determined that significant reductions in greenhouse gas emissions, like carbon dioxide, are necessary to mitigate significant environmental consequences. ACES meets this challenge by creating a framework to reduce U.S. emissions 83 percent below 2005 levels by 2050. ACES accomplishes these goals while limiting costs to businesses and the consumer. The nonpartisan Congressional Budget Office has determined that implementing this bill would cost the average household about 48-cents per day. ACES also includes assistance for energy- intensive manufacturing industries like steel, cement, and glass to ensure that these industries remain economically competitive in the global marketplace as we strengthen our environmental laws and transitioned to clean energy and greater energy efficiency. I am proud that this bill includes a provision I spearheaded that will require the Environmental Protection Agency Administrator to create a national strategy to reduce carbon emissions through biologic sequestration. Carbon dioxide can be absorbed from the atmosphere into plants, trees, and other vegetation through the natural process of photosynthesis. My provision would ensure that we utilize natural landscape and green infrastructure to maximize our ability to remove carbon from the atmosphere through a determined strategy for reforestation, improved agricultural practices, and urban greening. This important legislation defines new energy goals for our nation and enables us to lead the world towards a clean energy future. For businesses and families back home it identifies a way forward to not only reduce harmful carbon emissions but to create new economic opportunities, new ``green'' jobs, conservation and energy efficiency, and alternative, cleaner sources of energy. Together these actions will better ensure our nation's security, economy, and health. I urge my colleagues to vote ``yes'' on this important bill.

Ms. SCHWARTZ

Ms. SCHWARTZ. Madam Speaker, during an absence yesterday, I regrettably missed rollcall votes No. 365, No. 378, No. 388, and No. 395. Had I been present, I would have voted in the following manner: Rollcall No. 365: ``no''; rollcall No. 378: ``no''; rollcall No. 388: ``yes''; rollcall No. 395: ``no.'''

Ms. SCHWARTZ

Ms. SCHWARTZ. Mr. Speaker, I rise today to add my voice to all of those who have denounced the hatred and violence in condemning yesterday's tragic attack at the U.S. Holocaust Museum and to extend my thoughts and prayers to the family and friends of Officer Stephen Johns. Racism, anti-Semitism and other forms of hatred are not new. Sadly, they continue to impact too many people here and around the world. As a child of a Holocaust survivor, I know all too well the destruction and suffering that hate can bring. This same kind of intolerance that my mother faced in Austria in the 1930s still feeds the actions of foreign terrorists and domestic hate groups. The United States Holocaust Memorial Museum is more than a museum--it feels like a sacred space. It is a place that enables us to acknowledge and remember the horror that was the Holocaust--and it is a place for reflection on the horrific consequences that hate can bring and a reminder that we must remain ever-vigilant against hate's many manifestations. Yesterday's despicable act reinforces the need for the important work done by the Holocaust Museum. We all have a role to play in combating bigotry and intolerance wherever it may be, and it is a sad reminder of the work we still have to do that yesterday's tragic crime occurred so soon after President Obama's historic trip and his strong rebuttal of those who deny the Holocaust. So it is with a heavy heart that I join my colleagues in offering my sympathies to the family of Officer Johns, and that I commend the work--the wonderful work, the important work--of the U.S. Holocaust Memorial Museum, and that I pledge to do my part in never forgetting.

Ms. SCHWARTZ

Ms. SCHWARTZ. Mr. Speaker, I rise this evening to begin what I hope will be a Special Order time with my colleagues. It's a little earlier than we thought, so we're going to see as they make their way to the floor. Hopefully they will be joining me. But, as you know, there has been a great deal of discussion about health care reform. We just heard a Special Order now from my colleagues on the other side of the aisle talking about health care reform and some of their thoughts about it, and I think sometimes we focus very much on controversial issues and some of the difficult decisions we have to make as we move forward, and let me start with what we're trying to do on health care reform, on this. What we want to talk about tonight is some of the very important work we want to do as we really meet the President's goals. He has laid out to us the goals for health care reform, and they are really threefold. They are to make sure that we contain costs. The fact is that our businesses have said to us that the high cost of health coverage, providing health benefits for their employees, has gone up almost double digits every year. And what that really means is that we have doubled the cost of health care benefits to our companies in the last 10 years. That's unsustainable for our businesses, whether they are small businesses that are trying to be economically competitive in their communities or very large businesses that are really functioning on the global marketplace and really competing with companies that are in countries where health care is not an individual employer's responsibility and where costs are more controlled. So we know it's an economic competitive issue. There's no question about that. We also know that it is an issue for government. I serve on the Budget Committee. The costs, and we talk about this, for Medicare is really unsustainable if we don't do a better job of containing costs and improving quality and improving outcomes for our seniors. We're going to talk more about that this evening. But we also know that it's a huge problem for our families. We hear all the time from our constituents about families that have break in coverage and then suddenly find themselves faced with buying a family policy with a preexisting condition, someone in their family with a preexisting condition, and the cost of that policy, if they can find one, is too high for them to be able to afford. Typically, I know in the Philadelphia area, a decent insurance policy costs anywhere from $12,000 to $15,000 a year. Well, a family that's earning even $50,000, $60,000 a year, after paying their mortgage and paying their expenses and maybe trying to save something for their children to go to college and meeting all the taxes, local and State, really just don't have those kinds of dollars left for them to find $12,000 to buy a decent policy. So they're shut out, completely shut out, which is really a very significant problem when they want to go for health coverage. So we know cost is absolutely a major issue for our businesses, for our families, and for our government. So what can we do about it? How can we actually ensure that we will contain costs and improve quality and also be able to extend coverage for the 47, almost 48, million Americans who do not have ongoing health insurance coverage? And the fact is we can do numbers of things, and we have been working hard on this to make sure that we create the kind of market reforms that will enable people to buy meaningful coverage that is affordable for them and that they will have the kind of coverage that will really matter. We also know that we need to make some real changes in the delivery system. And, again, that's what we are hoping to focus on tonight. And what I mean by that, if for all of us who go to see doctors and nurses and spend time at all in a doctor's office either for ourselves or for our loved ones, we know, and our numbers bear this out, that, in fact, we tend to go to more specialists. We have very fragmented care. What we don't have is access to a primary care provider who knows us, who follows us, works with us when we get a serious disease, helps us know what it is that we need to be doing, helps us comply with recommendations, and really also helps us sort through if we need to see numbers of specialists. So whether you are basically fairly healthy or have a major health care crisis or a chronic disease, we know that we cannot only get better quality care, help improve health status for all of us and each of us, but also contain costs. And I'm happy to give you some of the numbers that we have in terms of some of the primary care shortages. We often talk about primary care physicians, but the fact is we also have a shortage of nurses, nurse practitioners, physician assistants, and so many of the health care providers that really should be there for us and want to be there for us but there is simply not enough of them. The Council on Physician and Nurse Supply says the United States may lack as many as 200,000 needed physicians by 2020. So here we are saying that we want you to go see the primary care physician or nurse practitioner. We don't want to go to the emergency room. Look at the Massachusetts experience where they really worked very hard and effectively to extend coverage to the uninsured. What they found was people were still going to the emergency room because there simply were not enough primary care providers or clinics or community health centers in their communities for them to go to. Let me go on with some other numbers, if I may. They estimate that there could be a shortage of 800,000 nurses by 2020; 46,000 of those physicians and nurses need to be primary care providers. The U.S. population rose 31 percent between 1980 and 2003, but the number of medical school graduates remained the same. So the population is growing. We're looking at a 30 percent growth in population, and the number of physicians is the same. And what is so interesting about that is I think for a long time we've heard we have enough physicians but they're just not in the right place. Well, I think we've gotten that a little bit wrong. There are simply not enough primary care practitioners, physicians, or other practitioners. Interestingly, the number of medical students who are choosing primary care is steadily declining. Even amongst those who are specializing in internal medicine, I will say that in 1985, half of all internal medicine residents chose primary care; now only 20 percent do. I was at a press conference this morning with Congresswoman Kathy Castor and Congressman John Sarbanes and a young woman who has just graduated from osteopathic school. And she talked about the statistics, and she said that most medical school graduates graduate with almost $200,000 in debt. Their first job as a resident, and still training actually, is usually paid about $40,000. So how do you train for another 3 or 4 years, make $40,000 a year, and pay $200,000? That's just medical school. You may have a course debt from college as well. So it is a major issue going forward to make sure that we have more primary care physicians. Older Americans also are seeking primary care services twice as often as other age groups. So as the population is aging, and we know the baby boomers are coming, and we are talking about them, of course, in terms of Social Security, but the fact is we know that as we are aging and needing more health services, it is very, very important for us to have access to primary care providers. Let me also talk about one of the reasons we need primary care providers, and that is all of us, but particularly those with chronic conditions. We think about needing health care when we get sick and have an episodic experience where we might need to go to the hospital and might need to see a physician, might even end up in the emergency room. But for many people, they have chronic conditions, and they need to have an ongoing relationship with health care providers so that they can get the kind of care they need, get the advice, get the right prescriptions, and then be able to work with their medical practitioners to be able to comply with that advice and to be able to make sure that they are healthy. And the number out there is that only 50 percent of Americans who do get health care comply with the recommended health care that they're told to comply with. So obviously we need some work here. This is a shared responsibility. This is not only a responsibility of those who pay for health services and are reimbursed for health services and those providers but, of course, for patients as well. So let me just say on chronic conditions, some of these numbers may surprise us. But the five most costly chronic conditions are cardiovascular disease, cancer, diabetes, asthma, and mental health disorders. Over 133 million Americans suffer from at least one of these chronic diseases, and over 75 percent of all Medicare expenditures can be attributed to patients with five or more chronic conditions. Just 10 years ago, these beneficiaries accounted for only 50 percent of the Medicare costs. So something's wrong. We have to fix this problem. We have to make sure that people can hopefully prevent some of these chronic disease. We might be able to do that in a number of ways. I know there's a lot of discussion about wellness programs for prevention. We have seen some very good models. Particularly some of the larger employers, smaller employers, some of the insurance companies are really working hard to try to incentivize people to eat right, to exercise to be able to prevent some of these conditions and some of these conditions from worsening. But clearly we have a long way to go and we have much work to do to make sure we, again, help folks with chronic diseases be able to be healthier, to get better, to not have the disease get any worse. And, of course, in that process it will save them money and it will save all of us the high cost of taking care of patients. Any of us who has ever visited a renal dialysis center knows that if we can do more to make sure that somebody who, for example, is diagnosed early as a diabetic follows the prescribed treatment, does try to eat right, exercise, really takes care of themselves, and gets good consistent health care and can prevent themselves from becoming more seriously ill and, of course, going into any kind of renal failure and needing renal dialysis is something that would save them many problems and would save us all a lot of the costs involved. Just a few more numbers because I think they're pretty telling. Chronic conditions cost American businesses nearly $1 trillion each year in lost productivity. We don't even think about the number of dollars that are lost as workers take time off for serious illnesses. About $125 billion of this is due to lost workdays, and the balance is due to diminished capacity while they are at work. So for businesses it's not only the cost of the insurance and the benefits, but it's also a cost when their own workers are not being able to really work at the full scale of their potential and their capacity. So we know that we can do more. Economic conditions, the health benefits, really taking serious action to make sure that we have enough primary care providers, and that we do a much better job of coordinating care for those with chronic diseases will really have a dramatic impact on the health status of Americans and on the cost to all of us. And that's really what we want to do. I think that we have heard some others talking earlier about the need to do medical research. We believe very strongly in that, and we have already made a very good commitment to doing that by putting $10 billion more into NIH. We did that in the Recovery and Reinvestment Act, and that was very significant. Of course, we want to see better treatments and we do want to see cures. That takes dollars for medical research and a real commitment to the science of biomedical research into some of the new products and devices. But it also takes prevention and it also takes better coordination of care. Patients with chronic diseases need to have access to primary care providers. We talked a bit about that. We need to be able to make sure that they get good ongoing chronic disease management. And I have introduced legislation. It's House bill 2350, and I have to say it's got enormous support here in the House, 100 cosponsors. I'm very proud of that. And many others are looking another it, and I have only introduced it just a couple of weeks ago. The idea of that legislation is to make sure that we preserve patient access to primary care. And one way to do that is to increase the number of primary care providers by increasing the number of residency program slots for primary care. We're going to hopefully do that. And for more nurse practitioners and more nurses in this country. That would be very helpful. But another concept, and I see another colleague of mine is going to join us, which is just great, but just to finish this thought, there's also reimbursement for a concept called ``medical home.'' This isn't a place. This is a group of services. It's a commitment on behalf of the provider, the doctor, the nurse practitioner, the physician assistant to be able to provide a medical home so that you know you have ongoing care, particularly when you have a chronic disease. And we can talk more about that going forward. But I want to thank my colleague for joining me. I see Congressman Jason Altmire has joined us. He's also from Pennsylvania, from the other side of the State, from a community, Pittsburgh, which is known for its medical care, medical schools, and it has a lot of health care providers. But I bet and would imagine that Congressman Altmire has some of the same experiences I do, that while we have great quality health care, it is also too often fragmented and is too often not accessible and too often not affordable for too many of our constituents. So we're here tonight to talk about health care reform, particularly the commitment that we're making as we move forward on health care reform to expand and extend access to more Americans, to make it more affordable. It also means a commitment to fixing our delivery system, and that means a commitment to primary care. I want to thank Congressman Altmire for joining us, and I welcome his comments.

Ms. SCHWARTZ. Would the gentleman yield for just a moment? I think, when some of our constituents hear some of those words, they really want to know--and I think that's one of the things that we're really interested in pursuing here. They want to know: Well, does it mean I'm going to get less health care? Does it mean I'm not going to get what I need? Does it mean I'm going to go to the emergency room, and they're going to turn me away? The fact is we're trying to be smarter than that. We want to say no. What we're saying instead is that we want to make sure you get the right services when you need them. I'm sure you hear from constituents who find that they don't go to emergency rooms because there simply aren't doctors in their communities. I remember when I was growing up that there was a general practitioner down the street. We all went to him. I'll bet there's no general practitioner there anymore. I know, in parts of my own district, we've seen some hospital units close. We've seen doctors' offices close. It just isn't the way medicine is practiced right now. The truth is, with reimbursement to insurance companies and with what we've done under Medicare, we've not created any incentive for doctors or nurse practitioners to go and open offices in small communities and provide those kinds of services. Instead, we've encouraged them to become specialists, to really do the fancy kinds of things. While we need them and while we want to make sure we have those specialized physicians there and available for us and while that has got to be covered, if we only cover that, if we only focus on that, we've really forgotten sort of the simple things, you know, which are: How do you really talk to patients and make sure that they understand what they need to do? How do we actually make sure that we have a shared responsibility instead of a patient's saying: Oh, I'm sure I can just go and get a pill for that. Wouldn't we all love that, to be able to take a pill and we'd all be fine. It takes more personal responsibility, and it takes a patient-doctor relationship. That's often what's missing is that ongoing relationship with primary care providers--that's both physicians and nurse practitioners--and it's one of the things we want to address. I'm sure that the gentleman has heard the concept of medical homes. Maybe you'll want to talk about that, about the idea of an ongoing relationship, about the fact that we're really interested in this health care form of creating a new opportunity to reimburse primary care practitioners for that kind of ongoing relationship with patients so that they know which specialists to see and so that they can help people sort through the many medications they take. I was just going to give you one number, which my staff gave me earlier, which I was really quite struck by. It said that medical beneficiaries with 5 or more chronic conditions see an average of 13 different physicians per year and are prescribed an average of 50 different prescriptions. That's a lot to sort through if you're not an expert. It really is. Think about actually having someone you can talk to and say: Wait a minute, do I really need to take these? Should I still be taking these? Shouldn't I? You know, who do I ask about this? I'm sure you've heard some of these stories from your own constituents and probably from some of your own providers as well.

Ms. SCHWARTZ. If the gentleman would yield, I appreciate very much your raising the issue of health information technology. You're absolutely right. The health industry has been so slow to really be involved--to really use the computer, to use information technology--in a way that so many other industries have been. As any of us know who started out in our professional careers not using computers, I think we sometimes were slow or were anxious to do it. We were nervous about that. I remember someone who worked for me a number of years ago who resisted it completely. She said: Don't be silly, I know exactly what I'm doing. I take notes. I do fine. We finally told her she had to use a computer. We just told her that we were doing it. Just a few months later, I remember the computer system went down, and she was like: Oh, my goodness. How can I function? Well, you can imagine this in health care, which has been so paper- driven and so labor-intensive, the idea that physicians would have this at their fingertips even within their own city or even within their own medical practice sometimes. I was talking with a medical practitioner who said: Sometimes--I don't know--a patient could have been in my office, seeing another doctor the day before, and because the notes weren't transcribed yet, I don't know happened--or 3 days ago. Another example: A patient who is just visiting Geisinger health system in Pennsylvania--a great model. The primary care physician has the ability to see the hospital records while patients are in the hospital. So they don't have to wait 3 weeks for specialists who saw them in the hospital to write them a summary, have it dictated and mailed to the primary care physician 3 weeks later or 4 weeks later. It turns out those 3 or 4 weeks are incredibly important, after discharge, for the patient to be following the advice of the physician and knowing what to do. It's a very uncertain time. You need to be able to have contact with your primary care physician during that time, and the primary care physician needs to know firsthand what happened to you. An electronic medical record is extremely important in helping a primary care physician provide the right care for you and prevent a re- admission, which is a huge cost for all of us. We've talked a lot about that in terms of infections, but there are a lot of reasons people get re-admitted to the hospital. If we can prevent that by the right kind of home care, as you pointed out, or by the right care and attention from a primary care physician, that is not only going to help that person stay healthier, but it is also going to help that person get the care he wants. I know we talked about this, too, which is, in terms of improving quality, there are now critical protocols. We like to think that every one of our physicians knows exactly what to do for us. By and large, most of our physicians, fortunately, are pretty good. As for all of us, if you have to do five things for somebody when one comes to you because one has some particular health condition and you tend to do four of those five most of the time, you're probably pretty good. It turns out, if you actually do all five every time, your patients are going to be a whole lot better off for it. So, you know, maybe we're not used to the fact that the doctor might actually look that up on the electronic medical record and have to check it off, but it turns out that it really makes a big difference when you really did remember to remind one to stop smoking and when you really did remember to tell a parent to put a child in a seatbelt. I mean all of those things may not seem so directly connected to what a physician was seeing one for, but it enables the physician to make sure one gets the care one needs: Remind them about mammograms. It's time. If a woman hasn't had a mammogram for 3 or 4 years, maybe it's time, not to mention making sure that they take the right medications and follow the right orders. So electronic medical records are what--you're right--the new Dems have really championed, and we have, of course, a President who has championed it as well. We put in $19 billion in the Recovery and Reinvestment Act to really help push this forward in a much more ambitious way--the use of electronic medical records in our physicians' offices and in our hospitals and having them be secure, private and interoperable. It's absolutely key. I don't know if you wanted to comment on that or on other issues related to primary care or on other things that we can do with the delivery system that really will help us be able to contain costs and to give better care to people.

Ms. SCHWARTZ. I was going to mention something else, too, that I think that's a really important and good point is that one of the other points that we make that we're also trying to do in health care reform in terms of prevention and chronic disease management is that so many health policies that people buy, the up-front costs are really on them and so that preventative services--the screening, the early intervention, the simple doctor visits that can reduce the incidents of disease and keep you out of the hospital and keep you healthy-- sometimes that's what you have to pay out of pocket for. Some people say, Good. You should pay out of pocket. I think we have to understand what we're doing in health care reform is very much about a shared responsibility. We were talking about providing some subsidies for lower-income working people. Everybody is going to have to pay into the system. We're going to keep the employer-based system. We're going to help those who really are at a lower income be able to pay on a sliding- scale basis for health insurance either in the private system or public option. But the fact is that we should be creating incentives to get early care: not wait too long, not wait until they're sick, not wait until they go to the emergency room. And that's what we're going to do as well. So I did want to just finish up by saying that this health care reform effort that we are engaged in is complicated, but it's also very important. We want to make sure that, again, our businesses are able to continue to provide health coverage for their employees, that families can afford it if they're on their own, and small businesses or individuals can afford to pay for health care, and that government can continue to meet our obligations under Medicare for our seniors, something so important. And we're only going to be able to do that if we do a better job of incentivizing, providing reimbursement, for delivery systems, medical providers, doctors and nurses, and all of the many health care practitioners that are so important to us. We have to make sure that they have the reimbursement, they have the tools to be able to provide the care in the right settings in the community to help us, have the information we need, have the right medical device to work with us to be healthier. At the end of the day, our hope, I believe, is not only that we will extend coverage, not only that we will contain costs, not only that we will improve quality, but at the end of the day, Americans will be healthier. And if Americans are healthier, we will, in fact, contain costs and be able to afford to make sure that we have no child in America without health coverage, that we don't have families who are bankrupt as a result of health coverage, that we don't have families worrying every day because they have one family member with a chronic disease and they can't get insurance and that they can't act responsibly. That is certainly something that we want to do. It's a goal that the President has set out. It's a goal that many of us have worked for years on. We're working hard right now to make it happen, and I look forward to standing on this floor to have the opportunity to vote for comprehensive health care reform that will contain costs, that will improve quality, that will help enable every American to have access to affordable, meaningful health coverage in this country. I yield back the balance of my time.

Ms. SCHWARTZ

Ms. SCHWARTZ. Mr. Speaker, I move that the House do now adjourn.

Ms. SCHWARTZ

Ms. SCHWARTZ. Madam Speaker, I rise today to honor and congratulate the Women of the Water Works upon the completion of the extensive restoration of the Fairmount Water Works. What was once one of the most popular tourist attractions of the 19th century will again enchant and educate both Philadelphia visitors and residents. The Water Works began operation in the 1790s when a yellow fever epidemic hit Philadelphia. People blamed the disease on the filth that coated city streets and looked for a way to deliver drinking water and wash roads. Construction on the Water Works began in 1812, and after three years, clean water was being pumped to the homes of Philadelphia. In ten short years, the Water Works was pumping over five million gallons of water daily. This engineering marvel was praised by many tourists and admirers, including Mark Twain and Charles Dickens. In 1909, the Water Works was closed due to pollution in the Schuylkill River. In 1976, the Water Works was recognized as a National Historic Landmark by the U.S. Secretary of the Interior. Shortly before the announcement, the Junior League of Philadelphia initiated a campaign to preserve this treasure. Since that time, other organizations have joined the effort to return this landmark to its former status as a prime recreational, educational, and historic attraction. By the turn of the 21st century, Women for the Water Works spearheaded a $26 million project to restore the Water Works, as well as to incorporate a new Interpretative Center. The Interpretive Center opened its doors in 2003 with a mission ``to educate citizens to understand their community and environment, especially the urban watershed, know how to guide the community and environment in the future, and understand the connections between daily life and the natural environment.'' In 2008, the Women for the Water Works reached their fundraising goal of $5 million for the final phase of the project, bringing the total dollars raised to more than $28 million since renovations began thirty years ago. It is commendable that the funds raised are not only restoring the site for today, but will ensure that future generations will be able to enjoy the restored Water Works for years to come. I share with the Women of the Water Works and the people of Philadelphia a common concern about wildlife, the environment, and the preservation of natural resources, as well as a commitment to a sustainable, livable City and region. Madam Speaker, I ask that my colleagues join me in celebrating the Fairmount Water Works and thanking the Women of the Water Works who worked tirelessly to protect and preserve this special gem.

Ms. SCHWARTZ

Ms. SCHWARTZ. Thank you very much. I'm very pleased to join you. I want to acknowledge the really good work, Mr. Murphy, you have done in having these kind of dialogues on the floor and talking about health care and how important and how possible it is for us to actually find a uniquely American solution to the problems that are facing us, and to just reiterate a little bit, which is why we are here, why we are talking about this. It isn't only because it is a moral imperative; I know many of us have worked particularly on making sure Medicare works very well or extending health care coverage for children, the CHIP program which we all really worked so hard on, I know some of us in our States, certainly I did, back in Pennsylvania in 1992, but even here on the floor, making sure that children of working families had access in most cases to private health insurance, to affordable private health insurance. But the fact is that we are here because it is also an economic imperative. And we know that from hearing it from our businesses, small businesses and large businesses, saying that they cannot be economically competitive because of double-digit inflation and inflationary costs of health premiums for their employees. A business owner just told me the other day that their rates went up 40 percent from one year to the next. That is just not sustainable. So we need to address that because if they are going to be economically competitive and continue private health benefits where the cost-sharing is reasonable with employees, we have to do something about the escalation in costs in health care. And third, of course, is as a government we are spending money that is growing again in unsustainable rates under Medicare, and we need to contain the growth of those costs. And again I think I would reiterate what was said before is that we believe that Americans should have access to quality health care. They should have access to doctors, to be able to continue to have relationships with their doctors, ongoing relationships. But we also think that we can do three things. We have to be able to contain costs. And we can be smarter and more efficient and more effective in the way we provide health care in this country. And I will talk about that in a minute. But secondly, we have to improve the quality of health care. We actually provide a lot of health care. And not all of it is exactly what you need and maybe more than you need, sometimes less than you need. We have to get that right. And we can. And then we have to extend coverage to all Americans because Americans do put off health care that they ought to get. They go to emergency rooms because there isn't a doctor for them to see. And they often don't fill a prescription because they simply can't afford to. They don't follow the recommendations of health care providers. I agree with Mr. Courtney. We are here in a moment when we can find a way, where we can, in fact, contain the growth of costs, extend coverage and improve quality for all Americans. And that is what we want to do. We are going to do it in a uniquely American way, which means it will be very much a public-private partnership. And we will build on what works in the system, which is that most Americans get their health coverage through their employers, 55 percent of the insured get it through their employers. They will be able to keep that. Hopefully it will be less expensive for the employers. And for the group in particular that is so hard to access health coverage, these small businesses, individuals, they are going to be able to find a way to find affordable, meaningful coverage. Mr. Courtney didn't even talk about his preexisting condition bill, which is really very important in making sure that when you buy insurance to find out maybe years later that you don't have coverage for a condition because, in fact, they found some reason that this was a preexisting condition, is really just not acceptable anymore in this country. We should make sure that coverage is meaningful. I do want to just say on the delivery system, we have already taken a very major step forward in putting some real dollars into the system and under Medicare to incentivize our hospitals and our doctors to use electronic medical records. Interoperable--that means different doctors and hospitals can see what is going on, patients can see what is going on to them, go and check their own records potentially, which is a very exciting way to empower patients. Under Medicare, we are going to say that physicians and doctors in this country are going to use electronic medical records. And this way they won't duplicate unnecessarily tests. They will actually be able to find out if a patient filled the prescription and if they are taking the medication, and if not, give them a call and say, you haven't been back in 2 months, you're early diabetes and you really need to be taking this medication. You really need to be monitoring what you eat. And if you don't, you're going to get a lot sicker. Why don't you come in and we will talk about that? Wouldn't that be something if a doctor gave you a call and said that? One of the ways we can do that is making sure that we have adequate primary care in this country. And we don't. We don't have enough primary care providers. I just had a conversation with another Member representing a rural area. And he said, I represent a small town. There are not enough primary care doctors. I You know what, I represent a suburban/urban district and we don't have enough primary care doctors. This is a problem across this country. In 1998, half of the medical students were choosing primary care. Well, just now, we are actually looking at 20 percent choosing primary care, and they expect that number is going down. And so there is a reason why we can't find a primary care physician. They aren't out there. And while we all want to have our specialists when we need them, having the access to primary care is extremely important to making sure you get the kind of care that you need and that you get it in a timely fashion and that you have somebody help you figure out what specialist to go to and figure out what kind of care you need and hopefully help you stay healthy and help those, particularly with serious chronic diseases, have ongoing care. I see you all nodding. You're probably ready for me to conclude. But this is something I think people do as part of health care reform. As we move forward, there are a lot of different pieces. It is complicated. It is not going to be easy to do. We have to believe in each other that we can do this right and that we can get it right. And that is what we are trying to do. The next 8 weeks will be very important to the American people, to American businesses, to the sustainability of providing quality health care to Americans. I look forward to working with all of you to get it done.

Ms. SCHWARTZ. I just want to mention a couple of answers. I was also going to say it prevents people sometimes from leaving a job. Sometimes they say, you know, I don't know if my next job's going to have the same health benefits. Can I risk taking another job? And you have sort of a job lock in that situation. And, of course, as we know, because of the high cost, a lot of employers are passing it along, there's more cost sharing. But there are several answers to this. There's a bill that's been introduced, we hope to get done, that requires transparency in the language that's used in insurance policies. All of us are supposed to read that fine print. Well, I don't know how many of us really read the fine print. And the fact is that even if you do, you may not really know what it means until you're faced with the situation. So there's a bill I worked on with Congresswoman Rosa DeLauro, and it says about language, if it says, I'm going to cover hospitalization, well, it means the same thing whichever insurance company is selling it. So if you're going to look at that, you will know what's covered and what isn't and then be able to decide whether that's the kind of policy you want or not. The others we also--there's legislation that I also actively support that says that small businesses should be able to band together to use their purchasing power to buy insurance in the private marketplace. And third, something that we can do to help individuals as well as small businesses is to do something called community rating. So you say it's not this small business that has five employees, somebody gets cancer, well, they're rated on that experience. Their rates can go skyrocket the next year. What you can do instead is say we're going to tell the insurance companies sell insurance, but the records have to be set not on the experience of that small group but on the experience of the broader community. We're going to really spread that risk. That's how insurance is supposed to work. Share the risk more broadly, come up with a community rating system that's fair, that the businesses or individuals would pay but isn't, one by one, based on your conditions, your gender, your age, and to be able to go forward on that. We can do those things. Those are just changing the rules of the marketplace, and that will make it more affordable, more accessible for more Americans to be able to buy health insurance.

Ms. SCHWARTZ. Please.

Ms. SCHWARTZ. Just to reiterate, I think what we want to really be very clear with our constituents and with all Americans is that we are looking for creative ways to increase the choices and increase access. And again, it should be affordable. It has to be meaningful coverage. We have to make sure we have the delivery system that works. We also think that this is a shared responsibility. I certainly do. This is something that we're asking individuals to take some responsibility, employers to take some responsibility, we're asking insurance companies, and many of them are stepping up to the plate saying, We can do this. Many big companies are also saying, We're doing some really innovative work on prevention and health care for our own employees. We're encouraging them to walk and to eat right. And, obviously, I think we should do that for school kids and all of that as well. So there's not really a single answer here. The issue is how can we improve the delivery system, the health care system you encounter so you get the best kind of care you might, that we make sure we have the right kind of providers working at their scope of practice, as we call it, and really providing you with the right kind of care. But all of this has to work together. One of the reasons we're looking at all of these issues at once is because we know it makes a difference if we can contain costs, if we can get everyone coverage, if we can actually improve the delivery system, then all of us will be better off. But it takes--it's not really the government doing this alone by any means. We're hoping to be a trigger for some of this, and we have asked all of the stakeholders to participate. Yes, the insurance industry, the pharmaceutical industry, the hospitals, the physicians, and they've really been at the table, a lot of advocates for the different groups as well, and so have we. We all bring our personal experiences, some of them good, some of them not so good in the health care arena, but we all recognize that we could be without health care coverage. We could be without access to the health care providers that we need, and we never, none of us, want to be in that situation. And, unfortunately, it's true for too many of our neighbors, too many of our constituents. And it's about time for us to step up and say we again are going to find a uniquely American way to address these issues for our constituents and for our country, and we're all going to be better off for it.

Ms. SCHWARTZ

Ms. SCHWARTZ. Madam Speaker, I rise today to commend a constituent, Hershel J. Richman, who is being honored on June 7, 2009 with the ``Peace Building and Environmental Stewardship Award'' of the Friends of the Arava Institute. The Friends of the Arava Institute is a Pennsylvania-based non-profit organization that supports the Arava Institute for Environmental Studies in the south of Israel. This institute, which has the particularly timely philosophy that ``Nature Has No Borders,'' brings together students from Israel, Jordan, the Palestinian Authority and beyond to study common environmental concerns and to forge mutual understanding among tomorrow's leaders in that conflicted region. Given the special and forward-thinking mission of the Arava Institute, it is no wonder that a special and forward-thinking man such as Mr. Richman became involved with it. For decades now, Mr. Richman has been one of Pennsylvania's foremost leaders on environmental issues. A graduate of the Pennsylvania State University and the Villanova University School of Law, Mr. Richman has devoted countless hours to environmental issues, in government, in private practice, in academia, and as a volunteer. Mr. Richman and his wife Dr. Elizabeth Richman have been involved with the Arava Institute since they participated in a five-day, 300- mile bike ride through Israel sponsored by Arava in 2007. Madam Speaker, I have no doubt that Mr. Richman deserves this and many other honors in recognition of his commitment both to the environment and to the cause of Middle East peace. I ask that my colleagues join me in congratulating Mr. Richman on this honor.

Ms. SCHWARTZ

Ms. SCHWARTZ. Madam Speaker, I rise to mark a significant victory in my district for open space preservation in Pennsylvania and the United States. Yesterday, an agreement was finalized to permanently protect 426 acres of the 450-acre Erdenheim Farm in Whitemarsh and Springfield Townships. The conservation of this property will become the centerpiece of 2,000 acres of open space between Fairmount Park in Philadelphia and Fort Washington State Park in Whitemarsh, Pennsylvania. It will also ensure the completion of a regional trail network between Fort Washington Park and the Morris Arboretum that has been envisioned since 1899. Erdenheim Farm has been working agricultural land since the days of William Penn. It was purchased in 1912 by George D. Widener Jr, son of the streetcar magnate. In 1971, Widener bequeathed the property to his nephew, Fitz Eugene Dixon Jr. Mr. Dixon maintained the property as a working farm raising cattle, sheep, and thoroughbred horses until his death in 2006. The preservation of Erdenheim Farm is a remarkable example of the excellent work that can be accomplished through public-private partnerships leveraging local and state funds. There are many organizations that deserve recognition: the descendents of the Dixon Estate for their willingness to work with conservationists to protect the farm; Peter and Bonnie McCausland, for purchasing 259 acres of the estate and placing all but 23 of those acres under conservation easements; the Whitemarsh Foundation led by Hugh Moulton for its efforts to acquire 189 acres using $26 million in state and local grants, tax revenue, and private donations; the Natural Lands Trust led by Molly Morrison, for its expertise in putting this deal together and enforcing the easements on the land; and state, county, and local officials who also deserve immense credit for their willingness to secure the necessary funding to make this happen. I ask that the full House of Representatives join me in congratulating everyone that made this historic accomplishment possible. On behalf of the residents of Philadelphia and Montgomery Counties, I acknowledge and appreciate this important work and the opportunity it provides for future generations to enjoy this national treasure.

Ms. SCHWARTZ

Ms. SCHWARTZ. As the designee of Mr. Lujan of New Mexico, I have an amendment at the desk.