Floor Statements

Mr. Speaker, many are concerned about waiting lines that would come with a government health care program, and their fears are well-founded. Canada and Europe restrict care for patients, especially the elderly.

The President has outlined three principles for his bill: lower cost, choice and access. I support these goals; and to back them, the President should also endorse the Medical Rights Act.

Congressman Dent and I will introduce the Medical Rights Act tomorrow. Our legislation is founded on this: The Congress should make no law that blocks the decisions of American patients made with their doctor.

If patients are our prime focus, then their rights should be protected in law. If we do not enact the Medical Rights Act, patients will be at risk when the government denies care, as routinely happens in Canada.

Once denied government care, many Canadians find doctors in America. If Congress orders the government to take over America's health care system, then where will we be able to drive once denied from a government health care system?

To prevent the mistakes of Canada and Britain, Congress should enact the Medical Rights Act.

I would just like to raise this point:

As you well know from criminal law--and I think the code is section 5, U.S.C. 1001--lying to Congress is a felony. So the question will be: Will criminal charges be brought by congressional officials against CIA briefers for lying, as they've said, which is a felony--then we can expose that record, have a criminal investigation and possibly a trial--or are these empty charges and no criminal process will be put forward because there were no crimes, and the Speaker will not be able to back up what she said on national television, and will not come forward with any potential felony accusations? It seems clear to us that she won't, and that puts quite a light on the statements that she made before the country.

I yield back to the gentleman.

Mr. Speaker, when I returned home from Afghanistan, I have been spending the last several months on the health care issue and the need for reform in this country.

Before being elected to Congress long ago, I used to work for the American Hospital Association as a young researcher in their hospital research and educational trust. Now, with the service in the Congress and this background, I have been working for several weeks now intensively building a bipartisan and centrist agenda for health care reform. Our base for this is the Tuesday Group, 32 centrist GOP moderates, which I co-Chair along with Congressman Charles Dent. Tomorrow, we will outline a detailed health care reform agenda with 70 representatives of patients, doctors, hospitals, employer and insurer groups.

Our President has set three top goals for health care reform: to lower costs, to increase choice, and to expand access. But what model should the Congress use in providing the reform that our country needs?

I want to talk tonight to provide some details on key issues that we are facing to review comparisons of health care systems in the United States and among our key allies and then to discuss detailed centrist, bipartisan solutions that we could put forward--especially in Senate health care legislation--that could make its way to the President's desk.

First, on the details. Our system is built largely on private health care for people under age 65, and we have seen a tremendous explosion in defensive medicine. Defensive medicine is driving costs up in our country probably faster than other countries because, as you can see from this chart, the cost of defending across a lawsuit has been rising steadily in recent years, and this is unique to the United States. This chart alone shows that especially for obstetricians, gynecologists, and neurosurgeons, the need is clear for lawsuit reform to restrain the growth in medical costs, especially in health insurance.

This chart shows a comparison in the critical issue, which I believe that our top focus is not in health care costs but in health care outcomes. The question should be whether you live or die in the system first, then how much does it cost.

When we look at, for example, patient-reported health care outcomes in pap smears and mammograms, we see stark differences in coverage for Americans and in other countries. Here you see pap smears in the last 3 years, women aged 25-64, 89 percent coverage for the United States; but among our British allies, only 77 percent, and probably the key model that many in Congress are looking at, Canada, falls well below the United States.

Also in mammograms, key for long-term health status among women in the United States, 86 percent coverage for women aged 50-64, and much lower across the board in more status, government-controlled health care systems.

We also looked at a key fact in health care, which is health care delayed is health care denied. The problem with waiting times is present in the United States, but it's much more acute in other countries. When we look at patients who waited more than 4 weeks to see a specialist doctor, we see in the United States it's about 23 percent, 1 percent better, actually better, in the German Republic. But in the principal cases of Canada and the United Kingdom, which offer so many examples to many in this Congress for the kind of health legislation they would like to put forward, waiting times are double what they are in the United States. That means that the health care that they provide would be much poorer than for our country, especially during a long wait.

This chart shows even a more serious situation. It shows the percent of patients that had to wait more than 4 months for health care. In the United States, just 8, even slightly better in Germany, but when you look at Canada, and especially the United Kingdom, now reporting 41 percent of patients who have waited more than 4 months for health care.

Health care outcomes are distinctly different for the United States and other countries, especially with breast cancer incidents. This chart shows mortality per 100,000 females of breast cancer, and it shows that the United States actually has the best numbers compared to Canada and the United Kingdom at 28 for the U.S., 29 for Canada, and 34 for the United Kingdom.

When we look at high-tech medical procedures in Britain, Canada, and the United States, the critical procedures necessary to actually survive key bits of morbidity are not available in Britain and Canada as compared to our country. In dialysis, and I speak especially as the co-Chair of the Kidney Caucus here in Congress, we can see access in Britain is far lower than in the United States. For coronary bypass, the United States is clearly much better. And in coronary angioplasty, we are significantly, by almost a factor of 6, better than other countries.

One of the key differences between the United States and other countries is people ask, Why do we spend so much money? Why do we have, in some areas, lower health outcomes? And part of it might be the health practices of Americans themselves.

This shows obesity across countries, and we know that, in general, Americans will be heavier than people from other countries.

And that leads to higher health care costs. The question is whether building a large State control which will restrict access to health care is the way to go, or whether a program, I think, that would have strong bipartisan support to encourage a reduction in obesity would be the more appropriate stand.

When we look at how to address health care needs, that is primary through health insurance. Health insurance currently in the United States is governed by the States. Some States have a fairly modest threshold for offering health insurance and therefore their health insurance costs would be expected to be fairly low. Other States would have extremely high mandates for health insurance, making it more expensive. As you can see here, the pattern differs, and it sets up a way for Federal officials to compare outcomes of health systems in our countries.

Probably the biggest difference that we see is in the difference of health care costs between New Jersey and California. In New Jersey, we see that health care costs are totaling $6,048 per patient, whereas in California they're down to $1,885. That roughly $5,000 difference is a tremendous barrier to access for medium- and low-income persons in New Jersey that is not present in California.

It should be the policy of the United States to remove barriers so that we can offer low-cost insurance like what is offered to the people of California and not have a highly regulated, high-barrier system, like New Jersey, prevail for the United States.

When we look at the uninsured, a number of people look just at the overall number, totaling $37 million in 2002,

totaling $49 million just afterwards. Obviously, with the recession that's going on, the number of uninsured has been rising. But we ought to look a little bit deeper as to who the uninsured are.

As this data shows from the National Survey on America's Families, we see that out of the 49 million uninsured, 22 percent were uninsured for just less than 5 months. Another 25 percent were uninsured for 6 months to 11 months. Roughly half were the long-term uninsured--over 12 months--that I think is very appropriate for Federal policy to look at.

As you can see, this problem might be somewhat smaller than originally estimated. Also, when you look at the uninsured, you have to ask the question: Can people access or do people have a problem accessing health insurance because they can't afford it? Or, for some, is it because they simply have decided not to pay for it?

When we look at the uninsured by household income, we find that 19 percent are over $75,000 in income, who really should have paid for health insurance on their own with that kind of income. That is above average for the United States. Eighteen percent, $50,000 to $74,000. Then, for the modest- and low-income, we see roughly 60 percent. Especially for the plus-$75,000 income, we ought to ask: Should the State, should the taxpayer be paying for their health insurance, or should we instead look for them to make some of their own decisions?

When we look at the very low-income uninsured, obviously we have a number of programs already addressing the needs of low-income Americans. This chart shows that a considerable number of low-income Americans are already eligible for public coverage. But as we have seen, for example, in the State of Massachusetts, for some of the very hardest to insure, with unsteady addresses, sometimes registering in the emergency room under different names, an insurance model may not be the best way to care for this group of people, our fellow citizens. A better way may be the public hospital approach that can take anyone at anytime, for a community in the 1 percent to 2 percent range that is very difficult in keeping solid addresses, solid identities, or keeping appointments.

When we look at the uninsured and how much the Federal Government already pays, by one estimate in 2004, the Kaiser Commission on Medicaid and the Uninsured estimated that we already commit about $35 billion on coverage for lower-income Americans. And the question that we may ask, which may not be fully explored in this Congress, is: Is that sum of money substantially above the gross domestic product of many of the members of the United Nations? Is that sum of money being wisely used already, or is there a system which would provide a more flexible and effective coverage for low-income Americans, which would in fact return a considerable amount of authority and power to them in making their own health care insurance decisions?

Now, in briefly reviewing the key details and issues before us, I want to also compare health care in the United States to that in other countries, especially the two principal models that many here in the Congress are looking to, Canada and the United Kingdom, for what they can tell us about how health care could be changed for the better or the worse in the United States.

In my view, our country should work towards providing a universal access to health care. While a nationalized government HMO could prompt tax increases, inflation, and a decline in quality, I think this Congress can enact policies to dramatically expand health care access for Americans.

When we reform health care, in my view, we should follow key principles, first and foremost, that reform should enhance the relationship that you have with your doctor. Insurance companies already interfere too much with our care. But a government HMO might do far worse.

Second, reforms should reward the development of better treatments and cures. Americans strongly support treating diseases like diabetes, heart disease, or cancer, but they are passionate about a cure.

Finally, reforms should be sustainable, because especially the sickest and most elderly of our citizens will depend for their very lives on these reforms.

The worst thing that we can do is to enact a health care program that the Federal Government cannot afford to keep. In considering United States health care reforms, many Americans look to Canada and Britain as our model. But Canadians have a very different view.

While over 60 percent of Americans are actually satisfied with their health care plan, only 55 percent of Canadians report the same satisfaction. Over 90 percent of Americans facing breast cancer are treated in less than 3 weeks, but only 70 percent of Canadians get such treatment. Meanwhile, thousands of Canadians come to U.S. hospitals instead.

The average Brit waits even longer--62 days. And Britain now has fewer oncologists treating cancer than any other Western European country. It may be no wonder that Britain ranks 17 out of 17 industrialized countries for surviving lung cancer.

Similar statistics tell a tale of lower quality care for coronary heart disease, where 94 percent of Americans are treated, versus 88 percent of Canadians; or emphysema, where 73 percent of Americans are treated versus just 53 percent of Canadians.

The most dramatic differences come in the field of cancer, where Britain's most respected medical journal, The Lancet, published the details of a very broad review of cancer and its survival rates in Europe and America. In short, here is what the Lancet reported:

The cancer survival rate for American men in September of 2007 was 66 percent. For European men, just 47 percent. The cancer survival rate for American women was 63 percent. For European women, just 56. Of the 16 cancers studied, only Sweden showed survival rates that were close to the American rates, but still well below our level.

We know that diabetes is one of the principal causes of senior health care problems. In the United States, 93 percent of Americans are treated within 6 months, while in Canada, less than half--43 percent-- see a doctor in the same time. In Britain, it is even worse. Only 15 percent of British diabetics are seen within 6 months.

Over 80 percent of American women receive a mammogram, while only 73 percent of Canadians receive one.

Hip replacements offer a very stark contrast between the countries. In the United States over 90 percent of seniors are treated with a hip replacement within 6 months. In Canada, less than half of patients are treated in the same time, but many Canadians wait for a hip for over a year. Britain is not the place to break a hip because only 15 percent of patients are treated within 6 months, and many die during the wait.

Many advances of 21st century medicine come from MRI scans. Most Americans wait less than a week for an MRI. Most Canadians wait for over a year. In the United States, doctors use 27 MRI scans per million people. In Canada and Britain, it's less than a fifth of that at just five MRI scans per million.

The care for children also varies. Newborns most at risk need the close care of a neonatal specialist. In the United States there are over six neonatologists per 10,000 live births. In Canada they have fewer than four, and Britain has fewer than three. In our country we have over three neonatal intensive care beds per 10,000 births, just two and a half in Canada and less than one in Britain. It may be no wonder that babies in Britain have a 17 percent higher chance of dying compared to 13 percent a decade ago. Overall, the life expectancy of a British woman below the poverty line is falling.

The starkest difference in care between the countries comes when you are the sickest. In Britain, government hospitals maintain just nine intensive care beds per 100,000 people. In America we have three times that number at 31 per 100,000. In sum, Britain has less than two doctors per 1,000 people, ranking it next to Mexico and Turkey.

Even dentists are in short supply. The average American dentist sees 12 patients a day while the average British dentist must see over 30.

Stories of poor care under a government-only system are common in Britain. Last February, the Daily Mail reported Ms. Dorothy Simpson, age 61,

had an irregular heartbeat. Officials at the National Health Service denied her care because she was ``too old'' at age 61. The Guardian reported in June that one in eight British NHS hospital patients wait more than a year for treatment.

We know that governments regularly run out of money, and this can have a real impact if they are in charge of you or your family's health care. Ontario canceled funding for childhood immunizations, routine eye exams and physical therapy services when they ran out of money. Government unions also regularly go on strike. In British Columbia they had to cancel 5,300 surgeries during a health care worker strike. The Fraser Institute, an independent Canadian research organization, reported that the average wait for surgery is now up from 14 to 18 weeks. Queen Elizabeth Hospital in Halifax reports that its X-ray machine--by the way, no MRI available--was installed during the Nixon administration. To compare, Northwest Community Hospital in Arlington Heights, Illinois, flunks its own publicly reported quality standard if a patient does not receive a PCI test within 90 minutes of surgery.

In Washington there are many proposals to have the government take control of health care. Some bills in Congress even call for pushing all uninsured people, including illegal aliens, into Medicare. We should look very carefully at such proposals.

Remember, Medicare covers 40 million Americans at a taxpayer cost of $400 billion annually. Adding another 40 million patients to Medicare's costs would likely cost taxpayers an additional $400 billion annually. Knowing the government will run a $2 trillion deficit this year during the worst recession in living memory, can we enact an enormous tax increase, or do we just have to borrow the money from China?

Seniors and low-income Americans will absolutely depend on the Congress's promises, and I believe the worst thing that we can do is make commitments that are too expensive and then pull the rug out from those who can least afford to cope. Instead, we should back bipartisan reforms that the government can afford to keep.

There are a number of steps Congress should take to expand access to care and bring down the cost of medicine. First, we should expand the number of Americans who have access to employer-provided health care. One of the best ways to do this is to allow small businesses to band together to form larger pools of insurable employees to share risks and administrative costs. We should also allow franchises to offer national health care plans so that their members, working at Starbucks or AlphaGraphics or Subway, can create one large national insurable pool of their generally younger and currently uninsured employees.

Second, Congress should expand access to care for millions of self- employed Americans who do not have insurance. A refundable tax credit for individuals and families equal to the same tax credit large employers get would help millions buy insurance. Individuals could be eligible for a credit of up to $5,000 annually, and lower income families would be eligible for a credit worth up to $8,000.

Third, as jobs become more portable, so should health insurance. We should protect Americans who lose their jobs, and their families, who are excluded from coverage by pre-existing conditions. Congress should also remove the current 18-month time limit on COBRA continuing health insurance coverage. This would give families the option of always, if they wanted to, at their own expense, sticking with the health insurance plan they like and currently have. This expanded coverage should also act as a bridge for retirees who may not yet be eligible at age 65 for Medicare.

Fourth, we must pass commonsense measures to bring down health care costs. The Veterans Administration already uses fully electronic medical records to care for 20 million patients while saving lives and cutting wasteful spending.

We also need lawsuit reform. State supreme courts controlled by the plaintiff's bar, like in my home State of Illinois, are expected to strike down local lawsuit reforms that cap noneconomic damages in medical liability cases. We need Federal lawsuit reforms to lower insurance rates across the country, keeping doctors in the practice of medicine.

Finally, the Federal Government should mandate and enforce the right to see in-house infections caused by hospitals. Nearly 2 million Americans contract hospital infections every year, costing Medicare about $5 billion annually. We should create incentives for hospitals to reduce their infection rates and to publish their results.

In sum, there's a great deal that the President and Congress could do without making the mistake of Xeroxing the 40 years of mistakes made in Canada and Britain.

So having described some of the issues that we face, let's look in detail at one of the key numbers driving the debate here in Washington--the uninsured. According to last year's Census, there are 45.7 million uninsured in America. But according to CRS, 9.5 million of those are illegal aliens, 6 million are children now covered by the SCHIP program that I voted for that was signed into law by President Obama in January, about 10.8 million have above-average incomes in the United States, and about 9.1 million are only temporarily uninsured. That means that if we focus on the problem of U.S. citizens who are of lower income, who have not been insured for longer than a year, it is 10.3 million folks, hardly a number that justifies a government takeover of health care, but one that a bipartisan centrist agenda could address to make sure that those family members have the health insurance they need.

Yesterday I took a survey of voters in Illinois. We received 3,400 responses, and the question we asked was this, ``Should Congress raise taxes to fund a new government health care plan?''

The answers came back: 2,730, or 80.3 percent, said ``no''; and only 454, or 13.4 percent, said ``yes''; 214, or 6.3 percent, said they didn't know. Clearly, in the face of the deepest recession in modern memory, we should not raise taxes in a significant way throwing millions of families out of work for a government program that we cannot afford to keep.

Therein comes the third part of my discussion tonight. Given these problems, given the comparisons to other countries, and given the fiscal constraints on the Federal Government, is there room for a bipartisan reform agenda in Congress? The answer is emphatically ``yes.'' And we will outline that tomorrow in front of 70 different groups.

In the view of the Tuesday Group reform agenda, our comprehensive reform agenda will accomplish eight major goals. Number one, we will guarantee the doctor-patient relationship. Number two, we will put forward reforms that will lower the cost of health insurance. Number three, we will increase the number of Americans who have insurance. Number four, we will allow Americans to keep insurance they like. Number five, we will improve quality and accountability. Number six, we will increase personal responsibility. Number seven, we will lower the demand for federal borrowing. And, finally, number eight, we will do it in a bipartisan and sustainable way so that momentum for this program will not just be built up during the Obama administration, but future presidencies, including Republican presidents.

In this agenda, our primary objective is to guarantee your relationship with your doctor. That is why tomorrow we will be putting forward the Medical Rights Act. The Medical Rights Act will guarantee the rights of patients to carry out the decisions of their doctor without delay or denial of care by the government. This legislation will uphold the right of individuals to receive medical services as prescribed by their doctor and will not allow the government to restrict or deny care if the care is privately provided. We allow, of course, the government to run its own health care programs for the military, for TRICARE, for the VA, for the Indian Health Service and others. But if the health care is paid for by you, you should control it. And there should be no attempt to control your health care by the Federal Government.

The reason why we think this is necessary is because in other countries it is illegal for patients to pay for the care out of their own pocket. The most infamous restriction comes against Canadian citizens that face this barrier.

For them, they at least have one out, because the drive is not too far to the United States. But if we have the government take over health care in America, where will we be able to drive? And how will we find care if it is denied by a government program? That is why we need the Medical Rights Act. And in my judgment, it fulfills the promise of the President that you will always have choice and control of your health care. It is a bill that he should support.

Secondly, our goal is to lower the cost of health insurance. What we would like to do is allow alliances to form, for example, among the Libertyville Chamber of Commerce members or among national franchise members to build larger and larger insurance pools from self-employed or small employers to spread risks, lower cost and share administrative expenses.

We would also like to equalize the tax benefits that the self- employed receive so that small and self-employed individuals have the same tax break that large employers have when they provide health insurance to their employees.

To lower the cost of health insurance, you also need lawsuit reform. And the proliferation of frivolous malpractice lawsuits, as demonstrated on late-night TV for all the ads that you see, would be a huge reform that would help us drive down the practice of defensive medicine and therefore the cost of health insurance.

Doctors who practice in certain high-risk fields such as emergency medicine, general surgery, thoracic surgery and obstetrics and gynecology especially need this reform to stay in the practice of medicine. By one estimate, the cost of defensive medicine in the United States is over $100 billion a year. Our reforms will call for blame to be allocated responsibly among key parties, to stabilize the compensation for insured patients and to encourage the States to adopt innovative strategies, especially alternative dispute resolution incentives for doctors and hospitals, and new health care courts specializing in resolving medical injury disputes.

We will also be calling for State innovation programs to reward States that reform insurance markets to provide a more flexible insurance product to meet the needs of patients. Instead of dictating and controlling health insurance from a new Washington national office, the Congress should follow the direction of the National Governors Association that said that States must have the flexibility to respond to justifiable variation in local conditions and costs. Obviously, health care in Alaska is very different from health care in Florida. And we should allow States to manage that flexibility in the most appropriate way. Programs that we focused on and looked at most intensely are Idaho's high-risk reinsurance program and the Massachusetts State insurance program. And these flexible programs should not be overridden by Congress.

We also want to provide more control and flexibility, but most importantly, dignity to low-income patients. With 25 percent of people already eligible for public coverage, not even enrolling in the public plans currently offered, we should find ways to have patients be able to join lower-cost private plans that with a combination of subsidies and tax credits, lawsuit reform, health information technology and deductions would not only make their insurance more affordable but would suddenly give lower-income Americans the same control over their health care that middle- and upper-income Americans have.

Another key point of our agenda reform is to increase the number of Americans who have access to health insurance. There is a key point of common sense here that lowering the cost of health insurance will expand access. As I outlined earlier, on average, health insurance in California costs about $5,000 less than health insurance in New Jersey. By permitting health alliances and pooling national resources, deploying health information technology and equalizing tax breaks for self-employed Americans, we will dramatically lower the cost of insurance and therefore expand access.

We should also take some time to expand rural health care. In the Congress, the National Health Service Corps and the area health care centers should be reauthorized and expanded to make sure that we can address this critical rural need, especially in primary care.

One of the items not talked about very much in the House or the Senate is the potential for damage that we could cause to the health insurance that Americans currently have. Legislation in the House and Senate called the Healthy Americans Act would end the tax break for employer-provided health insurance in the United States. That sounds like a technical phrase, but you should remember that employer-provided health plans cover 160 million Americans. And most of those plans are supported through the ERISA legislation and tax break that employers receive. Legislation like the Healthy Americans Act not only kills the Federal Employer Health Benefit Plan that covers every Member of this Capital, staffer, Senator, Congressman and all Federal employees, but it then goes on to wipe out the Federal tax break under ERISA for the other 155 million Americans that depend on this health insurance.

In fact, just yesterday, the Director of the Office of Management and Budget said we may need to look at cutting back the tax benefit that supports employer-provided health care. In my view, this is an idea whose time has never come.

One of the key rules in health care is to do no harm, and for this Congress to attack employer-provided health care is an attack on the health care of every Federal employee and 155 million civilian employees who depend on employer-provided health care.

Instead, our bipartisan agenda strengthens employer health care and continues the benefits under ERISA that cover 160 million Americans. We should not only allow Americans to keep the health insurance they like, we should also improve quality and accountability. One of the best ways to do that is to accelerate the deployment of health information technology.

The Congress should accelerate the setting of standards and using payment incentives under Medicare, Medicaid, TRICARE, which covers military retirees, and the VA and Indian Health Service to encourage the more rapid deployment of health information technology to reduce medical errors, to limit the waste of defensive medicine, and to improve health outcomes. Many of these advances, especially with electronic medical records, have already been made at the Veterans Administration, leading to an 80 percent reduction in health errors.

Key health information technologies also include e-prescribing, chronic disease registries, and clinical decision systems that will dramatically lower cost, improve outcomes, and eliminate errors.

This Congress also needs to work on eliminating fraud, waste, and abuse in the current government health care systems. The Congressional Budget Office estimates that more than $10 billion in improper Medicare payments were made in 2008 alone. There is strong bipartisan support for a number of policies outlined in both the Ways and Means and Finance Committees to improve transparency, to prosecute fraud, and to require provider accountability.

When we look to the future, I think we should emphasize research and not rationing. It was a bipartisan effort led by President Clinton and Speaker Gingrich that doubled the resources to the National Institutes of Health. In my view, we should accelerate that momentum on basic research.

The Congress also approved funding for comparative effective research. Now, this research has the potential to help patients and doctors to make informed decisions. But many in the Congress would like to use the $1 billion recently approved for comparative effectiveness research to actually begin a system of restrictions and rationing in the United States. In my view, this takes us into the problems that I described earlier in my talk and would ruin some of the key advances that distinguish American health care among those of our allies.

We should also foster public-private partnerships to avoid an innovation gap that is currently existing between where public research, especially funded by the NIH, ends and where real

health care delivery mechanisms can begin.

Congress can use this opportunity to foster a new bridge for biotech companies, universities, patient advocacy organizations, pharmaceutical companies, and research institutions to accelerate the deployment of new research in the practice of medicine, an area where the United States has excelled, a country that has already received more Nobel Prizes in medicine than any other country on Earth.

Finally, on the research side, we should look at compassionate access. With little to lose, many terminally ill patients can only hope for the very quick FDA approval of cutting-edge treatments and drugs for hope in their own case. Compassionate access can provide real hope to patients that need it most, can save their lives, and can accelerate treatments for nearly everyone, but especially the seriously ill.

When we look at the key objectives of this bipartisan agenda, we also have to return to a basic principle, I believe, central to the American character, which is increasing personal responsibility. It's time, like the chart that I outlined here, to look at bad health habits, principally obesity, drinking, and smoking, and to encourage or reward Americans who do not exhibit these habits. Normally, we see 75 percent of the Nation's health care spending is dedicated to chronic diseases related to these three areas, all entirely preventable if we encourage the right habits.

Also, we ought to expand the use of health savings accounts, because we know that Americans who directly control health spending from their own tax-deferred health savings account, much like an IRA, will take a much greater role in the health care decisions they make. Their patient compliance will likely be higher, and the choices they make will be more appropriate for end-of-life care. These health savings accounts are critical, not just to empowering patients, but also to eventually either becoming part of a patient retirement savings or an estate for their children.

Finally, when we look at all of these reforms, we have to pay key attention to the bottom line. Health care reform in the United States has to lower the demand for Federal borrowing, now at what the President already describes as a completely unsustainable rate. Because many sick and elderly Americans will depend on the reforms that we make, the reforms instituted by this Congress must be fiscally responsible and sustainable over time.

The Congressional Budget Office reports that we will borrow $1.18 trillion just in fiscal year 2009 in a completely unsustainable way, and that new revenues for a health care bill that could be put forward by this House are simply not there.

In its place, this Congress could look at an enormous tax increase or at faltering climate change legislation that already looks like it will not provide the revenues initially hoped for in its early drafts. In the face of this lack of funding, either on the borrowing side or the unwillingness of Americans to go through a new tax increase and faltering prospects for a climate change bill, it's essential that we return to the kind of reforms that I just outlined here tonight as a way to lower the cost of health insurance, expand access, and improve health care outcomes.

I spent quite a bit of time here tonight talking about the situation in detail because, in my view, this is going to be the biggest subject this Congress deals with this summer. When we look at the worst angels of our nature, we might be able to expect a fairly fierce and partisan debate here in the House. That is predictable but unfortunate.

My hope lies in the moderates of the Senate who can come forward and make sure that we have a bipartisan, modest, and sustainable set of health care reforms that will improve health care for every American in this country in a sustainable way across Presidential administrations and across parties, and not end up making the same mistakes as our allies in Canada and Britain.

Well, those are the details. We will be providing further details in the Tuesday Group meeting tomorrow, and we look forward to joining with many Members on the Democratic side in building what can be one of the greatest opportunities for this Congress to affect the daily lives of the Americans that we represent.

And I yield back the balance of my time.

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

The motion was agreed to; accordingly (at 10 o'clock and 39 minutes p.m.), under its previous order, the House adjourned until tomorrow, Tuesday, May 19, 2009, at 10:30 a.m., for morning-hour debate.

I rise in opposition to this rule on what is a relatively noncontroversial bill just to ask the majority, What are you afraid of? You have a 78-seat majority in the House of Representatives, but you are afraid that amendments may carry. It is an astonishing admission of weakness by the leadership that you cannot withstand a House vote on amendments. As someone who has been here as a staffer and a Member since 1984, I will tell you that closed rules generally end speakerships over time.

Announcement By the Speaker Pro Tempore

I stand corrected.

I would just say that closed rules generally end speakerships over time because what happens is if you do not let democracy reign on the House floor, what happens is big bills wipe out. And we certainly saw this in the end of Speaker Wright's service when on closed rules he misguided the rules on the Chamber and then collapsed entire huge pieces of legislation, by the way, reconciliation legislation, which then wiped out his speakership.

With a 78-seat majority, it is an astonishing admission of weakness that the leadership cannot win on amendment votes on the House floor and that they do not want to be subjected to scrutiny and feel that in the Speaker's office alone there is a judgment which will always carry the day on the House floor. And I will refer to the end of Speaker Wright's career, the end of Speaker Foley's career, even the end of Speaker Hastert's career, as a reflection that democracy is much better served if you can actually allow some controversial amendments or two. And to sit on a 78-vote majority and think you are going to lose on the House floor is an amazing admission on your part.

Now one of the things that is not being considered, because this legislation closes down amendments, is a bipartisan amendment by Congressman Carney and me. Now, what we wanted to do was simply open up eligibility under this legislation to the 44 percent of American schools that, under the terms of this legislation, are not eligible for funding. This legislation stands for the principle that only roughly 60 percent of schools in America can even apply for funding under this legislation and that 44 percent cannot apply.

In my congressional district, we have seen good green school initiative programs like at the Thomas Middle school in Arlington Heights, in which they assembled public and donor funds for a 1- kilowatt solar array on their roof and for conservation measures. They learned an important lesson. And by the way, the kids learned an important lesson that maybe solar power in Chicagoland did not have the greatest potential as in other parts of the country because we only have about 58 sunny days a year. It was an important renewable energy lesson where in the Windy City wind power might be the more appropriate solution. And I'm very happy that our students learned that lesson. And some of them may be inspired by their experience at Thomas to pick up a career in the field of science and engineering.

We had a similar program at the Elm Place middle school in Highland Park, Illinois, a greening project in which the students reported that despite all of the attention on the renewable energy side, they actually saved more money with conservation. These are important lessons that we know apply to the Nation, as well, and I'm very happy the students were able to learn this lesson.

Under our amendment that was rejected by this rule, we would have opened up just 1 percent of the funding in this legislation to the other 44 percent of schools, mainly suburban schools, which are locked out of any consideration of funding under this bill. In Illinois, there are 32 school districts that may not receive funding from this legislation. And I think that the other 44 percent should have been considered, that 44 percent of kids should have participated in green school projects, as the kids in my congressional district have done with their own money; and yet we rejected that possibility.

It is astonishing because I think the Carney-Kirk amendment would have carried, would have provided an opportunity for a lot of kids in America to learn some very valuable lessons about the future of the economy, but also astonishing that on a 78-vote majority in this House of Representatives, the Democrat leadership feels that they will still regularly lose in open debate on this House floor.

Madam Speaker, I thank the chairman and thank the ranking member for this opportunity to speak in praise of Chris Carney. It is no accident that Chris and I work on a number of pieces of legislation. The bond between us, forged in the United States Navy, is stronger than any partisan bond, and he has become a real hero to me in building these bipartisan efforts to commemorate our men and women in uniform.

We put forward H.R. 1209, the Medal of Honor Commemorative Coin Act, and it is bipartisan legislation. Under the rules of the House, it had to get over 290 cosponsors. We think it will help the Foundation raise over $5 million for their benefit.

As everyone knows, the Medal of Honor is the Nation's highest award for valor in action against an enemy force, and it symbolizes how uniformed Americans have gone above and beyond the call of duty in defense of our Nation.

Today I am wearing a Navy Commendation Medal, which in my view is about 17 ranks below what is given in the Medal of Honor. There have been 3,400 medals awarded to date, but we are focusing our effort on the 97 living recipients who are among us.

They are people like Al Lynch of Gurnee, Illinois, a man who serves on my Veterans Advisory Board and who I know and respect. Like many of us veterans, when one of the Medal of Honor recipients walks into a room wearing that very unique insignia, everyone goes silent. I will say, at least from my experience and I think from other veterans, we all know where a Medal of Honor recipient is in the room for as long as he is in the room.

Al grew up in our area, went to high school, enlisted in the Army, and in 1966 volunteered for service in Vietnam as a rifleman and a platoon radio operator. In December 1967, his company was deployed to the Bong Son area of the central highlands. And after a month of almost daily fighting with the enemy, his unit was ordered to the rear for rest and recuperation; but that rest was short-lived, because the company which relieved his unit was ambushed.

As Al's platoon mobilized the next morning, he saw three wounded men. Not thinking of himself, he dashed across 50 meters of open ground, through a hail of enemy fire, and carried them one by one to safety. When his company was forced to withdraw, it was Al who remained to aid his comrades rather than abandoning them. For 2 hours, he defended their position against an advancing enemy.

Following this heroic action, he located the counterattacking friendly company to assist the attack and to evacuate the three casualties. He successfully completed his tour in Vietnam and was sent to Fort Hood, Texas, where he was discharged from the Army in 1969. A year later, just before he was to be married, he learned that for these actions he would receive the Medal of Honor, and on May 14, 1970, President Nixon presented it to him.

We also commend men like Sammy Davis of Flat Rock, Illinois. On November 18, 1967, while serving as a cannoneer at a remote fire support base just west of Cai Lay, Vietnam, he came under heavy mortar attack. Sergeant Davis single-handedly fired his howitzer several times at the enemy. Undaunted by an enemy mortar blast which landed 20 meters from his position wounding him, he continued to fight. Disregarding his extensive injuries and his inability to swim, Sergeant Davis used an air mattress to rescue three wounded comrades trapped on the other side of the river with the Vietcong. Upon reaching the wounded men, he stood and fired into the dense vegetation to prevent the enemy from advancing.

You may slightly recognize Sergeant Davis' story because it was the model for the iconic movie ``Forrest Gump,'' which was largely based on his experience. Footage from the Medal of Honor presentation to Sergeant Davis was actually used in the movie, with Tom Hanks' head superimposed on the body of Sammy Davis.

On July 11, 1969, Captain--then First Lieutenant--Hal Fritz from Peoria, was seriously wounded when he was suddenly ambushed escorting a truck convoy in a seven-vehicle armored column near Quan Loi in Vietnam.

After realizing his platoon was completely surrounded, he ran from vehicle to vehicle in order to reposition his men, assist the wounded, and provide encouragement. When the enemy attempted to overrun the platoon, Captain Fritz manned the machine gun and inspired his comrades to break the assault. Moments later, a second enemy force advanced, and only with a pistol and a bayonet, Captain Fritz led his small group of men in a daring charge that routed the attackers.

When relief arrived, Captain Fritz stayed to manage the troops. And when he saw they were not being deployed effectively, despite his wounds, refused medical attention and organized everything until his wounded comrades were treated and evacuated.

Maybe the most dramatic story that we have in Illinois comes on the day of January 8, 1945. During a battle near Kaysersberg, France, Sergeant Russell Dunham of Jerseyville, Illinois, single-handedly assaulted three enemy machine guns using a white robe made of mattress cover as camouflage. Sergeant Dunham crawled 75 yards under heavy fire, and as he jumped to his feet 10 yards from the gun, a rifle bullet hit him, creating a 10-inch gash across his back and sending him spinning 15 yards down the hill into snow.

In excruciating pain, he got back up and renewed a one-man assault. After kicking aside a German egg grenade, Sergeant Dunham shot and killed the German machine gunner and assistant gunner. Sergeant Dunham then proceeded 50 yards through a storm of enemy fire to destroy the second machine gun by throwing two grenades into the emplacement. Under heavy fire from both machine guns and grenades, Dunham again advanced by crawling farther up the hill. At a range of 15 yards, he jumped to his feet and killed the crew of a timbered machine gun emplacement with hand grenades.

Despite a painful wound, Sergeant Dunham spearheaded a spectacular attack that saved many of his men, and he just passed away a month ago.

The stories of these four Illinois residents are just a few of the many extraordinary acts of heroism by soldiers, sailors, and airmen who went beyond the call of duty in the face of grave danger.

The legislation authored by Congressman Carney before us, H.R. 1209, is important because it will serve as a

reminder for these brave men and women--still numbering 90 strong--to promote the qualities the Medal of Honor embodies.

As the first U.S. Representative to be deployed into an imminent danger area since World War II, I know many of the sacrifices and challenges that men and women in our Armed Forces face. Almost every morning I think about the men and women I served with in Afghanistan when I left there in January.

This legislation helps us recognize the true heroes among that cadre. I think we will have some more heroes emerge from conflicts in Iraq and Afghanistan that are award winners. But today, we mark the 97 who are living, and those 3,400 who all received the Medal.

This legislation will help us raise money for the foundation, will help us advance the values that these awardees embodied, and teach us a very, very painful but important lesson about how important this country is, how valuable it is, and how much it takes to defend her.

Madam Speaker, today I am proud to join my good friend, the gentleman from Washington (Mr. Larsen), in unveiling the bipartisan U.S.-China Competitiveness Agenda of 2009. This agenda includes four legislative priorities to expand America's influence in China and increase American competitiveness in the global marketplace.

As co-chairs of the bipartisan House U.S.-China Working Group, we are working in Congress to elevate the sophistication of our debate on U.S.-China issues. The U.S.-China Competitiveness Agenda provides Congress with a constructive legislative package to expand U.S. engagement with China while supporting key domestic and foreign policy objectives.

Along with two other Working Group members, Congresswoman Susan Davis (D-Calif.) and Congressman Steve Israel (D-N.Y.), we are introducing bipartisan legislation to expand America's diplomatic infrastructure in China, boost support to small- and medium-sized businesses exporting to the China market, increase funds for domestic Chinese language instruction and build new cooperative energy ties between the U.S. and China.

The U.S. has one embassy and five consulates in China, leaving more than 200 cities with a population greater than one million people with little to no American representation. Additionally, while 60 percent of U.S. exports go to the Asia-Pacific market, the U.S. contributes 100 times more dollars to Europe's Organization for Economic Cooperation and Development than to the Asia Pacific Economic Cooperation Forum.

My legislation, the U.S.-China Diplomatic Expansion Act of 2009, authorizes the construction of a new consulate in Fuzhou and 10 smaller diplomatic posts in cities with more than a million people. The bill triples funding for public diplomacy, boosts funding for a range of language, student and teacher exchange programs, increases funding for rule of law initiatives and more than triples the U.S. contribution to Asia Pacific Economic Cooperation.

If we are serious about expanding export promotion services, defending intellectual property rights, improving consumer product safety and enhancing economic competitiveness, we need a diplomatic infrastructure in China that reflects those priorities.

I am proud to co-sponsor three other bipartisan bills in the U.S.- China Competitiveness Agenda, including Mr. Larsen's U.S.-China Market Engagement and Export Promotion Act of 2009, Ms. Davis's U.S.-Chinese Language Engagement Act of 2009 and Mr. Israel's U.S.-China Energy Cooperation Act of 2009.

Mr. Larsen's bill would help states establish export promotion offices in China and create a new China Market Advocate program at U.S. Export Assistance Centers around the nation. The bill provides assistance to small businesses for China trade missions and authorizes grants for Chinese business education programs.

I strongly support the U.S.-China Market Engagement and Export Promotion Act because we need innovative programs that support our small business exports and arm them with the tools they need to succeed in China.

Roughly 200 million students are learning English in China today. By contrast, only about 50,000 primary and secondary school students study Chinese in America. Ms. Davis's bill increases Chinese cultural studies and language acquisition for elementary, high school and college-age students. Grants would be available to fund university joint venture programs, virtual cultural exchanges with Chinese schools and intensive summer language instruction programs.

We have more than just a trade deficit with China--we also have a knowledge deficit. That is why I strongly support the U.S.-Chinese Language Engagement Act. We need additional funding for domestic Chinese language programs, educational exchanges and Chinese teacher exchanges to fix this knowledge imbalance.

To create green jobs in America and fight global climate change, we must expand energy cooperation between the U.S. and China. Mr. Israel's bill authorizes new grants to fund U.S.-China energy and climate change education programs, along with joint research and development of carbon capture, sequestration technology, improved energy efficiency, and renewable energy sources.

In my view, China's connections to unstable energy markets like Iran, Sudan and Venezuela could set a foreign policy collision course with the United States. I strongly support the U.S.-China Energy Cooperation Act. To protect our environment and avoid future conflict, we need creative programs to boost U.S.-China energy cooperation.

I want to thank my colleagues for their hard work on this bipartisan agenda. I urge my colleagues to cosponsor all four bills and move quickly to enact this legislation into law.

The majority leader is correct: the committee just finished consideration of this legislation and the Tiahrt amendment. During our debate, Congressman Wolf highlighted reports that he had received from law enforcement that three terrorists from the East Turkmenistan Islamist movement were scheduled to be released in McLean, Virginia, last Friday. But for his objection, that might have happened.

And so it gave an urgency to the Tiahrt amendment, since former Chairman Wolf, now Ranking Member Wolf, had received this report from local law enforcement in his district and was concerned that things were moving much quicker than otherwise we would have thought.

Mr. Speaker, over the last weeks, I have spent hundreds of hours helping craft a moderate, centrist bill on health care.

Our country should work on lowering the costs of health insurance. And while a nationalized government HMO could prompt tax increases, inflation and a decline in quality, we could instead enact policies that lower the costs of health insurance for Americans.

When we reform health care, we should follow key principles. First, reforms should defend your relationship with your doctor. Insurance companies already interfere with much of our care, and a government HMO would do worse. Second, reforms should reward the development of better treatments and cures. Americans support treating diseases like diabetes, but they are passionate about a cure. And finally, reforms should be sustainable because so many senior citizens depend on them. The worst thing we could do is enact a program that we cannot afford.

In considering health care reforms, Americans look to Canada and Britain as models. Canadians have a different view. While over 60 percent of Americans are actually satisfied with their health care plan, only 55 percent of Canadians are happy. Over 90 percent of Americans facing breast cancer are treated in less than 3 weeks, while only 70 percent of Canadians get such quick treatment. Meanwhile, thousands of Canadians seek treatment in U.S. hospitals. The average Briton waits even longer, 62 days. Britain has fewer oncologists than any other Western European country. It is no wonder Britain ranks 17 out of 17 industrialized countries in surviving lung cancer.

The most dramatic differences come in the field of cancer, where Britain's most respected medical journal, The Lancet, published results on a review of European and American survival rates. In short, The Lancet reported, American men have a 66 percent chance of surviving cancer, European men 47 percent, American women 63 percent, European women 56. In short, you are more likely to live if you are treated in America.

Newborns, most at risk, need the care of a neonatal specialist. In the United States, we have six neonatologists per 10,000 live births. In Canada, they have fewer than four, in Britain fewer than three. In this country, we have more than three neonatal intensive care beds per 10,000, just 2.6 in Canada, less than one in Britain. It is no wonder babies in Britain are 17 percent more likely to die compared to just 13 percent a decade ago.

The starkest difference appears when you are sickest. In Britain, government hospitals maintain nine intensive care beds per 100,000 people. In America, we have three times that number, at 31 per 100,000. In sum, Britain has less than two doctors per 1,000 people, ranking it next to Mexico, South Korea and Turkey.

Stories of poor care under government-only systems are common in Britain. Last February, the Daily Mail reported on the case of Ms. Dorothy Simpson, age 61, who had an irregular heartbeat. Officials of the National Health Service denied her care, telling her that she was ``too old.''

The Guardian reports in June that one in eight NHS hospital patients have waited more than 1 year for treatment. In Congress, we have proposals

to create a new option for Americans to sign on to a government health care plan. Proponents claim that this will offer a choice between their current health insurance and the government plan. That is what proponents say. What they do not say is that under many of the major pieces of legislation under consideration, the government health care plan is funded by ending the tax break employers receive for providing health care insurance. This tax break supports health insurance plans for most families, 165 million Americans. Do they know that the legislation being considered will trigger a tax decision by their employer to cancel health insurance for their family, leaving them actually no choice but an untested, brand new, government-only HMO attempting to care for their family?

The new legislation also depends on funding from a climate change bill that press reports indicate a number of majority Members will not support. Without funding from a climate change bill, there is little revenue except borrowing or printing more money to support new government health care.

Seniors and low-income Americans depend on the promises we make. The worst thing we can do is make commitments that are too expensive and pull the rug out from those who can least afford to cope. We should back reforms that the government can afford to keep. And we will be putting forward new legislation on that in the coming days.

There are a number of steps that Congress should take to bring down the cost of medicine.

First, we should expand the number of Americans with access to employer-provided health care. One of the best ways to do this is by allowing small businesses to band together to form larger pools of insurable employees.

Second, the Congress should expand access to care for millions of self-employed Americans without insurance. A refundable tax credit for individuals equal in value to the same tax breaks large employers get would help them to buy insurance.

Third, as jobs become more portable, so should health insurance. We should protect Americans who lose their jobs and families excluded from coverage by pre-existing conditions. Congress can remove the current 18-month time limit on COBRA continuing coverage, giving family members the option of always sticking with the insurance plan they currently have.

Fourth, we must pass common-sense measures to bring down health care costs. The VA already uses fully electronic medical records to care for 20 million patients while saving lives and cutting wasteful spending. We also need lawsuit reform. We need federal lawsuit reforms to lower malpractice insurance premiums and retain doctors in high-risk professions.

In sum, I working with Congressman Charles Dent, my co-chair of the Moderate Tuesday Group of 32 moderates on a health care bill. We will have a detailed plan by the May recess that makes, insurance less expensive . . . and therefore covering more Americans without burdenings our treasury with new borrowing needed from China or any other country.

Mr. Speaker, I yield myself 3 minutes.

Mr. Speaker, I rise in support of this bill and would recognize the work of President Bush 19 years ago when he signed the first hate crimes information bill into law. That law allowed us to collect data showing two hate crimes in my district, 191 in the State of Illinois, and 7,600 in America.

This legislation is backed by the National Sheriffs' Association, the International Association of Chiefs of Police, the National District Attorneys Association, and 26 State Attorneys General.

Much of this bill may not have been needed in the earlier days of our country when we were, frankly, much less diverse. But unlike those earlier times, we have now built the freest country on Earth, with the largest economy and also the most diverse population.

This bill provides Federal help to fight violent crime. It can be important, especially to suburban police departments like Palatine, Illinois, that could be overwhelmed as two groups

squared off, overwhelming the resources of a small suburban police department.

While this bill does provide modest Federal support to help preserve order against violent crime, in my heart I support this bill for a different reason. We have witnessed diverse societies in other countries crack up and go through much pain and anguish and suffering when one group attacks another simply because of their membership or identity.

In the United States military, I saw this most clearly in Bosnia and Kosovo. Part of the modern Yugoslavia, well-entrenched in Western European values, they thought their diverse society would always remain calm and peaceful with different groups relating to one another. In those societies, the arrogance of that idea was laid bare and the countries cracked up and we saw the darkest part of the human heart open, only a few hundred miles from the capitals of Europe where we draw our own cultural heritage. It would be the height of arrogance to say something like this could never happen in the United States of America, and it is the job of this Congress to make sure that never happens.

We see violence in other countries, like in Mexico, attempt to come across into this country. We see various groups try to bring their struggles from Asia or the Middle East to the United States. Our job is to make sure not just big city police departments, but also suburban and rural police departments, have what they need to quickly respond and make sure that a kind of identity violence that has plagued so many other countries who may have thought that they were immune can never come to our shores.

If this bill in any way tried to interfere with the First Amendment or other speech of this country, I would not support it. But, instead it is directed against violent crime, and that is why I support it.

I would now like to yield 3 minutes to the gentleman from Louisiana (Mr. Cao).

Mr. Speaker, I yield 2 minutes to the gentleman from Delaware (Mr. Castle).

Mr. Speaker, I would like to yield 2 minutes to the distinguished gentleman from New Jersey (Mr. Lance).

Mr. Speaker, this Congress has voted for unprecedented debt, and a look at Treasury's borrowings shows a stark picture. On Monday, we borrowed $98 billion. Tomorrow, we will borrow another $61 billion. On average, Congress is forcing the Treasury to borrow $157 billion a week.

Over the first 100 days, our debt has increased by more than $5.5 billion per day. China has cut its lending to the United States by 95 percent, effectively canceling this Congress' credit card.

Let me finish with a couple of personal facts.

With only 111 million Federal taxpayers, the rate of spending by this Congress in the first 100 days has shown the congressional leaders put each taxpayer into debt at a rate of $1,400 per week, $3,200 per quarter, and over $9,000 each just for the first 6 months of this Congress. That's quite a record, a world record, and one our children will live to regret.

Mr. Chairman, I have an amendment at the desk.

I am very honored to rise on behalf of the Kirk-Quigley amendment on behalf of me and our newest Member of Congress, Congressman Quigley, who replaced Rahm Emanuel in the House.

When we look at the Great Lakes, we look at one of the crown jewels of our country's environment. But we have seen data over the last few years showing a declining lake level. That lake level has been estimated by the Army Corps of Engineers using projections that just last over the next 6 months.

Under the Kirk-Quigley amendment, we would draw on the additional resources of the National Oceanic and Atmospheric Administration, which is able to project lake levels for quite a bit longer than the Army Corps' 6-month standard.

The purpose of this amendment is to generate more science and data about what's happening to the dropping levels of the Great Lakes. Next to me is a chart showing an environmental disaster that did not happen in the United States. Instead, it happened in the former Soviet Union, now Kazakhstan, which shows the Aral Sea, a great inland sea, very much like Lake Michigan, subjected to a very poorly designed Stalinist irrigation plan that drank it dry. We should never allow an environmental catastrophe like what happened in Kazakhstan to happen in the United States.

From the data that we have, we have a number of causes which could potentially be involved in the disappearance of the Great Lakes. One of them could be the declining levels of ice cover over the Great Lakes. Due to other forces, the normal coverage of ice over Lake Michigan, for example, has been declining, therefore, possibly allowing evaporation all year long. This declining level could be involved in the lowering of the lake. We need more data to support that conclusion. Good data, in my view, leads to good policy.

At this stage, we do not know why the levels of Lake Michigan are dropping. But NOAA tells us from 1972 to 2008 Lake Michigan ice cover has declined by approximately 30 percent, or a drop of 7,000 square kilometers from 1972-1973 winter, to approximately 5,000 square kilometers last year. This is a decline of 40 percent.

Now the Lake Carriers Association estimates that a 1-inch decline in Great Lakes waters causes the ships to reduce their cargo from 50 to 270 tons. This translates to 8,000 tons of lost cargo in the lakes each year, or equivalent of enough iron ore to make 6,000 automobiles in the United States.

For economic reasons, for ecological reasons, for scientific reasons, I think the Kirk-Quigley amendment should pass to give further resources to look at this emerging trend in an ecosystem that directly involves the future of 30 million Americans and many of our Canadian allies.

I reserve the balance of my time.

I thank the gentleman.

I reserve the balance of my time.

On this, then, I'd like to close by saying that this is a bipartisan amendment endorsed by the National Wildlife Federation and by the Lake Michigan Alliance. It represents the ability of the Federal Government to look further into what is an evolving environmental trend in a place that's home to 90 percent of America's freshwater. And with that, I would urge adoption of the amendment and getting to work on what is happening with the falling Great Lakes levels.

I yield back the balance of my time.

Madam Speaker, the U.N. Security Council has voted five times highlighting the violations of Iran, a party to the Nuclear Non- Proliferation Treaty, for its uranium enrichment activities.

According to the International Atomic Energy Agency (IAEA), as of January 31, 2009, Iran has produced more than 1,000 kilograms of low- enriched uranium hexafluoride, which is 30 percent higher than previous IAEA estimates.

If we are serious about stopping the emergence of a nuclear Iran, our window for effective diplomacy is starting to close.

Former Secretary of State Madeleine Albright is a strong proponent of ``enhanced diplomacy.'' History teaches that negotiations in the absence of effective sanctions are likely to fail. Negotiations following effective sanctions are likely to succeed.

When it comes to Iran, we already know the most effective sanction: a gasoline restriction.

A close look at Iran's economy reveals a significant weakness. This top OPEC nation lacks the required refining capacity to meet domestic demand for fuel and must import some 40 percent of its gasoline.

That's right: Iran depends on foreign gasoline.

Nearly all of Iran's imported gasoline is provided by just five European companies--the Swiss firm Vitol, the Swiss/Dutch firm Trafigura, the French firm Total, the Swiss firm Glencore, and British Petroleum. The majority of tankers carrying gasoline to Iran are insured by Lloyds of London. An interruption in the supply of gasoline to Iran would considerably impact the Iranian economy and significantly bolster diplomatic initiatives.

Just last year, then-Senator Obama suggested ``banning the export of refined petroleum to Iran,'' and said such a restriction ``starts changing their cost benefit analysis'' and ``starts putting the squeeze on them.''

That is why I am joining with Congressman Brad Sherman in introducing the bipartisan Iran Diplomatic Enhancement Act of 2009, which would extend current sanctions to any activity--including production, brokerage, insurance, and tanker delivery services--that contributes to Iran's ability to import gasoline or refine petroleum domestically.

Only from a position of strength can we expect diplomacy to succeed. A restriction of gasoline deliveries to Iran offers the best chance to stop Iran's uranium enrichment program using the soft power of the United States and our allies.

Madam Chairman, the United States, according to the Bureau of Public Debt, has already borrowed $2.07 trillion this year. This is in borrowings of short-term debt and adding new debts to the accounts of the United States.

But what is known, and not well in this Congress, is we gave new authority to the Fed to buy Treasury securities. That means that one part of the government is already borrowing money from another part of the government. This new Fed authority has been used very heavily since the start of the new year. In fact, records from the Bureau of Public Debt show that the Fed has bought $75 billion of U.S. debt.

But here's the key thing: All of that purchasing power is from newly printed money. These charts show how the printing presses of the United States are now running on overtime to fund the current spending of this Congress, and the budget underlying this proposal that we're talking about would accelerate that.

You have to worry with the President of the United States at the G-20 summit now, being told by the Chancellor of the German Republic and by the French President that our borrowing is already too heavy. In fact, according to CBO scoring for the majority budget, which is the real debate that we will consider here today, the United States, if it applied to enter the European Union, would not be allowed because our borrowing is already too heavy and would violate the Maastricht Treaty. You've got to worry when the Chinese Government is saying that the dollar is unsound. And when you see these results of the Fed printing money and then purchasing U.S. securities, how the debasing of the dollar threatens the long-term economic future of the United States.

When we see the borrowing rate of the Bureau of the Public Debt, we see that they are now borrowing at a rate of $159 billion per week. Look it up on their Web site. And that is just to support the underlying budget. To accelerate the borrowing requirement of the United States would be fundamentally unsafe and unsound.

Mr. Speaker, we will vote on a budget this week, we will discuss spending and taxing, but we will not discuss how our kids will eventually pay these debts.

The Bureau of the Public Debt will now undertake a massive borrowing campaign. We used to borrow from about 45 major lenders, but that has now dropped to 16. Our biggest lender used to be China, but they are now reducing.

To fund the stimulus, the Bureau tells the Congress that we have to borrow at a rate of $160 billion a week. And, last month Germany and the United Kingdom both failed to auction their debt because no one wanted to lend these governments more money. Each week, at four auctions a week, the United States will now risk the same fate.

What happens when this Congress runs out of other people's money?