Floor Statements

Mr. Speaker, on rollcall No. 402, I was unavoidably detained. Had I been present, I would have voted ``no.''

Motion to Reconsider

Madam Speaker, pursuant to the Republican Leadership standards on earmarks, I am submitting the following information regarding earmarks I received as part of H.R. 2847, Commerce, Justice, Science, and Related Agencies Act, 2010:

Requesting Member: Congressman Tim Murphy

Bill Number: H.R. 2847, Commerce, Justice, Science, and Related Agencies Appropriations Act, 2010

Account: Department of Justice; Juvenile Justice

Legal Name of Requesting Entity: Kids Voice

Address of Requesting Entity: 437 Grant Street, Suite 700, Pittsburgh, PA 15219

Amount: $500,000

Description of Request: The funding would be used to increase their impact in the community and to support programs that are offered to abused and neglected children in Allegheny County.

In addition, KidsVoice seeks to increase its impact by expanding services that will help clients become productive adults, despite the obstacles they face. The funding will expand KidsVoice efforts in assisting foster youth to pursue post-secondary education, job training and employment. I certify that this project does not have a direct and foreseeable effect on the pecuniary interests of me or my spouse.

I took extreme care to ensure that these projects are well vetted and strongly supported within the community. The KidsVoice appropriation is of particular interest to my district and importance to my constituents.

I thank my friend from Pennsylvania and also thank Congressman Kirk of Illinois for putting together this important session tonight to talk about health care.

One of the concerns that comes up repeatedly when you talk about health care is the cost. And one of the things that happens, as Washington deals with it, is two approaches: one, they say health care is expensive, let's have the government pay for it, which means you raise taxes. And the other one they say, health care is expensive, let's deal with insurance issues, perhaps some tax credits, which means it's still taxes that pay for it. And I understand in both cases we are trying to lower health care cost, but neither one really gets to the root of that, and that is, dealing with some of the issues that have to do with improving the quality of health care to make it more affordable and accessible. So I would like to focus a little bit on some comments tonight that specifically address this issue of how we lower health care costs.

As part of the plan that Congressman Kirk and Congressman Dent have led here for our group in coming up with some cost savings in health care, one of them has to do with trying to make sure we are providing health care to those who are not able to afford it. We know that currently the government provides assistance for those who have a low income through Medicaid, for the elderly through Medicare, for veterans through the VA; but for those just above the level of Medicaid income, that's the group that we are really deeply concerned about because we want to make sure they get the care they need.

One thing that's also important then is to make sure they have a health care home. Those who have a doctor or a specialist they can go to when they have an illness are much more likely to have that illness treated in a timely manner to provide a cure for them. Care delayed, care denied. When we look at how Medicaid and Medicare operate, that it really sometimes takes an act of Congress to get something done, that's care delayed. Let me give you a couple of examples about how there are problems with that. Let's say you have a stroke and an ambulance takes you to a suburban hospital. Sometimes those hospitals do not have a neurologist. Many times they don't have a neurologist on staff 24/7 or a radiologist. So what happens? Wouldn't it be great--imagine a world whereby a neurologist, through telemedicine, for example, could connect up with the patient, looking at them on a video camera, the patient seeing the doctor. That doctor could be half a country away or could be 20 miles away, whatever it may be, doing the exam with the assistance of a nurse on site. Look at the signs, look at the way the patient responds, and be able to diagnose and offer, does that patient get one type of treatment, which is if there are blocked arteries in the brain leading to the stroke, or another type of treatment which might be hemorrhagic, that is, a burst artery. Each one critically different life-saving treatments. It could mean the difference between the patient who lives and dies. Also it could make a difference between the patient who has years and years of physical therapy, occupational therapy, and speech therapy or one who has

a shorter recovery time. Because when you have a stroke, time is brain. That would make sense if we imagined that, but Medicare doesn't cover that. Instead, it's going to take an act in Congress--I know our friend and colleague Lois Capps from California has been pushing a bill for a while to allow Medicare to do that. This is not a new idea, but we have to take an act of Congress to do this. Or how about this--if you are going to get something called home infusion therapy to provide an IV line, to provide some medical treatments to you, you could do that at home, in many cases, with insurance companies, but not necessarily with Medicare and Medicaid because they want you to go to hospital where you have to go all the way to the hospital, and your risk for problems could increase. It's also going to take an act of Congress to make it so that hospitals actually have to state what their infection and complication rates are. I always find it amazing, you can go online and you can find out, if you are shopping for a new car, everything about that car. You want to shop for clothes, you can go all over the place, checking out the quality reports, consumer reports, all those things on that. If you want to look up the records on a hospital, am I more likely to get sicker or better when I am there, you can't find out that information. As my friends know, for a number of years I put forth a bill to provide transparency in this area, whereby you could look up and find out the infection rate of a hospital. This is critically important because nosocomial infections, that is infections you pick up in a hospital or clinic, kill 100,000 people each year, cost $50 billion, and there are 2 million cases. Sadly, Senator Byrd, one of our colleagues in Congress, is right now suffering a staph infection; and many of our colleagues have had a family member who has faced the same problem. It would be nice to know, and the advantage of having that information out there is that you can look it up, and you could find out. Hospitals that have paid attention to this have actually reduced some of their infection rates to near zero. That's what we want to see, but it's going to take an act of Congress to change that.

As an important part of this, we're trying to drive the point that the losses themselves do not guarantee quality. But it's quality that is very important. I believe you have a chart up there about some tests and procedures. I wonder if you could explain and comment on them a little bit.

That brings up an important point of how in the U.S. system we handle such

things as dealing with breast cancer and cervical cancer. One of the sad stories in this country is, more often than is necessarily believed, the U.S. handles lumps, et cetera, by providing mastectomies to women. Other countries may not do that. In part, it may be that the tests come much lower, are much more difficult to get in other countries; but it also brings up the other point. We need to make sure that physicians are empowered to provide that ongoing primary care so they can monitor the patients, get the tests they need. Unfortunately we have a system that pays for quantity, not quality; that pays for defensive medicine, not really working on prevention.

Let me read you an important quote. This comes from the New Yorker magazine, an article entitled The Cost Conundrum by Atul Gawande. It's about Texas towns. It says that between 2001 and 2005, critically ill Medicare patients received almost 50 percent more specialist visits in McAllen, Texas, than in El Paso and were two-thirds more likely to see 10 or more specialists in a 6-month period. Why? It was a different approach to care and, that is, providing more care, providing more surgical procedures, et cetera, doing more tests that were not necessarily warranted. You have another area, like where the Mayo Clinic is up in Rochester, Minnesota, where that dominates the scene. They have fantastically high levels of all this technological capability and quality; but its Medicare spending is in the lowest 15 percent in the country, $6,000 per enrollee in 2006, which is $8,000 less than the figure from McAllen, Texas. I bring that up to say that in the U.S., it is a part of what you are describing that patients need access to these tests in a timely manner, number one; but number two, we also need to make sure the physicians and nurses and all medical specialists are getting the information they need to make sure the quality is what we're driving here. When you are dealing with just issues of insurance or just issues of defensive medicine, you are not necessarily driving quality. You are driving more tests.

Another issue with regard to this bill we've introduced has to do with allowing doctors to volunteer their services. And here is something that only the United States would mess up in our government. Community health centers, which provide great health care at home for people with lots of different services from primary medical care, dental, mental health, pediatric care, et cetera. But they are strapped for money. In many cases they have a 15 to 20 percent shortage of family physicians, OB/GYNs, et cetera. The doctors are covered under the Federal Tort Claims Act. The Federal Government handles their malpractice at a lower cost for them. But if a doctor wants to volunteer, they're not covered. Basically if a doctor says, I would like to give my time to work a couple days a month, offer my time on a volunteer basis, the clinic has to turn them away because they cannot afford the full price of their malpractice insurance. It is the opposite in a free clinic, where if a doctor is paid, they have to cover their own insurance. But if they volunteer, they are covered under the Federal Tort Claims Act.

We have a bill we've been trying to get in for a number of years to allow doctors to volunteer. The advantages people have at health care home, it is a much lower cost. It even reduces the cost for Medicaid patients to go there by some 30 percent, and it focuses on getting the doctor near the patient and the patient near the doctor and eliminating any incentive of defensive medicine, any incentive to do lots and lots of tests just to make up for the losses.

If the gentleman will yield. As you know, many of those younger folks you are talking about consider themselves to be the invulnerables. They don't need insurance, they are never going to get sick. The problem becomes one that when they don't do that and they do get sick and they do end up in the emergency room, we pay for it. It is important that we remove any barriers and provide every encouragement and incentive for them to purchase that insurance that many times the employer does offer.

In addition to that, it has to do with how they purchase it. The Federal Government recognizes that if we allow people of low income to pool together they can negotiate better prices. The VA does this all the time. They combine the purchasing power of the VA to purchase for veterans across the Nation. Yet we don't let individuals do that.

We don't let a small business that only has half a dozen employees or 20 or 50 employees to join other businesses of the same type, and that wall placed by insurance companies and by the government leads to higher costs. We ought to allow businesses to do the same thing the Federal Government does and use that as a mechanism to drive down costs substantially.

And as you described, it brings the thought too that in addition to people having this hodgepodge of how disjointed a difficult system that does not allow individuals or employers to purchase insurance is, we oftentimes look upon other solutions and think, well, they are not purchasing it for other reasons, and we artificially keep those things high, and we keep a system that also incentivizes lots of tests, we incentivize a system that is really dysfunctional.

In that I bring to my colleagues' attention an article published by the New England Health Care Institute that said out of this $2.4 trillion health care system, this Nation wastes about $700 billion a year, and all these inefficiencies have to do with care delivery, even beyond that of what we are talking about here, with the tax, the incentives, the insurance and barriers we set up too.

Let me add to that. That is a great base to be moving from that what they do there does need to be these basic rights outlined, because we have a system that stands with huge barriers between doctor and patient and much of that barrier is the government.

The government through Medicare and Medicaid, for example, handles cost controls by delaying care, by denying care and by denying or diminishing payment. So physicians and hospitals that are paid, for example, 30 or 40 percent less for Medicare services, or saying you are not allowed to do these other tests, we are not going to pay for it, end up promoting a situation that is more based on quantity than quality, and that actually increases many costs and increases the chances for fraud and abuse. In Pennsylvania, there was news in the paper of just millions of dollars again of abuse in this system.

What is so important is if you have the patient and the doctor in charge of their care, you incentivize quality, you make sure the doctor has timely information through electronic medical records, et cetera. Those are important things which we are not doing yet as part of this.

But then you look at other clinics, you look at a Mayo Clinic, you look at the Geisinger Plan, you look at the University of Pittsburgh Medical Center, ones that have really focused on, We are going to change the quality and delivery of care and focus on outcome--you actually see those costs go down. That is part of the focus we need to have.

With that, I yield back to my colleague.

As that goes, when we look at the government running a plan that costs $1 trillion, that's several hundred billion more than the Pentagon. And I'm not

sure that people would say the Pentagon, for all the pride we have of all our soldiers, our sailors, our airmen and marines, I doubt that people would say that's the model of economic efficiency.

Would they say that Social Security run by the Federal Government is the best investment system? Would they--I mean, pick a system that the Federal Government runs, and it's hardly seen as the best. We know we have a lot of dedicated employees there, but oftentimes they are saddled and handcuffed by regulations.

We have a system that is still, after all these years, Medicaid, that has been around since the 1960s, so fraught with inefficiency that it invites waste, fraud and abuse. It has not been revamped.

An article that appeared in the New England Journal of Medicine a couple of weeks ago by Victor R. Fuchs was saying we've got to fix this system first; otherwise--and I go back to this article from the New Yorker. It says this: Providing health care is like building a house. The task requires experts, expensive equipment and materials, and a huge amount of coordination. Imagine that, instead of paying a contractor to pull a team together and keep them on track, you paid an electrician for every outlet he recommends, a plumber for every faucet and a carpenter for every cabinet. Would you be surprised if you got a house with 1,000 outlets, faucets and cabinets at three times the cost you expected, and the whole thing fell apart a couple of years later?

That's where we are with our health care system. It must be focused on quality and on outcome. And I worry that if we have a government-run system and this bureaucracy created, it's going to be a matter between you and your doctor and this Congress. To get anything done, it's going to take an act of Congress or bureaucracy. That's going to be such a huge cost on top that all the people will say, well, it's going to be less involved with regard to administrative cost. I don't see how that is possible, given the track record we have.

As this goes, I mean, I believe the government does have a role in terms of providing regulations, standards of clinical excellence, and pushing companies toward this constantly. Provide the oversight that says, if you're going to be spending the taxpayers' money on Medicaid, Medicare and the VA, we want to see quality measures.

So, if the Federal Government's going to put up money for electronic medical records, to say we need to see you driving constantly towards interoperability, towards intelligence systems, towards integrated systems, towards ones that are highly interactive with the physician. If the Federal Government can play a role in pushing people towards higher quality, I worry if the Federal Government is the prime owner of this, will the Federal Government, itself, push things towards that, and that's were I have trouble reckoning that.

When I look at this, I want Americans and all of us to imagine a system that's based upon cures and based upon outcome, a system where doctors are in charge of your health care, not insurance companies, not the government. And I know that both sides of the aisle are deeply concerned about this. It is not that one side or the other wants insurance companies or the government to win. We all want patients to win, Democrats and Republicans alike. But we must have a system that's focused upon this, not that creates incentives because we're paying people so low to do more and more tests, not to promote more and more medical procedures, but to really focus on this outcome. We can do this through these things we're doing, the patient and doctor in charge. Don't create more barriers. Make sure we have all the efficiency there for quality. We can do those things. Imagine what can happen. Imagine the possibilities. And let's just not throw it out and say it's too difficult; let the government run it.

With that, I yield back to my colleague, Congressman Dent.

I thank the gentleman from Nebraska. And, Mr. Speaker, I also want to thank my friend and colleague from California, Grace Napolitano, who has been a great advocate. And I'm pleased to serve with her as leaders on the Mental Health Caucus. Her passion for working to bring awareness to our Nation and more treatment to those with mental illness is truly commendable and admirable.

With 57 million people in this country suffering from mental illness, it is no small problem. With one in five children and adolescents, with somewhere between 17 percent to 24 percent of our returning soldiers affected with mental illness, it is of great concern to us. Unfortunately, the problem that so often comes up with mental illness is not that it is not diagnosable, for it is. It is not that it is not treatable, for it is very treatable. The problem is for so many, the chosen treatment and approach to mental illness is denial. What we do is we deny its significance, we deny its existence, and therefore we deny the treatment to so many.

In some ways, we have not advanced beyond those Puritanical days of the Salem witch trials, where prejudice haunts the ability to get help, so people who have need of mental health treatment avoid it, families are not supportive of it, employers oftentimes will dismiss employees without understanding what it is, and quite frankly even here in Congress people have an awareness that is, well, dated, to say the least, when we do not understand that the way we need to approach mental illness is to vigorously approach it and treat it.

In the workplace, when mental illness is something that is part of someone's treatment insurance plan, we find that it actually saves money for employers because those employees get back to work. When we find that employees are denied mental illness treatment, and may I also add Medicare for the longest time also did not cover mental illness treatment, we find people worse. People who have chronic illness have twice the risk of mental illness. People with chronic illness, which is 75 percent of our health care cost, have twice the risk of mental illness. And yet for many years, Medicaid didn't cover it, and many insurance plans still do not. When you have a chronic illness and you have mental illness combined together, the health care costs double. They double. And it is important that we treat this with all of the tools possible.

Unfortunately, many times mental illness is treated only by pharmaceutical approaches. Some 75 percent of mental illness drugs are prescribed by nonpsychiatrists. That is unfortunate because I'm sure that many heart surgeons with their cardiac patients would not be very happy if noncardiologists treated the heart patients. And it goes on. But unfortunately when insurance plans do not pay for it, that is the only recourse.

There is one particular group of folks suffering from mental illness that have been mentioned a couple of times here, and that is our returning veterans from Iraq. Initial studies have suggested that some 17 percent of combat veterans may suffer from post-traumatic stress disorder. More recent studies suggest that of those who are coming back who actually experienced combat, those numbers may be as high as 24 to 25 percent. The military has made remarkable advances in dealing with suicide and depression and post-traumatic stress disorder in our returning soldiers, and with good reason. Right now, more soldiers die from suicide than from combat. It is also something that is contributing to those soldiers who have returned who have some mental health problems may actually engage in highly risky behavior, driving fast, more drinking and more drugs, which leads to further problems for families and more undetected mental illness.

The Navy, for example, has established programs where they actually send teams of Navy psychologists and sociology workers out to see where they can return with the veterans and work with them while they are onboard ship, helping to identify problems, screen them and get them involved with the help they need. The Army is also advancing in this, as the Marines and the Air Force, and that is good, because over the last couple of centuries in our country, if you look at the pictures, the photographs, the drawings and the paintings of our military, the ships have changed, the uniforms have changed, the guns have changed and the weapons have changed. But the soldiers have remained the same. Over the last century, we referred to such things as ``combat fatigue'' or ``battle fatigue.'' And for the longest time, soldiers were treated with ``three hots and a cot'' as a method of treatment. But now we are recognizing that teams of mental health professionals in the theater of combat are very helpful.

Recently the combat stress center in Iraq at Camp Liberty came literally under some fire, however, when one person they were treating allegedly walked into this combat stress facility and opened fire. He had had his weapons taken away, but then on his way back after he was dismissed from there and told to come back later, he took someone's gun, came back and opened fire. Two therapists and three people waiting for care were all killed. It is worth noting that one of those people waiting for care stood up and tried to stop him from killing others, and that person was killed in the process. So even in the course of trying to get some help, we have somebody who stood as the hero.

I had mentioned early on that denial is a huge problem, and it is important that all of us understand post-traumatic stress disorder and acute anxiety disorders in our returning veterans. Because whether you are a family member, you are a friend or you are a member of the American Legion or the VFW, it is the responsibility of all of us to look out for these returning citizens and help them get the help they need.

Watch for these symptoms:

Recurrent and intrusive distressing recollections of an event, including images, thoughts and perceptions such as seeing a comrade's dead body or experiencing flashbacks of the sounds of explosions and screaming;

Recurrent and distressing nightmares of the traumatic event;

Intense psychological distress when exposed to cues or reminders of any aspect of the trauma, such as the backfiring of a car or an explosion that could set someone off again;

Extreme physical reactivity, such as racing pulse, sweating, and intense fear, when exposed to any cues or reminders of the trauma. This could even be set off in Vietnam veterans or World War II veterans when they watch a program or a movie on television;

Persistent avoidance of any reminder, not wanting to talk about it, avoiding any thoughts, activities, places or people, of the traumatic event;

A general numbing in responsiveness, such as the person feels detached and estranged from others and may have little range in emotion and few strong feelings. Oftentimes this is a concern raised by spouses when their spouse returns home from combat, and they say he or she is just not the same anymore. The emotions are blunted. They have less ability to show the depth of emotions, less interest in the children.

They may also have a sense of a foreshortened future; having come close to death, they may see their own death and problem as imminent and may engage in more risky behavior.

They may have hypervigilance. They may be constantly scanning the environment for danger, even when there are no problems. They may be driving along the highway, if they were perhaps the driver of a Hummer in Iraq, they may be constantly scanning the road to see, are there problems ahead?

They may have an exaggerated startle response, especially to sudden movement or loud noises. They may have poor concentration, irritability and anger. And anger is an important symptom that we need to pay attention to for depression and anxiety disorders and post-traumatic stress disorder for veterans. And of course they may have disturbances in one's ability to sleep.

Many times the veteran will work towards self-medicating, alcohol and drugs, and, of course, keep that quiet from others too. They may find themselves not sleeping at night but having a job where they sleep a lot during the day so they can hide this from others.

But what is so important, as I said in the outset, is that denial is not appropriate treatment, and that the rest of us do not get engaged in denial too. It is absolutely essential that we support our returning veterans no matter what. Regardless of someone's political views, we need to stifle our own comments and understand they were doing what we asked them to do. They were following orders.

And, quite frankly, they were doing it pretty darn well. And they accomplished their mission, and we're happy to see them returning home.

But, that being said, the silent battle that our veterans continue to fight, that invisible, silent battle that goes on inside their own heart and in their own mind is something that we need to be reaching out and paying attention to. And as we look at Mental Health Month, as we have just come back from Memorial Day, as we continue to see the yellow ribbons fly from trees and posts in every hometown of America as our soldiers return home, as we continue to send our notes and our e- mails and our care packages to our veterans, let us remember that we must continue to reach out for the veteran who has borne the battle, for their orphans and for their spouses and for those persons who have come back with that silent problem of the posttraumatic stress disorder and other disorders. We will work with them. We will help them. And God bless our veterans. And again, I thank the sponsor for this bill on Mental Health Month.

Mr. Speaker, I would just like to add a few more comments here. We have no more speakers, and I'll close with that. But it has to do with this.

As I discuss the issues of our returning soldiers, it is important I add this element too, and that is that we need to reflect to them a tremendous sense of hope. Many times soldiers in theater and after they return home are hesitant to talk with anybody about their symptoms for two fears: one, if they're in theater or combat, they worry that it will prevent them from going back to their unit. If their deployment is ending, they are worried that it will delay them from coming home; and they also are concerned that it will affect their promotion, their advancement, their continuation in the military, and they don't want to let their fellow soldiers down or themselves.

What our military is working on, however, is making sure they understand that our duty as mental health professionals is to make sure they're back to full form, and, in fact, that is something that's a change of how the military has handled this. Whereas, in the past someone would be pulled out

of their unit if they could, now the work is to get them back on their feet as fast as possible, but making sure they're not adding risk to their fellow soldiers.

Along those lines, it's important we send the same message of hope, whether it is someone who is a veteran in battle, or perhaps a veteran, as my friend from Rhode Island just pointed out, someone who has faced the same sort of problems in their neighborhood.

There are also genetic aspects of mental illness that may have very little to do with environment. There are parts that have to do with other neurological problems that occur.

Overall, our advance in the mental health field has grown tremendously. It may be that you cannot necessarily do a CT scan or a x ray or a blood test to diagnose mental illness, but it is diagnosable. It is treatable. And we have to make sure that part of this resolution for Mental Health Month and the goals and ideals is to help our Nation understand that it is diagnosable, it is treatable. We need to come to grips with it and deal with this in a way that understands that the science and the technology and the medicine behind mental health treatment gives a lot of hope for the future.

And with that, Mr. Speaker, I yield back the balance of my time.

A cap-and-tax energy bill is working its way through the House. Democrats and Republicans alike want to make sure that we put caps on emissions to

reduce pollution in our country, but we need to make sure we find a way of doing this without increasing family electric bills, losing manufacturing jobs, or losing steel jobs.

They say we should trust China that they won't cheat and somehow send cheaper goods over here. But this is the same country that sends us fungus in their diapers, leaded toys, toxic baby bottles, poison dog food, harmful building materials; they dump steel on our shores, hack into our computers, and spy on us. Hardly a country I would trust.

They say that we're going to get 200 tons of steel to build a windmill, and that's true, but it takes 90 tons of steel to build a clean coal power plant. What we ought to be doing is spending our money tearing down our old dirty coal plants, building new ones, and using our massive resources.

Let's use the oil off our shores to fund clean coal technology, build nuclear power plants, get a million more jobs in America, and clean the air in our country. Put a cap on emissions, okay. But let's put a cap on job losses. That's how we help our country.

Madam Speaker, last Monday a tragic event occurred in Iraq when five servicemembers were killed at the Camp Liberty Combat Stress Control Center. It points out the importance that we need to pay attention to with posttraumatic stress disorder, acute stress disorder, and a wide range of other mental illnesses which can occur after prolonged combat or exposure to severe stress.

We need to understand and communicate with our soldiers and their officers that these problems are real and they are treatable and you can get a soldier back in emotional shape. It is not a sign of weakness. It is not a sign of failure on the part of the soldier or the officer, but they need to get help.

Over the centuries in our military, the uniforms have changed, the weapons have changed, the ships have all changed, but the soldier remains the same, brave and strong and true. But Congress must, nonetheless, provide substantial funding to take care of our soldiers and their families and keep them in mental health shape and physical shape and to get them back on their feet strong and ready.

Congress and our Nation must continue to support them. There is hope, there is treatment, and we need to continue and support our soldiers in that endeavor.

Madam Speaker, our Nation needs an energy renaissance. We must develop a wide range of energy sources with a shared goal of reducing emissions and leaving our planet cleaner. We must have clean coal, efficient renewable energy, clean nuclear energy, and responsible use of fossil fuels.

It is time for an energy renaissance that uses American resources to create American jobs and stop spending hundreds of billions of dollars each year to OPEC. We know that building this bridge to America's clean energy future will require the largest commitment this Nation has ever seen. It is expensive, it is necessary, and it is time.

Over the past few months, I worked with my colleague, Representative Abercrombie, and other Democrats and Republicans, with no members of leadership or special interests involved with us, but wrote a plan for American energy independence focusing on exploration, conservation and innovation to build this bridge to America's clean energy future. We introduced H.R. 2227, the American Conservation and Clean Energy Independence Act, which uses American resources to cut our dependence on foreign oil, clean up our air, land and water, dramatically improve energy efficiency and conservation, create millions of new jobs, fuel our economy, and do all this without raising taxes. I urge my colleagues to sign on as cosponsors of this bill.

Madam Speaker, pursuant to the Republican Leadership standards on earmarks, I am submitting the following information for publication in the Congressional Record regarding earmarks I received as part of H.R. 1105, Omnibus Appropriations Act, 2009:

Requesting Member: Congressman Tim Murphy

Bill Number: H.R. 1105--Omnibus Appropriations Act, 2009

Account: Department of Education, National Projects, Innovation & Improvement

Legal Name of Requesting Entity: National Writing Project

Address of Requesting Entity: University of California, 2105 Bancroft Way #1042, Berkeley, CA 94720-1042

Description of Request: Appropriation in the amount of $24,291,000 for the National Writing Project for activities authorized under the Elementary and Secondary Education Act.

Requesting Member: Congressman Tim Murphy

Bill Number: H.R. 1105--Omnibus Appropriations Act, 2009

Account: Department of Education, National Projects, Innovation & Improvement

Legal Name of Requesting Entity: Reading Is Fundamental

Address of Requesting Entity: 1825 Connecticut Avenue, N.W., Suite 400, Washington, DC 20009

Description of Request: Appropriation in the amount of $24,803,000 for Reading Is Fundamental authorized under the Elementary & Secondary Education Act.

Mr. Speaker, it is not often that we get to talk about people that we consider to be a true gentleman, a true friend and a great American. That is what Arnold Palmer is to all of us. I am honored that he lives in my congressional district, at least during the warm months, out in Youngstown, Pennsylvania, an area close to Latrobe, Pennsylvania, at the place that he grew up.

Now, I am not a great golfer. And, in fact, to discuss it at all would be an embarrassment to me. But I did have a chance to play with Mr. Palmer once, and in so doing, traveling across his golf course, he points to a tree, or formerly a tree, which is now carved in the likeness of his father. And that brings about many a story about Deacon and how he taught young Arnold to play golf and many of the other things about him that have become famous icons: that tractor which he brings out now and then to show people when they come to the golf course, or how you will often see Arnold sitting out there talking to anybody who comes by, signing anything they put before him, because he is just so close to the people of the district and of America, always willing to shake their hand.

And a handshake means something to Arnold Palmer. Very famously, he had that long-term agreement with his former manager, Mark McCormack, that lasted from 1960 until his death in May of 2003. He has the same kind of agreement with Doc Giffin, his assistant. That's the way Arnold does business. A handshake means something to him. You don't have to put it in writing.

We can also look at other parts of his life. Back when he was a champion golfer at Wake Forest, he left there after the death of a friend and joined the Coast Guard. And one would have thought he gave up golf entirely except he went out and played a little golf in Cleveland and rediscovered this great talent he had, and, well, the rest becomes history.

But more so than the stories of golf are the stories of what he has done in western Pennsylvania and really around the Nation.

As a pilot, he helped to develop Latrobe Airport, and interestingly enough, served in its authority for many years except during a time when he had his own business interests there. Being the true gentleman and person of high ethics that he is, he stepped off that aviation board for a while to make sure he didn't have any conflicts of interest.

He's also given a great deal to many charities. He helped establish the Winnie Palmer Nature Preserve that just yesterday, there was the laughter of children there on the St. Vincent's College campus exploring that area in the woods and marshes that his former wife, Winnie, had talked about, how it was so important to preserve that area. He's also given so much to Latrobe Hospital where he remains head of their charitable board after raising so many millions of dollars for that hospital to help with charitable care. And also the Arnold Palmer Pavilion, part of Latrobe Hospital's Mountain View Medical Park facility.

But beyond all of that, other ways to describe him is when you go to his office there--it's along the same road where he grew up out there on Arnold Palmer Road it's now called--you go up to his office and you'll see it's filled with trophies and photos of people he's played with of all levels. And of course that famous room where he always tinkers and works on his own putters and a wall filled with I don't know how many thousands of putters. He's got another area there, a warehouse filled with everything that anybody has ever given him. In fact, I gave him some congressional golf balls, and he said, ``I'll put these in the warehouse with everything else.'' I'm sure he catalogues it all.

I remember walking through and pointed to a certain club and said, ``Do you know what all these are for?'' He said, ``Sure.'' You name a certain hole, a certain year, a certain course, he will tell you what club he used and what happened on that. Most famously he has that twin set of golf balls mounted on the wall in his office. This is when he hit the back-to-back holes-in-one in 1968 at TPC Avondale. He hit it one year--I think it was the No. 5 hole, I'm not sure--hit it and the next day he shows up on the hole again and there's all the camera crews there. He said, ``What are you doing here?'' They said, ``We want to watch and see you hit another hole-in-one.'' He didn't expect it, but that's what he did.

There's a couple other things about him, too. In his office, he has a table, and it's filled with the medals that he receives from every tournament that he wins. But there are a couple of empty spaces on that table. I remember asking Arnold what those are for. He said, ``You never know. You might just win another medal.'' Quite frankly, I think that would be a good place for this Congressional Medal to go.

A story about him and golf was told to me by a person who probably doesn't want me to use his name, so I won't. But it's probably some of the best golf advice any of us could ever have and, again, shows some of the spirit of Arnold Palmer.

He was playing with this other golfer who was not having a very good day and was probably doing his share of slamming his club down and cussing and swearing, I suppose, as he shanked the ball and hit it to the left and right off the course. At some point, Palmer said to him, ``Would you like some advice?'' Now, imagine what any of us, no matter what level of golf you have as talent or lack thereof, if Arnold Palmer, the King of Golf, says to you, ``Would you like a little advice?'' At this point the golfer eagerly said, ``Yes, I'd love it.'' And Palmer said to him, ``You're not good enough to get mad.''

Well, so it is great advice for all of us. We're not good enough to get mad. Let's leave that to the professionals in this.

But it is important that we recognize Arnold is good enough to receive this recognition. And I might say in all the years I have known Arnold Palmer, he's never asked me for anything--well, except for one thing. The man who seems to have it all has never come to his Congressman saying, I want you to do this or that. He just asked this: When you drive down Arnold Palmer Road and you come across the entrance to Latrobe Country Club where the sign says ``slow down, golf cart crossing,'' he really doesn't want anybody to get hurt there, and he would sure appreciate it if you just slowed down your car.

All in all, though, for a life that is still very rich in its accomplishments and for a person who has made America a better country because of what he has done, not only for the sport of golf but for health and for so many people around this country, Mr. Speaker, Arnold Palmer is a man well-deserving of this Congressional Medal.

I thank my friend Dr. Gingrey for yielding. Of course, Dr. Gingrey, you are well aware as a practitioner of how Medicare works. I want to lay out for a few moments here, as many people will start to say that we should use Medicare and Medicaid as examples of how to expand health care because they are run so well. I want to point out a few things about how I disagree with that premise and those that say that Medicare has a very low cost overhead.

In part, that is because some of the administrative fees are set, but there are several other things we need to know about that, and that is that they

pay very low fees to hospitals and physicians, and perhaps that is why so many physicians do not participate in Medicare-Medicaid payments. Another aspect too, is, understand that Medicare covers only about 58 percent of beneficiaries' health care expenses.

So when you leave that much in other fees on the table unpaid, what happens? Well, hospitals use some of their own coverage to cover that gap in Medicare coverage. Patients also carry their own supplemental insurance on their own to cover it, and many times it is left that the actual cost of Medicare that we are told does not anywhere near describe what the real cost is.

The Medicare Payment Advisory Commission, otherwise known as MEDPAC, said the way Medicare is going, its well-known design deficiencies and financial problems will certain inhibit the delivery of high quality care, in its June 2008 report to Congress. They said, ``Without change, the Medicare program is fiscally unsustainable over the long term and is not designed to produce high quality care.''

Let me give you a couple of examples of where I think Medicare is a particular problem, and Medicaid as well.

A constituent of mine has multiple sclerosis, and some of you may know that multiple sclerosis affects nerve cells and really affects the ability of those nerve cells to communicate with one another. There is a membrane over the arm of nerve cells called a myelin sheath, and what happens is the sclerosis or scarring of that sheath affects the ability of one nerve to communicate with another.

In multiple sclerosis, a person may have discrete attacks or long- term attacks that may affect their motor skills, their muscle skills or their thinking and cognition. At times it goes away completely for long periods of time and then comes back.

The annual cost per patient, however, for treating such patients may be $30,000 or $40,000 or $50,000 a year. And yet how does Medicare and Medicaid handle that? Well, they have this strange notion that says, for example with Medicaid, if you want to have some payment for that, you must be disabled. But to be disabled you have got to go 24 months of disability, which is not a characteristic of this illness. And, of course, to be disabled means you can't work. If you are not working, you can't pay for your medication. If you stop working and they find out you really are without symptoms, it is a problem. So, you see, it is one of those catch-22s we put people in with this.

There is also something here that Medicare and Medicaid does not pay for: Disease management. This is particularly important, because disease management for people on Medicare is extremely important because of the complexities of their illness. And these complexities are not small.

Nearly 80 percent of Medicare beneficiaries have at least one of the following chronic conditions: Stroke, diabetes, emphysema, heart disease, hypertension, arthritis, osteoporosis, Parkinson's disease, urinary incontinence. And because of this, 5 percent of Medicare beneficiaries account for about half of all Medicare spending each year. Among this top 5 percent, nearly half had congestive heart failure and 35 percent had diabetes.

You see, there is such complexity among people with chronic illness, it is a wonder they can manage it at all. That is why people with severe illness do better if the doctors and nurses can work with the patients to manage this complex care.

You don't have to be a member of our GOP caucus to notice how difficult it is, and hopefully some of the comments made by some of my colleagues tonight can illustrate that. But I know patients that I have worked with, sometimes it is absolutely overwhelming for them to have multiple visits and dealing with so much with their illness, and yet Medicare and Medicaid won't pay one penny to have anyone from that medical practice work with that patient.

So what happens? They forgo their treatments, they make mistakes in the medications, there are many difficulties that come up, and it could lead to unnecessary hospitalizations. And those, Mr. Speaker, those issues are ones that cost so much in the area of health care. I am sure my colleagues, no matter what branch of medicine or health care they are from, know this full well. When you have a patient with multiple complications, if they cannot deal with it, well, the complications increase.

Part of the reason that this is even more of a problem is that what happens, these complexities go on. If you have Medicaid and Medicaid plans that say we are going to pay for what they call quality of care, and it is only based on a narrow measure of outcome, then what happens is that patients stop to be compliant and hospitals may discharge some of them early because they are not paying for actually managing these difficult cases.

This is a serious, serious problem, and one of the reasons why out of this $2.4 trillion health care system we have no less than $700 billion or $800 billion worth of waste. It is because of that, Mr. Speaker, that what we ought to do is, before we say let's have the government expand Medicare and Medicaid and make it available for all, we ought to say let's use all of our abilities to fix these broken systems. It is wasteful, it is harmful, it is difficult for patients, and it is not effective health care. And because of that, I would certainly encourage what Congress should do with all full speed is instead of saying let's just replicate this broken system and expand it for everyone, we ought to fix this system.

Medicare's hospital payment system doesn't encourage or reward hospitals to reduce readmissions. It is a matter that we almost have like 18 percent of admissions results in readmissions within 30 days of discharge. What is wrong with a system that has those kinds of problems?

So, Mr. Speaker and my colleague, Dr. Gingrey, I know, doctor, how you and I have talked many times about these difficulties and how they go on.

I might add this other point, if I may, doctor. You are aware that with Medicare, that as people lay this out as being this great cost- effective plan, one of my concerns is if it is so cost-effective, why is it going belly up? It is out of money in less than 10 years. Yet it is touted all the time of having this effective health care system. It is not that way. I think it is that way simply because it is not paying for effective health care along those lines. That is one of the issues that the GOP Doctors Caucus is trying to bring before the American public, and certainly before our colleagues here in the House.

Will the gentleman yield?

I thank the gentleman.

I wanted to just take a moment to illustrate what Dr. Gingrey was saying as to the effect of the inefficiency of government-run health care.

The New York Times, just a couple of weeks ago in an article written by Julie Connelly, talked about a growing number of physicians--it's an article entitled ``Doctors Are Opting Out of Medicare''--particularly internists, who are dropping out of Medicare all together because of low reimbursement rates and the burden of paperwork and, I might add, because of some of the ridiculous policies sometimes.

It's noted in a Texas Medical Association survey that 58 percent of Texas doctors accepted new Medicare patients, but only 38 percent of primary doctors did so. Think of some of these absurd principles in some of these government-run plans.

For some patients, they might need home infusion therapy, that is, they may need antibiotics; but the strange thing about this is that the person has to come to the hospital to get them. They're sick. Instead of being at home and having a nurse or someone in the family trained to give some home infusion, they've got to get up, leave the house and go somewhere else. I know my colleague, Representative Eliot Engel, and I are working on a bill to allow a part D drug benefit to cover some of these home infusion drugs because, right now, when you are denied access to home infusion therapy and are being forced into receiving infusion therapy in hospitals and in skilled nursing facilities, it's significantly higher in cost.

There is one other example I wanted to talk about, too. I've talked to some oncologists who have pointed out, when patients come in for chemotherapy, they need to be evaluated at that time to see if they're healthy enough or in the right condition--that they're not sick at that moment or have the flu or something else which would cause serious problems if they received chemotherapy. Yet what happens is, when they get to have those results and to have those tests and to have that treatment done, you have to do certain lab work, and they don't get reimbursed for that. So the medical practice eats that cost, once again, to supplement the Medicare and Medicaid plans.

I point that out as some of the many examples of how, anytime someone says Medicare and Medicaid are much cheaper, of course they're cheaper. They don't pay for treatments; they discourage comprehensive medical care, and they place the burden back on the patient and back on the States. That's not how we want to run a health care system; and I believe, in many cases, it leads to more difficult care.

God bless the doctors and hospitals who do the right thing and give of their time anyway.

With that, I yield back.

Madam Speaker, our former colleague, Bud Shuster has taken on a new challenge to promote wellness through his central Pennsylvania region. As a trustee at Saint Francis University in Loretto, PA, he's spearheading the creation of Community Wellness Fairs through the exciting new DiSepio Institute for Rural Health and Wellness located at the university.

The extraordinary story of Bud's survival and recovery from a broken neck and other injuries suffered in a car crash several years ago recently appeared in the Altoona Mirror, and I'm pleased to insert it into the Record:

Run For Your Life

(By Congressman Bud Shuster, M.C. (Ret.))

Twenty-seven years ago on my way to a Rotary speech in

Altoona a speeding car swerved around the bend on a rain-

slicked road and smashed head-on into our car where I was a

front seat passenger. The crash broke my neck and six ribs.

The neurosurgeon who put me back together said I was less

than a millimeter away from being a paraplegic. If I had not

been wearing my seatbelt I would have been killed.

He also said if I had not been in shape through my daily

running and weightlifting regimen, I might not have survived

the multiple, lengthy, and delicate surgeries required.

But within a year I was back running and working out, and

now in my seventies, I'm still feeling great, running and

working out every day.

So it's probably no surprise that I'm thrilled to

participate in a wonderful new opportunity that is being

created to promote our health and well-being right here in

our region.

The DiSepio Institute for Rural Health and Wellness will be

formally dedicated next month at Saint Francis University in

Loretto, Pa. as part of the university's Health Sciences

Program thanks to the generosity of Joseph and Marguerite

DiSepio, with whom I have the privilege of serving on the

Board of Trustees.

The multi-million dollar institute, designed by the

architectural firm of Celli-Flynn Brennan, and being built by

Leonard S. Fiore, Inc., is dedicated to improving medical

technology and wellness opportunities, not only on campus,

but also throughout the region and across America. It

includes a world-class fitness center for training, teaching

and research, as well as human performance, cardiovascular-

metabolic, and kinesiology/biomechanical labs. A Faculty-

Student Practice in health and behavioral sciences, along

with a conference center and spiritual wellness center also

are included. In short, it will be a premier facility of its

kind in America.

The challenge now is to capitalize on this wonderful

endeavor by carrying its message to promote a healthy

lifestyle throughout the communities of our region.

So, the university in cooperation with private funding is

creating ``The Bud Shuster Run For Your Life Program'' to

which I have happily agreed to lend my name and effort.

The purpose will be to take the program into our

communities, our schools, service clubs, senior centers,

health facilities and other organizations to promote wellness

through gatherings and events including running, jogging,

walking and other fitness challenges, coupled with health

screenings such as blood pressure, asthma, body fat, posture,

etc.

But a fitness program is only half the wellness story. Dr.

Kenneth Cooper, considered the father of aerobics, writes

that no amount of exercising can make up for bad nutrition or

obesity. A cholesterol reading of 240 triples your odds of

having a heart attack compared to a reading below 200, and a

systolic blood pressure of 160 quadruples the chance of a

heart attack compared with one below 120. At his Cooper

Clinic in Dallas, Texas, he focuses on a lifetime ``Positive

Eating Plan'' or PEP. There's nothing fancy about it, and the

Saint Francis Wellness Program pretty much follows it:

limiting animal fats, sugar, alcohol, and paying attention to

calories. It's taken me half a lifetime to find, through

trial and error, a PEP plan that works for me, and hopefully

the Saint Francis Wellness Program can work for you.

We're delighted that the Hollidaysburg Area YMCA, under the

leadership of Tom Kopriva, has agreed to team-up with us for

the inaugural Community Wellness Fair on Saturday, April 25th

at the Hollidaysburg Y.

Starting with the race at 8 AM, it will be a fun-filled day

to promote healthy kids and families. Professionals from the

university's DiSepio Institute for Rural Health and Wellness

will be providing health screenings and sessions including

healthy eating, sports injury prevention and physical

activity recommendations. A healthy Kids Day will include

sports activities led by the university's football,

basketball and soccer teams.

I'm thrilled to provide a friendly challenge to young and

old alike--to join me on Saturday, April 25th, in running or

walking and participating in this exciting Community Wellness

Fair. There will be prizes for everyone. But the best prize

will be a long and healthy life.

I thank the gentleman from Georgia, not only for your leadership in health care but for your time here.

You know, we have many times discussed the issues involved in health care, and although I hear many people talk about the issue of accessible and affordable quality health care, very often the solution offered in this body by government is more government, and that is health care is expensive, so let's have someone pay for it--the government. Along those lines, Medicare and Medicaid oftentimes list it as, because so much is spent there--and I think Medicaid is $350 billion a year there. Between Medicare, Medicaid and the VA, almost half of the Federal mandatory budget is spent.

The question is: Are they effective? Are they efficient? Does it have quality-based health care?

I want to bring up just a couple issues here and emphasize the importance of that doctor-patient relationship. I am a psychologist. For many years, I have worked for hospitals in the Pittsburgh region in the pediatric, maternity and general medicine settings, but I have always had a strong relationship in working with a wide range of physicians and with other health care specialists, recognizing it is a team and in letting the team do their work that you really end up with some significant savings in quality of care. Let me talk about a couple of ways that that does occur.

A recent report sent out by the New England Health Care Institute noted that the U.S. really spends more on health care than any other nation on Earth, and many times people talk about the negatives of our health care system in terms of higher rates, for example, of infant mortality, but there are concerns about how that data is reached. I will not go into that now.

What I do want to point out, however, is that out of this $2.3 trillion health care system, which is very expensive and gets in the way of a lot of families affording health care, one of the deep concerns, perhaps, is that 30 to 40 percent of those health care dollars are wasted. $600 billion to $700 billion is what is listed in this report. Let me name a couple of things that go into this. If we let the doctor-patient relationship take supremacy over this and let physicians make decisions for what patients need, there are some changes we might see.

First of all, unexplained variations in the intensity of medical and surgical procedures, including but not limited to end-of-life care, the overuse of coronary artery bypass surgery and the overuse of percutaneous coronary procedures has the potential of avoidable costs of $600 billion. The misuse of drugs, overprescribing and underprescribing: some $52 billion. The overuse of non-urgent Emergency Department care: the savings could be $21 billion. The overuse of generic antihypertensives: a potential savings of $3 billion. The list goes on.

Now the question is: Why would these conditions exist?

Well, actually, government, itself, stands in the way in many cases, and sometimes, well, it is the way health insurance is set up, but if the issue were instead that physicians could be the ones who are moving forward in this, I believe a lot of savings could take place. I believe what we should be doing as a legislative body is finding ways to break down those barriers and really helping to improve. One of the points to be made by a number of the doctors here on the floor tonight is about having more physicians involved. Let's take one of those aspects.

Having a health care home is important, and one of the health care homes for people in some areas has to do with having a community health center. Now, community health centers provide great quality of care with a wide range of medical services, as my colleagues note. Yet there is a shortage of physicians, in part, because it is not the best paying position in the world, but many physicians want to help. The strange thing about this is that, in a wide range of health care areas, if you work at a community health center, your medical malpractice insurance is paid. If you volunteer, you are on your own, and so these clinics say, We cannot possibly afford that. There are different kinds of malpractice insurance that is not important to get into at this point. We have tried a number of times to allow it so physicians could actually volunteer--so psychologists could volunteer, so dentists, podiatrists, social workers, and nurse practitioners--but no, the government says, We cannot let you do that.

There are also areas, too, that come up here in terms of how we could let disease management work. Here is one of the strangest things that happens with Medicaid:

You know, one group that has a great deal of problems is that of people with severe diabetes. The severe diabetics, if they have problems with the circulation in their feet, for example, the real tragedy might be that they might have their feet amputated, but isn't it strange that Medicare and Medicaid will not pay for that physician or that nurse to monitor the patients closely--to call them, to work with them, to do more than just give them a pamphlet, but to work closely with them to keep them out of the hospital, to make sure that they are getting their insulin, to make sure they are monitored for their weight, et cetera, but we will not pay for that? We will pay $50,000 for that tragic surgery that could have been avoided, but we will not pay money to help when they manage the care.

Now I might say that there is a recent study that came out that, I believe, is filled with methodological flaws, saying that disease management has some questionable applications. Unfortunately, they focused on those who oftentimes had the most severe illnesses. As I am sure many of the physicians here tonight can attest, the real value is getting to that patient early or when the complications begin to show up rather than to wait until the end. I know, in my career as a psychologist, I had a patient who is now a deeply depressed, suicidal inpatient. When you could have been working with them years before, it makes a big difference in their outcomes.

We have to make sure that the system that we allow here with health insurance and with physicians working with patients really allows for a great deal of predischarge planning, of working closely and individualizing that care and for making sure that it is there.

Let me mention a couple of other things as we proceed forward. Recent legislation under the House set aside nearly $2 billion to help physician practices have health information technology. A good idea. The question is how it is done. If that health information technology is merely paying for keeping hospital records on a computer, that is not going to be enough because that is a passive system that only makes it a little easier to pull up records rather than having to wait for the records to arrive.

What we need is a smart, interactive system that is portable for the patient so that records follow the patient, not so that patients follow the records. We have to make sure it is private, that confidentiality is protected, and we have to make sure it is personal so that the relationship between doctor

and patient is what is paramount here. That physician and information they are obtaining and what they are writing whenever they have a diagnosis is a smart record that also helps provide information to that doctor about best practices, about feedback, about prescriptions, and even about the feedback of whether or not that patient got that prescription and if he is following through. It is all of those things. In today's world, because there is a shortage of physicians and because insurance with Medicare, Medicaid or private insurance oftentimes does not pay for having the physician actually work to follow up with the patient, then that health IT is just one, big, expensive thing on the desk of the physician, and it is not really providing the care they need.

Let me mention one other thing here, and that has to do with point of care lab tests. The system we have designed is one where--and because some physicians have been found when they own the labs--the concern was were they overprescribing lab tests. I would love to hear some input from my physician colleagues on that, too. So what did they say? They said, Let's not allow physicians to do this at all, where sometimes the most valuable thing is if the physician says, I need an x-ray; I need a lab test; I need this information right away. Instead, they have to send that patient out to a lab or send the information out. It could be a couple of weeks before they would get it back.

The best way to improve patient compliance is quicker information. Even to allow, for example, pharmacies and drug stores to provide some of this lab information would be more valuable. All this feeds into the system that part of the way to save the $600 billion or $700 billion worth of loss in the health care system is to put the tools in the hands of those who provide the health care. Make sure there are enough physicians. Make sure they have the tools they need so that as they diagnose, as they prescribe, as they work with other colleagues in the health care field that that information is shared in an effective way that is personal, that is private, that is portable, and actually that is permanent, too. These are not records that are lost as a person moves on to another health care plan or whatever they do in life.

Part of what we are doing here as the GOP Doctors Caucus is operating on the idea that we are all gathered together here to really work on making sure that we are developing patient-centered, patient-driven health care reforms based on quality, access, affordability, portability, and choice. Over the coming months, you will hear from us continually speak about this because we believe we have a health care system that can be based upon those, that can save massive amounts of money and that can save hundreds of thousands of lives. That needs to be our goal, not only to do no harm but to make sure we put health care back in the hands of those making those health care decisions. In so doing, we go at the very thing that people are raising the concerns about, and that is making health care more affordable and more accessible with quality as the underlying point.

With that, I yield back to the gentleman from Georgia.

Mr. Speaker, on March 7 and 9, the young Government of Northern Ireland was put to the test. Two British soldiers and a policeman were killed by fringe groups trying to change peace to chaos, trying to reach the future through a return to the past. They failed, and the people of Northern Ireland became stronger.

The people voted for peace and acceptance of the Good Friday Agreement. The people voted for their First Minister Peter Robinson and Deputy First Minister Martin McGuinness, who jointly condemned the murders.

The people of Northern Ireland grew stronger when thousands of Catholics, Protestants, Unionists, and Nationalists marched together saying ``No going back.''

As Americans, as fellow lovers of freedom and democracy, we are with the people of Northern Ireland. We are both nations of law, and can only survive when the law is upheld.

God be with the families who have suffered a loss. And God bless the people and the peace of Northern Ireland.

Mr. Speaker, today the White House convenes a forum on health care, and we do need health care reform. We have the best health care available in the world, but it's just too expensive for too many. Why?

A brand new report from the New England Health Care Institute stated that in our $2.3 trillion health care system, a full 30 percent of total spending could be eliminated without reducing health care quality. This is a savings of $800 billion; savings that comes from improving the quality of care, savings from eliminating misuse of drugs and less effective treatments. And we can find even more savings from stopping Medicare and Medicaid fraud.

We can make quality health care affordable and accessible. Let us work together for true reform. Let's fix it and make it better, not finance a broken system. Reform is the best medicine.

Mr. Speaker, this week President Obama came before us and outlined the priorities for health care reform. Good. But let's keep in mind what reform is.

The high cost of health care is not cured by massive injections of money and taxes. We must eliminate the $500 billion in annual waste. Electronic medical records will help, but only if it puts critical information in doctors' hands and they are personal, private, and portable.

Eliminating hospital-acquired infections must also be a priority. Infections kill 100,000 patients a year and cost us $50 billion. In the 3 years I have come to this floor to ask Members to take action, nearly a quarter of a million people have died unnecessarily. How many more will have to face this preventible disease before we push for meaningful reform?

Health care reform is about fixing our health care system, not just financing it and financing its problems. Let's make health care reform real reform, because lives depend on us.