that you provide that to the committee and that be made part of the record. without objection. while i have the floor here i wondered whether it would be possible for me to comment on three issues that were raised earlier and maybe the fourth issue, the nursing situation, if i might. >> you may use my time for that. >> the nursing problem, the staffing problem in general is something that could also be handled in a single payer system because then you would have the ability to coordinate and distribute resources to make manpower decisions that you can't do in a fragmented system or non-system. we really don't have a system. it's a nonsystem. so you need some kind of a system to make these kinds of decisions. that's another reason for doing it and that would include manpower decisions or woman power

compare that with the insurance system, the private insurance system where you may not get

insurance if you have a pre-existing condition. if you do get the insurance, you may have certain things covered, but other things not covered. >> if i may jump in here. i have the closest possible relationship with the medical professi >> and indeed, if most doctors had to choose between medicare rules and restrictions, and that of any number of private insurance companies. it would be hands-down. >> and those patients also. and it's the most popular part of our health care system. something was said earlier about cancer outcome being better in this country than in some other countries. cancer is a disease of older people, and i suspect what we are seeing is the success of the medicare part of our system and not the private employment

-based heart. montenegrin part. so i think the notion somehow the government administered system is less responsive to patients is quite the opposite of the case in this country. second, the slight from canada. first of all i'm not aware of droves of people coming, but we have now about 50 minutes. >> i should warn you, our time is warning out. >> i will be faster to 50 million americans with no insurance at all. they would love to go to canada for health care, if they could afford it. that would be droves going the other direction. if the king of jordan can come here and get health care, that's a sad commentary on both of our countries, that he can't get health care in his country, that's adequate. and that he can jump the queue and 50 million people here don't have health insurance but he can buy his way in. >> the gentleman's time has expired.

>> i want to add a word of appreciation and thanks to the witnesses and also make a request of them. the appreciation is obvious. you have prepared thoroughly for this morning here you have endured the delay in the middle of the hearing for which i apologize that we had the floor votes. and we very much appreciate the very substantive contribution that you have made. the committee and the congress are at the onset of our deliberations on passing a bill. that we hope will address the problems that you very articulately have identified to date, and to summarize them, i think includes the fact that we pay too much and too little. the fact that there is too much interference with the relationship between a patient and provider. and the fact that the problems seem to be escalating rather than being resolved. i would ask each of the four witnesses to continue to have dialogue with the committee as the process goes forward. i would invite you to do that we

are accessible circling all the different modes of communication and we would very much like to hear from each one of you. i do want to ask if the substitute ranking member has any comments before we conclude. >> thank you, mr. chairman. i want a show our appreciation for the witnesses and especially for chairman conyers who has labored long in an effort to try to reform the system. i think a couple points i would like to make. one, those of us on our side of the aisle do not believe that the status quo is acceptable. reform is absolutely imperative for all of the reasons that all of us have grave concerns about, the situation that we find ourselves in. whether it's on the provider side as physicians and hospitals and nurses and others who are working as diligently as possible to care for patients, or whether it's on the patient side where they are having difficulty gaining access to. i suggest simply respect an

honest and sober reflection of what has gone on before in other systems would be appropriate, and in our system. if one is a new medicare patient in this nation, access to care is markedly limited because it's difficult to find a physician who is taking new medicare patients. the mayo clinic has limited the number of medicare patients that it is taking in jacksonville. that's a frightening, frightening statement about an indictment of our current system. the limitation of care under medicare system i know very well and firsthand as a physician practicing under that system, and medicare limits the ability of physicians to care for patients in a remarkable number of ways. so i would join the chairman and hoping that we would have a very thoughtful, sober, reflective, honest debate and discussion. and if we do that, i have great faith we will come up with a system that will reflect the

ideals of americans. >> i thank the gentleman. and i would just conclude with this comment. an american president stood up and said that the country needed a law to be sure that every person had access to quality health care and health insurance. and he said that if we did not take steps to achieve that objective, that the economy of the country would suffer greatly, and more importantly individuals and families would suffer greatly. that president was harry truman, and his words were repeated by various other presidents since then. in 1971, richard nixon proposed a system of universal health care through an employer mandate. icy chairman conyers shaking his head. he remembers that. i was in high school, but i do remember the proposal. [laughter] >> obviously, there have been against most recently in 1994 in

other reiterations since then. there is one common thread i hope is running through members of both parties and through both houses. i know it exists in the white house. this time there is going to be a law, not a discussion. and we are going to do our very best to make sure it's a law that works, and obviously that can pass. i think that today's discussions have been very fruitful and constructive in helping us get to that point. as i said to you, chairman, at the outset we hope this is the beginning of our interaction with you, not in. and with that i would like to thank the members and without objection members will have 14 days to submit additional materials or question for the hearing record. without objection. hearing is adjourned. [inaudible conversations]

[inaudible conversations] tonight on c-span. >> was discontinuing the steelers really necessary for chrysler's survival? the answer is absolutely yes. today's automotive industry cannot support the number of dealers currently in the marketplace. we've gone from 17 million new vehicle sales in 2006 to less than 10 million today. as a whole, the chrysler unit is

not profitable and not viable. i would like to mention to the committee the human element of these actions by gm and chrysler. nearly 90 so depend on carlisle for their existence. with our closing, these people will be subjected to serious economic hardship. i had numerous offers to sell my business. i have had that right taken away. my family will be left with a single purpose dealership facility with no tenant. this is senseless. >> my grandfather paid for carlisle chevrolet for his from his labor to my father paid his mother through his efforts. it took me nearly 20 years to pay my parents for carlisle chevrolet. it took gm and chrysler a mere 24 hours to take carlisle chevrolet away from the. >> members of the house congress oversight committee russians ahead of gm and chrysler today about their decision to close dealers. see the full hearing tonight at eight eastern on c-span.

>> every weekend the latest books and nonfiction authors on c-span tv.

>> here is our present policy. just as we are eager to stop the war. >> telephone conversation from the final months of lyndon johnson's presidency on vietnam, un appointees and troubles for his pick for supreme court justice. listen saturday morning at 10 eastern on c-span radio in the washington baltimore area at 90.1 fm. on line at c-span radio.org. and nationwide on xm satellite channel 132. >> the congressional tri-caucus announced this week of legislation dealing with the issue of health care disparities. the tri-caucus is made up of members of the black, hispanic and asian pacific american caucus is. this is about 45 minutes.

>> good morning, and thank you all for being here. some of us may have to leave for markup, but we will make your statement and we will be coming and going as schedules permit. but i'm barbara lee. i represent the ninth congressional district of california, also the chair of the congressional black caucus. and i stand here before you today as a very proud, original cosponsor of the health equity and accountability act of 2009 with my colleagues who have worked on this bill for many, many years. honkers woman christensen, this year will lead not only the efforts of the congressional black caucus but the congressional tri-caucus in terms of our health disparity elimination efforts which began actually three congresses ago, but also represent our collective commitment, the

tri-caucus is collective commitment to ensure that health equity is an integral part of health care reform. it represents our unwillingness to forgive those who have been left out of the health care system for far too long, and it represents our very thoughtful solutions to ensure that health care reform improves the health, health care, wellness and of course, life opportunities of every single american, regardless of race, ethnicity, gender, language, sexual orientation, geographic, or socioeconomic background as well as age. it's unfortunate that the reality of our legislative thrust has been that it's been about 10 years, a decade ago that the last minority health bill was enacted. but in that time, in the last 10 years, we have learned so much about health disparities, the

causes and the trend, as well as the economic and human impact. and so much unfortunately know is not very positive. let me just give you an example. more than three in every four persons of color, 76%, were uninsured for six-month remote in 2007 and 2008. and studies confirm that found some uninsurance have a disastrous impact on health and wellness. especially for people who live with chronic conditions like cancer, diabetes, asthma. of course, these diseases and others require a regular and routine care to manage. and we also know that african-american women are nearly four times more likely than white women to die during childbirth, or from pregnancy complications. and that the infant mortality rate for african americans and american indian, and alaska natives are more than two times higher than that for whites.

and so today, we have more and more, and you will hear more of these statistics from members of the tri-caucus. and we had decided that once again we will introduce our bill, the health equity and accountability act of 2009 because it will begin to close many of these tragic disparities that there was a report in 2002, unequal treatment, many of those recommendations which again our nation's leading health disparity elimination experts chickened. this was, remember, in 2002. we are now in 2009. so we're sending a very clear message that health care equity, disparities must be included in any health care reform bill that we debate and that we work on this year. because in the end, the inclusion and hopeful enactment of health care reform must leave no one behind. and that is what we are here to talk about today. so thank you again very much. i want to thank all of the

members for their hard work on this bill because of this is in such a long process. but i think we have come together with an excellent bill and we will be introducing a very centered so congresswoman christiansen now will come forward. she is our physician, medical doctor, from the virgin islands who has championed this with our tri-caucus for many, many years and will be the leadoff. congresswoman richardson. thank you. >> thank you so much. thank you and all of our other great chairs for your outstanding leadership and my tri-caucus help colleagues for your untiring effort on the behalf of health equity. thank you all for joining us today. clearly we are at a very pivotal and a very exciting time. one of the tri-caucus tends to take full of vantage of. for those of us who have been calling for health disparity elimination legislation, that will diversify the health workforce, focus on prevention, apply a community centric approach to address health disparities, and the tens of thousands of premature

preventable deaths every year, and improve the health and wellness of all americans, for us it's a more, even more exciting time. because the reform that's about to take place in our health care system, we are about to take it to another level of transformation with the legislation that we are about to introduce. and this will truly make a difference in the health and well being of millions of people in this country. in this historic year, this historic 111th congress, i had the honor to privilege of being the lead sponsor of 2009. and the time and the opportunity to get past is now. this bill which applies a very conjured up his approach to ensure health equity address of the illnesses that cause this disproportionate disease disability and death. but it goes the needed steps further to address many of the root causes of health disparities. causes that people don't often think of as factors. yet, those that create the environment, because poor health and impede any personal or

community attempt to achieve wellness and we address them in this bill. i want to focus on two key provisions of the bill which relate directly to .4 and five of our joint tri-caucus help care reform priorities. the first are the health workforce provision which aim to incentivize and support underrepresented racial and ethnic minorities, doctors, nurses, dentists, psychiatrist, pharmacist, community health workers, and all the full spectrum of health care providers. and would also strengthen the institutions that predominately serb minorities and educate, train and graduated in the health care fields. this is not a proposal. there is not any proposal that is out there that doesn't make it clear that we will have to greatly expand the provider workforce to meet the demands of a fully insured populace. but there is also an increasing body of research which affirmed that the true health equity, this expansion of schematically increase the diversity in that

workforce that reflects the demographics of our country on all levels. that research further shows that these providers will practice in the underserved community and that the cultural and linguistic accordance with gender better patient-doctor relationship and trust and achieve better outcomes are ethical every american can support. the second provision is a creation of health empowerment zone because of the good health either begins orients in the community and because some of the most respected health equity efforts of those that are community-based, this bill also includes zones, health empowerment zones which are modeled after economic empowerment zones to provide areas, be it a neighborhood, preservation, burrow, county, township or city with resources and technical assistance identify their health disparity challenges and to courteney existing resources and expertise to develop and implement community-based solutions. but the health equity and accountability act of 2009 dozen much more.

throughout the provisions that you will hear about that goes beyond reaching -- that goes beyond reducing racial and ethnic disparities in it also reduces to rural health disparities. disparities. and so in many ways the health equity and accountability act would improve the health care and health status and thus all americans have been on the downside of opportunities, retention and access in the current is functional health care system. it's also important to minority health and the proper perspective. many reports for the document that improving the health of the poor and people of color will improve the quality of health care for everyone and help to bring the skyrocketing cost that everyone bears the burden of down. for this reason i'm proud to stand here today with my colleagues, not only to ask all americans to support this bill, but to strongly support its inclusion in the final health care reform bill. and now i'm pleased to present the next bigger, my classmate and my colleague and the cochair of the cdc health, congressman

danny davis of chicago. thank you very much. i'm pleased to be here with all of the members of the tri-caucus. i want to commend the leadership of our individual caucuses for bringing us together and having us to work so effectively. for more than 40 years, we have seen the growth and development of community, rural, migrant and family health centers. i maintain that these have proven themselves to be the most efficient, most effective and most comprehensive approach to provide health care to large numbers of low income people throughout america. as a matter of fact, they are the best thing that had happened to health care probably since the indians discovered cornflakes. >> these centers currently service more than 18 million, mostly low income people

throughout america. they are linked and connected with secondary hospitals, with tertiary care centers, and provide enormous training opportunities for individuals to work, especially in primary care. it is our position that any health legislation passed, any health reform legislation, and certainly in our field that we must c-series expansion of the centers. not only do they provide health care, but they are economic wounds to most of the low income communities where they are located. when we see many of the minority health care pressures in the country, they got their training, they got their beginning. some of them actually started as community health workers, as health aides, as pharmacy

assistance, and technicians. now they are full-fledged physicians, full-fledged pharmacists, many of them have earned master's degree in public health and we think that there is no better way of nicking sure that low income minorities have opportunities for the highest level of health care than to expand the community health center program. now we will have congressman mike who will speak about the importance of comprehensive and coordinated data collection. thank you very much. >> thank you, madam chair. house reform without adjusting and solving disparities is not really reform. insurance alone does not guarantee access either. particularly for the limited

english efficiency of patients which is why we need a strong public option to create expanded access to more providers for all. approximately 21% of asian-american and islanders, they are our parents, our children and brothers, our sisters. although all aspects of health reform are important to our community, it is particularly critical for us to topple language and total barriers to affordable quality health care. get back, the congressional agency for asian-american, is the island for the congress. and i'm very proud of them. the long working long hours hours that our task force chaired and i represent québec. congresswoman, who represents the territory of guam, and also a new member, the congress that

represents, congressman. were just very glad for him to join us today. we want to make sure that we stand firmly with our partners cbc, to ensure that we move in the right direction and health reform. and that's why we need to strengthen existing workforce diversity programs, create new programs and investing community for health care. must be integrated for the whole of the health reform bill and not relegated to one little or one title, or an afterthought. the great expenses that we see and that we have struggling with in the past with regard to health care has been originating from those gaps that we have described. the time is now for congress and the president to come together on this issue and i look forward to continuing my dialogue with the leadership on this important issue and let me reiterate again

that the work that the tri-caucus along with those in the indian country and the community is critical to the entire health program. thank you. >> congresswoman, who chairs the congressional age caucuses. >> thank you, madam chairman. that's the word we use for greeting and guam. i join my colleagues here today and they have all stressed that this bill will do so much more than just expand data collection and bolster diversity in the health workforce and it will also do so much more than reduce the incidence of diseases and chronic conditions in our nation's most underserved communities. this bill will literally save lives, innocent lives many of which are during their productive life years.

it could strengthen the ongoing health care reform efforts because it will fix the most broken aspects of our nation's health care system. for example, in addition to improving health care services and treatments at the patient level, the health equity and accountability act of 2009 which i was a an original cosponsor of this bill also includes provisions to strengthen and expand the federal agencies and offices with health jurisdiction. including the office of minority health, and the national center on minority health and health disparities at the nih, the national institute of health. which this bill will elevate to an institute. these provisions are necessary because they will bolster efforts to coordinate and strengthen accountability and evaluation of health disparity elimination effort within and among our largest federal health entities. and so by including these

provisions, and others from the health equity and accountability act of 2009, and the health care reform bill, we will be ensuring that as we work to reform our health care system, that we successfully transform every aspect of it in a manner that champions health, equity, and treats every man, woman and child with dignity and equity regardless of their race, ethnic background, language or geography. this is a particular importance to me because i represent a u.s. territory. and by congresswoman christiansen, and my other colleagues, representing the u.s. territories, but i am very pleased that this act includes provisions that will finally bring a quality and health and health care to the u.s. territories. for example, this bill includes provisions that ensure that the public health programs in the u.s. territories will finally be structured and will finally have the