disease and control prevention, the age-adjusted death rate for all cancers for african-americans in 2001 was 25% higher than caw caution americans. in 2002, the percentage of hispanics and latinos who were 65 years or older and received adult immunization shots was only 47% as compared to 70% of caucasians. in 2000 the infant mortality rate among native hawaiians was 60% higher than caucasians. and the rate of leg amputations as a result of diabetes is four times greater of african-americans who receive medicare than their counterparts, caucasians. a list of disparities can go on and on and so we must put an end to this inequality. therefore, i've introduced h.r. 2744 so that congress can take another step towards equal rights and i look forward to my colleagues on both sides of the aisle joining me. i'm proud to have a long list of

diverse organizations that are supporting this legislation, groups such as the family equality council, the families of the united states of america and lastly, the national minority equality forum. i urge all my colleagues to support this legislation that ensures that equal services, once and for all, will also extend to health care as well. from diagnosis to treatment and the a part of the fast-growing health care debate. it's important that a statement of beliefs is made when we reform health care. equality must be a founding principle and we must insist that as health care debates move forward we take the time to ensure that all americans have the same rights. let's move forward on title 42 as we did in title 9. i yield back the balance of my time. the speaker pro tempore: mr. jones of north carolina. ms. kaptur, ohio. mr. paul, texas.

ms. lofgren. mr. burton, indiana. mr. moran, kansas. mr. paul zen, minnesota. mr. mc-- mr. paulsen, minnesota, mr. mcclintock, california. mr. olson, texas. under the speaker's announced policy of january 6, 2009, the gentleman from connecticut, mr. murphy, is recognized for 60 minutes as the designee of the majority leader. mr. murphy: thank you very much, madam speaker. i thank you and the speaker of the house for allowing the 30-something working group, which has been empowered by the speaker's office to come to the house floor every so often and share with our colleagues in the house some of the burning

questions of our constituents out there, especially those that affect younger individuals and younger families. and to talk about how this house, under new leadership, with a new face in the white house, is rising to answer those questions and meet those challenges. we'll put this poster up at the end of the hour as well but we are always eager to hear feedback from people who want to know more about the 30-something working group. madam speaker, thanks to members of your class, we have a number of new members of the 30-something group and they've been coming down to join us in these hours, i'm glad to have mr. altmire with us and hopefully some guest this is evening, as we try to focus our discussion this evening on an issue of just incredible importance to our constituents, that is the issue of health care for all americans.

we sit at a moment of great economic per rill for this country and the -- per ill for the -- pearl for this country and the -- perle for this country and the people we represent. hardly a day goes by when we're not talking to a factory owner or shop worker or small businessman about the difficulty they face in this economy. it's getting harder and harder to keep businesses open, it's getting harder and harder to hold on to your job and for the now 89 1/2% of americans that are out of work, it's getting hard to find a way back into the workforce. for those of us who believe that now is the time to pass, not incremental health care reform, but major, structural health care reform, we support that, not just because we think it's a moral imperative, as the richest nation in the world that we shouldn't be the outlier in the global health

care system by which we still stand as the only couldn't rip in the industrialized world that has such a high percentage of our citizens without access to our health care system. not just that as the country which claims to be the leader of the free world we still sit in a country where children go to bed at night sick because their parents can't afford a doctor but because we believe it's part and parcel of how we start to get this economy back on firm footing again. for families out there that have seen their wages remain flat over the last five years and have seen the percentage of their income dedicated to health care costs grow exponentially, they didn't figure out this economy was in trouble last fall when the banks collapsed. they knew it long ago. for our auto companies that have been struggling for a very long time to compete competitively on a global stage, chen $1,500 of every car

they sell is attributable to health care costs, $1,500 more than their competitors in japan or germany, they knew that the health care system was dragging this economy down long before last fall. and for small and medium sized businesses across -- across this country who have seen their premiums dedicated to keeping their employees insured grow by 10% or 12% or 14% a year, far outpacing the similar increase in revenues coming into their coffers, they knew health care was weighing this economy down long before the newspapers discovered that this economy was in crisis and in trouble last fall. if we really want to emerge from this recession stronger than ever if we really want to be competitive in the global stage if we really want to

recognize the strength of this economy lying in the hundreds of thousands of two and five and 10 and 20 person businesses out there in each and every one of our districts, we've got to fix health care this year. we can't just do it with a band-aid here or there, pardon the pun. we've got to do it with real reform that at the same time lowers the cost of care and expands access to more people. i happen to think it should be a right as a matter of being a citizen of the united states you should get health care. i recognize that the only way you do that is by lowering the cost of care across the board. we spend twice as much as all of our other industrialized nations on health care, essentially, maybe a little less than twice as much, for a system that still leaves 50ing million people uninsured -- still leaves 50 million people uninsure. we can get access to everybody

out there as long as we start spending less or start controlling the rate of growth. i think we're going to talk about all of these things tonight as the 30-somethings come to the floor, that we're going to talk about health care as health care reform as a moral imperative, a matter of consciencefish this nation, we're going to talk about it as an economic imperative and from the perspective of getting care to people who don't have it today and trying to lower the cost of care so all of us, whether or not we have it or don't have it, don't continue to pay for a system that far too often provides very expensive care without having accompanying results. so i'm glad to be here on the floor today with my good friend who i've joined here for a number of special order hour, mr. altmire, and ms. baldwin has joined us as well. i'll be glad to yield the floor to you. mr. altmire: i cannot think of a bigger issue to be dealing with right now.

we have so many issue this is congress is dealing with, energy, education, this enormous mountain of debt which we've accumulated over the years. all these issues are critically important and all of them are issues that this congress is going to deal. with the issue of health care is an issue that impacts our national debt. we cannot dig our way out of this hole. we cannot achieve structural surpluses like we had in the 1990's. we can't ever even approach that until we deal with the skyrocketing costs of health care. and this is an issue that affects every american in this country very directly. it affects every family and it affects every small business in the country in ways that other issues we deal with don't on a daily basis. so what we're talking about here tonight and what this congress is going over the course of this summer as we put together this health care reform bill is the three legs

of the stool as the gentleman pointed out. making sure we find a way for every american in this country to gain access to our system and get affordable health care. making sure that we bring down the costs for everyone. because we talk about the 47 million americans who don't have any health insurance right now. they get treated they show up at the emergency room. and they get their health care. it's certainly not the most cost effective way. it's probably not the most efficient way. and it's probably not the best way for them to get health care. but they'll end up in the system somewhere. as the gentleman knows, those of us who have insurance pay for them. they get covered. they get their treatment. but the cost shift that takes place is the reason why an aspirin costs $10 when you go to the hospital. and it's very easy to demagogue this issue if you're in it for political reasons to say,

here's what they want to do. they want to take your money and give it to those people who don't have health insurance. because 87% of americans in this country have health care. we spend a lot of time talking about those who don't. 87% of americans have health care. now they are in many cases one illness or injury away from losing everything. certainly one job loss away. and tens of millions of americans that have coverage live in fear of losing it for those very reasons. tens of millions more are underinsured. they have some coverage, but don't have what they need. and in many cases, the insurance companies have people, millions approximately two million people, that are employed in this country specifically to find a way if you are insured, to make sure that they can deny your claim. to red line you. to find a preexisting condition

exclusion. to find a reason why they shouldn't have to pay your claim. now that's another of the issues. lastly is quality. so you have cost, you have access, and you have quality. we have in many ways the best health care system anywhere in the world. and the challenge that we have in putting this bill together is we want to preserve what works. we want to say to the 87% of americans who have health care, if you like your plan, if you enjoy the health care plan that you have and you want to keep it, we're not going to touch it. you can keep it. but if you want another alternative, we're going to find you another alternative. if you have too much out of pocket costs, you're not satisfied with the situation that you have, we're going to give you another alternative. but we want to preserve what works in the current system. we want those who have health care to be able to keep it and we want to make sure our medical innovation, our technology, our research, which

far exceeds anything available anywhere else in the world is preserved. we want to fix what doesn't work and we want to preserve what does work. so we're going to increase quality and we're going to talk about tonight ways that we're going to do that. the approaches we're going to fake. we're going to increase access, bringing everybody into the system, which helps us all. and we're going to do access, we're going to do cost, and we're going to do quality improvements in this bill, all while preserving what works in the current system. the gentleman used an example of how we're already paying for health care, something i mentioned earlier. those who are afraid to bring new people into the system because they fear that this is going toin crease their own costs, well, what i talk about when i have town meetings about health care, again, they're already paying for people who don't have health insurance in a variety of ways. when that individual shows up at the emergency room, the cost shift takes place because the

person without insurance gets their treatment, somebody else pays for it. those of us who have health insurance pay for it. it's why an aspirin costs $10. i had a knee surgery many years ago and to make sure they operated on the right knee, they put a black magic marker that said l on my left knee. when we got the bill, i saw that that black magic marker to put that l on cost $20. that's because of the cost shift that takes place. now, that's one example. every american who has had to deal with the health care system has a similar example. if everybody is covered and everybody is in the same risk pool, we're not going to have that type of cost shift that takes place. but that's only one example of how we're paying for it. the gentleman talks about $1,500 of the price of every car made in this country is due to health care costs.

because american manufacturers have to pay health care -- they pay health care for their employees. other countries don't have that burden with the manufacturing sector. so we're starting at a $1,500 disadvantage for that one product. think about the supply chain. think about the way goods and services end up in the consumers' hands? think about the distribution from the person who manufacturers it, the company that manufacturers it, to the people who distribute it, to the people who stock the shelves, to the people who operate the stores, to the people who run the cash registers, at every segment of that supply chain, there's a health care component to that. that company, that business, is paying in many cases health care for their employees. . so when you hear about people who don't have insurance and the

skyrocketing cost of health care, think about that part of it as well. not just what your co-payment or your premium or your deductible is. think about how every sector, every segment of our lives is impacted by that. mr. murphy: i want to just put an example on one of the points you made here that this cost shift that happens. you talk about folks that don't have insurance or underinsured, they get it. we have universal health care in this country, you just got to wait until you're so sick you end up in the emergency room until you get it. president bush he stalled on health care reform for eight years famously remarked, don't worry about the uninsured, i'm paraphrasing, because they'll get health care when they need it. they just have to show up to an emergency room. i have told the story maybe even on this house floor before, i i have told it a hundred times back in connecticut. when we were debating health

care reform in the state legislature, i'll never forget a woman who came and testified before us. she told this story. she said, i was working. i was employed but my employer didn't provide health care. and i didn't make enough to go and get it on my own. i think she might have had some kids and got them insured but she didn't have insurance herself. she started noticing over the course of a couple weeks she had a real pain in her foot. the pain would get worse and get better. she knew she should go see a doctor but she knew a couple things was going to happen. one, she was going to be billed an exorbitant amount for the visit and two she would have to go into the pharmacy and probably pay for some antibiotic to treat it. she was savvy enough to understand when she did that she was going to pay the highest cost in the whole system. if you are uninsured you are going to pay top dollar for that visit and that drug. because you don't get the benefit of the bulk purchasing that federal government does through medicaid or medicare or

insurance companies do through similar programs. so she finally one night decides the pain is just so unbelievable she can't stand it anymore. so she goes to the emergency room. she gets to the emergency room too late to save her foot. she has a foot infection that has gotten so bad she has to have it amputated. that for her is a life changing event. her life is never going to be the same. she's never going to be the same person, same mother. she'll have to deal with the disability for the rest of her life just because she didn't have the money or the coverage to get some simple antibiotics that would have treated that foot infection. that doesn't make sense in the richest country in the world, but think about it from the cost perspective. i don't know how much that surgery cost, but it's in the thousands of dollars i'm sure. she didn't have the money to pay for it. maybe she got billed for it. but probably more than likely it got just sort of sucked into the

unreimbursable costs by that hospital, picked up essentially by the taxpayers in subsidy for that hospital or by those people that had insurance by higher insurance rates to help the hospital compensate for people like that woman who didn't have care. we paid for that surgery. but we paid for a surgery that didn't need to happen. there's a woman walking around now with her life fundamentally altered simply because she didn't have access to insurance. sometimes people need to sort of hear these examples, mr. a.m.t. mire -- altmire, of what it really means when somebody only has health care when they get so badly sick or ill that they show up in the emergency room. mr. altmire: i thank the gentleman. that is just one example. we are going to deal with a lot of policy options over the next several months. and to talk about just one related to what the gentleman is talking about, prevention and wellness. something that everyone can agree has to be an important

component. we have to incentivize doctors and hospitals and our health care system more generally to keep people healthy. to keep them out of the system. to not wait until the last minute. until the situation develops that the gentleman talks about. just think about one disease which in western pennsylvania where i'm from is in near epidemic proportions and that's diabetes. which in some cases is preventable. some cases it's not. but for every individual that you can put on a program of wellness and prevent diabetes from taking place, or at minimum delay the onset, you are changing that person's life for the better. you are making a material difference in the life of that person and their family, but you're also in a more global sense saving money for the health care system and you take that one person times the entire country and the entire group of

people who you can delay the onset for not just diabetes but any affliction which they may later get in life, you can prevent injuries if you keep people healthy. the weekend warriors and so forth, joint injuries, arthritis, the onset. these are very costly diseases to treat. and they can be debilitating in many cases, but they can be prevented or at least made better in many cases. so this is the type of thing that we want to incentivize in our health care system for which right now there is no incentive. under our current reimbursement in health care, we reimburse based on the number of times you show up in the doctor's office. their incentive is almost for you to be sick. they make more money the more often you come to see them. we want the reimbursement system to be based on keeping you healthy and keeping you out of of the system. reimbursing based on quality of care provided not volume of services provided. so this is one example of a

policy option we are considering. i would be delighted to yield to the gentlewoman from wisconsin at this time. ms. baldwin: i thank the gentleman. i also want to appreciate my friend and colleague, congressman murphy, for bringing us together on this really critical issue. health care for all is the issue that brought me to politics in the first place. it's certainly the issue that keeps me here. i join my colleagues tonight on the floor to affirm our fight that we must complete comprehensive health care, meaningful and affordable comprehensive health care reform this year. we can no longer afford to wait for health care reform. there's a recent report from the very respected robert wood johnson foundation that projects that if federal reform efforts are not completed, that within

10 years the cost of health care for businesses could double. and the number of uninsured americans could reach 65.7 million. and the middle income families would really be the hardest hit. they would bear the brunt of our inaction. i represent a district in south central wisconsin. last month i had the opportunity to gather and meet with a number stakeholders in my constituency. and i got a chance to hear from diverse perspectives, from public and private, urban and rural health providers. from patient advocates, from insurers, business and labor. and i always find it extremely helpful to hear from divergent viewpoints. and get new suggestions as we prepare to write this bold new legislation. but no matter what their

particular perspective in this debate is, their main message was very clear. that the system is broken and we have to fix it. some would argue that we really don't even have a system intact anymore. i wanted to share just three quick stories from constituents and wisconsinites that symbolize what is broken in our health care system. the unaffordability of individual markets, insurance discrimination based on pre-existing conditions, and the struggles of small businesses. i really think it's important that we as americans and we as members of congress hear these stories. our constituents using their own words and telling their powerful and compelling stories, they make the best care -- the best case for health care for all and for the actions that we must take. so i'm just going to share with you three letters that i received.

excerpts, one from jean from ryo, wisconsin. jean writes, my husband steve has worked hard his whole life but as of last year he's not been able to find work because of the downturn in the economy. neither of the jobs that i have held have offered me health insurance. we have relied on insurance that we purchased in the individual market. which costs nearly $10,000 a year and has a $5,000 deductible. meaning that we pay out of pocket for basic doctor visits, screenings, and prescriptions. 20 years ago, jean writes, her husband steve became very ill and in the intervening years has developed multiple brain tumors that require extensive treatment and care. we eventually realized he has recurring tumors due to a neurological disease and he should be screened on an annual basis. unfortunately insurance does not

cover these $13,000 procedures and we cannot afford to pay that on an annual basis. we can only hope and pray that more tumors are not developing. it is just so infuriating that in this wonderful country we cannot get wonderful medical care. lorraine from port washington, wisconsin, writes when my husband filled out an insurance application in july of of 2002, he was asked if he had ever been diagnosed or treated for cancer within the past five years. he replied no. he had never been diagnosed with cancer nor operated on or treated for cancer. what he did have was basil cells, small carcinoma which are never malignant and have to be removed from most blue eyed blondes in the course of getting older. when my husband was diagnosed with bone marrow failure

disease, the insurance company denied any coverage for his medical care citing a pre-existing condition. we were left with over $125,000 in medical bills. my husband has now passed away, and i am just thankful that i am not in complete financial ruin. sally from madison, wisconsin writes me to say, i have had my own law office for 29 years. i employ two full-time employees and one part-time employee. i provide health care benefits for our small firm. but i have faced an annual increase in premiums of 12% forcing me to pass on higher cost sharing to these three employees. one employee has diabetes. and also extends coverage to her husband who is a dairy farmer without health insurance coverage. because of their high medical

costs, it would have been very difficult for me to find new health insurance without facing even higher rates. health insurance is becoming steadily less inclusive and more difficult to keep. and it's no wonder that in today's economy families count health care costs as one of their top pocketbook issues. madam speaker and colleagues, the stories illustrate why affordable, quality health care for all is so important and so necessary. universal coverage is both a moral and economic imperative. if we are to succeed in the 21st century. for the first time i firmly believe that health care for all is within our grasp. we must act now. and i want to again thank my colleagues, my friend, congressman murphy, and friend

congressman altmire, for taking this fight up and bringing us together to address this important issue. mr. murphy: thank you very much, ms. baldwin. i'm always amazed how articulate your constituents are. it really is amazing to hear the stories firsthand because as mr. altmire mentioned one of your constituents mentioned, there is an entire industry out there dedicated to trying to stop people from getting care. and that's what you get when you build in the type of profit motivation that we have and the pressure on shareholder return. we treat health care and the economy around it just like we treat basically every other industry out there. i think there are a lot of us here that believe that there is something fundamentally different about health care than the auto industry or the cereal industry or widget industry. and when the consequences of somebody not being able to get