that product is life or death, that maybe we should have some different rules that govern it and maybe there's no problem with having some incentive built in for innovation and success and all the rest, but there should be be a limit to that and there should be some constraints on the system. . i thank you for joining us and hope you stick around for a little while. mr. altmire, you're talking about the three pedestals here of access and costs and quality. i think it's just important for us to talk for a second about how we have an assumption in this country that the more money you spend, the better care you're going to get, right? what we have found as we sort of surveyed one particular segment of the country to the next is that that isn't necessarily the case. that spending more money and having more health care doesn't

necessarily deliver better health care. there's great surveys from dartmouth university and others that show if you can better coordinate care, if you can get physicians talking to each other if you can get primary care doctors doing more work up front, if you can spend more money on preventive health care, as you talked about, you can get better health care out there one of the things when we talk about controlling costs is trying to actually get people to have a decrease rather than an increase in utilization. i think it'll be a big central part of our discussion here about how we do that. i think a very -- i think there are very interesting ideas about how to encourage doctors to work together, but a subject we talked about on the house floor, which is fundamental to this discussion is giving the physicians and hospitals the tools to do that. the only way to get doctors talking to each other about complicated patients, the winal

you can try to really empower the consumer themselves to take more ownership over their own health care is to make sure that they have the ability as physicians or providers to track those patients through the sorm as a consumer of health care yourself to track your care as you move through the system. and technology is really the key to that. and we have already take an great step forward on that issue through the stimulus bill. $19 billion in the stimulus bill, dedicated to building out the world's best, most connected, most highly technologically advanced health care system, so that as an individual walks into the emergency room, that that treating physician can immediately figure out what his medical history is, what tests he's already had, what's been ruled in been ruled out relative to the illness they present with. we can save billions of dollars

just by having better information in the system and i'm so glad that our president had the foresight to see those savings down the line by investing money in the stimulus bill to get that technology out as quickly as possible so that it can be a platform for those savings. there are going to be a thousand different ways we talk about to save money in this system. we know that that's how we get access. i don't think any of it will be possible, mr. altmire, without that investment in technology, something you talk a lot about. mr. altmire: we have talked about that i think the money in the stimulus plan and money in the succeeding budgets, which we're also going to make a priority, is going to make a big difference. health care is the only industry in the country remaining, major industry, that has not gone to an interconnected, interoperable, computerized system. i would ask my colleagues to think about the fact that the gentleman's from connecticut, i'm from pennsylvania if we go to san diego and we put our

bank cord in the machine, we can pull up all of our financial records in a safe and secure way, never think about privacy or any type of intrusion, you take for granted that that's going to work. few but if you show up on that same trip at the emergency room in san diego, they don't have any of your records. they don't have your history, your family medical history, they don't have your allergies, they don't have any of your imaging, your x-rays and so forth. they're going to ask you half a dozen times when you're there, what are you allergic to? can you fill out these forms? and most importantly, how are you going to pay? but if we went to a system like every other industry has, where you have an electronic health record that goes with you every where you go and has those records for your family history, your personal medical history, your allergies and all your insurance information, when you show up at the emergency room, they're not

going to have to ask you half a dozen times, they're going to be able to get right down to the business of treating you for whatever the reason is you find yourself in that situation. we have to make sure that as we move forward as a country, that we reward those who have already taken matters into their own hands. there's a lot of major health systems in this country from coast to coast that have spent hundreds of millions of dollars of their own money to make this a reality. to connect their own systems. and the problem that we have in implementing this is if you're a wealthy community and you have a system that's making a lot of money a hospital system, you can afford to do that. but if you're a rural physician, health care provider, in central pennsylvania, or anywhere in this country, 80 miles from the nearest hospital, you can't afford hundreds of thousands of dollars to upgrade your computerization and interconnected records with the nearest hospital.

that's something you can't consider. that's where this is going to go, we're going to move toward having an intersected system in this country like the gentleman has talked about. we're not going to let it get to the point with the department of defense, for example, which has a wonderful health care information technology system and the department of veterans affairs which also has a wonderful health care information technology system but there's one problem. they literally cannot communicate with each other. if you're one of the brave service men or women serving our country as part of the department of defense, you're part of their program, they have your medical records. when you leave the military and become a veteran and enter the v.a. system under the current system, the department of defense sends a p.d.f. file by email to the v.a. and somebody has to open up that file, can't manipulate it in any way, they have to type by hand your

entire career's medical history if you've been there 30 years think about what we're talking about, into the new system for the v.a. now, secretary shinseki and secretary gates announced that moving forward, they're going to merge the systems for the new people who enter the military, moving forward with the newer generation of our military men and women and our veterans, we're not going to have this problem, but for the millions who have served up to this point, it's not interoperable. they can't communicate with each other. mr. murphy: mr. altmire you know, scale it down. there are thousands of hospitals, some of which in the state of connecticut, that have competing systems even within their own hospitals that don't talk to each other. there are hospitals that have one record system, one electronic record system for their emergency room, and then one electronic medical records system for their inpatient

unit. so the same thing that happens as you move from active service out to be part of the veterans health care system, works within a matter of days in a hospital setting when you come in and present to the e.d., you then aren't on the same record system when you move over to the inpatient unit. that's because we do not have a sort of nationally agreed upon platform for how systems communicate to each other. hospitals say to themselves, i've got one really good system for the emergency rooms, i want to buy this other really good system for inpatient care. we need national standards that say to any hospital or physicians office that's buying into a records office, you can be guaranteed you're getting a system that presents you with the data and tools you need and will be able to communicate with everybody else. in fact, there's no way we're going to spend that stimulus

money without some national standards to guarantee that that happens. but as a sort of preview as to how politicized and how politically charged this debate can become, when we were debating that portion of the stimulus bill which really is common sense, investment in information technology, something there should be no reason why republicans and democrats should disagree on, i don't want to put words in mr. burgess' mouth, but he comes down to this floor, republican from texas, he comes often and talks in an articulate way about the need to upgrade the information system. so there's a lot of potential agreement, but it didn't stop the sort of right wing in this country from going out and spreading lies that this investment in information technology was the federal government's attempt to have a big brother takeover of health care, and this was the federal government reaching in and controlling all of your health

care information and knowing everything about every ill thans you've had or prescription drug you're on. it's the furthest thing from the truth. we're trying to standardize private health care investments that have been made by hospitals and doctors across this country. but i think it speaks to how difficult this debate is going to become. there is just a group of folks out there who are either jurs ideologically opposed to having the government have any role in health care or folks who are part of the status quo, who are making their fortunes off health care today, that don't want the rules of the game changed and even when it comes to what should be fairly noncontroversial issues like investments in information technology, i mean, there's no -- it's boring to say. but it's so important. it's just not that controversial. we're still going to find a lot of people on the outside that are going to fight us on this issue, as they will on many others, mr. altmire.

mr. altmire: there are many other issues just like that, as the gentleman knows. this gets to the complexity of the bill we're going to be bringing to this floor and the other body over the course of the next several weeks. if you look at what we expect at minimum the outcome on the insurance side, i think everyone agrees a very likely outcome will be the insurance industry will not be able to red line you, will not be able to use preexisting conditions to exclude you from care. they're not going to be able to do lifetime limits for people with chronic diseases. basically, they'll have to take all comers and they're not going to be able to set your rates based on your individual health status. i think we all iagree that's a likely outcome to this debate. the insurance industry makes a compelling case and i think an actuary will tell you the only way that works is if we find a way to make sure everybody is included in our health care

system. you can't just have the sick people or the people about to become sick part of the risk pool. you have to have everybody. that's why it's so important we expand access to the entire nation, include these 47 million americans who don't have health coverage, the tens of millions more that are underinsured because the only way the risk pool works is if you have the young and healthy, people who aren't going to use the services right now, today to offset the risk for those who are. as the gentleman indicates there is still going to be opposition to this concept when we move forward. when we talk about ways to move people into the system that currently don't have access, one of the ideas that we talk about which the gentleman from connecticut is very involved in is the idea of having a choice for people to join a plan that would compete with the private insurance industry. we hear a lot of talk about how the private sector always does it better than government. they're more efficient, more cost effective, the government is too bloated.

i would say to those who make that case, then, what are you worried about? what are you worried about the competition from the government if the private sector always does it better than government? the difference in this case, if we do it right, and certainly there are ways you could structure it that wouldn't be the correct way, but if we establish a level playing field for the competition, you'll have a situation where there's not going to be a profit motive and there's not going to be any reason for someone to choose that plan who is involved in share holding and so forth. you're not going to have that. you're not going to have people who are employeed to try to deny claims and that might be a difference in the way these plans compete. but if we do it right, it would be a level playing field. mr. murphy: the gentleman knows that for me this is critical to reform going forward. i think if you empower consumers to have real choice, that's one of the ways in which we're going to control costs. right now, when you decide you

want health care insurance if you're a business or an individual, you know, it's a real cloudy picture out there. you've got to -- you don't know exactly what you're buying, don't know the combination of deductibles and premiums that are going to force costs on you. you can't be ever sure exactly what the benefit plan is, whether preexisting issues are covered here or not here. one of the things that's fundamental to this reform is trying to standardize the market. recree ating national standards for health care insurance. you've got to have this basic benefit package that covers preventive services and real catastrophic care you can't discriminate against people with preexisting conditions, you can't have lifetime limits to basically give people some certainty when they go out and purchase insurance, they're going to get insurance. they're going to get something they can actually use. so a lot of us say, well, you know, why not give people the option if they don't like the

private insurers, who are nevertably going to take a piece of their premium and pay the c.e.o. a big salary or pay back shareholders or turn it into profit, why not give them the option to purchase a nonprofit, government-issued plan. mr. altmire, you're right that that only works if the government option, that government health care option has to finance itself. it doesn't get a subsidy from the federal government to help it compete with the private plans. but if that public insurance option has to pay for itself just like every private insurance company has to, they collect premiums, pay for care, and all has to be self-financing, then you're exactly right, what's the problem? if the government is so inefficient, then they will end up having a insurance plan that costs more than the private insurers and nobody will buy that. but if our theory is correct that by not having the profit

motivation that the private insurers have, that they can run a more cost effective product, then why shouldn't consumers have that choice? the people in this chamber who are going to say there can be no public insurance option available to individuals are taking choice away from consumers. i'd rather have my 700,000 constituents be able to have as many choices as possible. i want them to decide whether they think that private insurance or public insurance is better for them. . everybody will answer that question differently. but those of us that will be favoring a public responsive health care plan as one of the options for individuals and businesses are going to be on the side of consumer choice. if we give consumers that choice, it's going to create a really competitive structure that will end up with some people having public insurance, some people having private insurance, but a real competition by which we lower

health care costs, mr. altmire. i get it. the devil's in the details of making sure that you don't give a little competitive advantage to that public option. but i think it's really a linchpin of health care reform going forward if we can get it right. mr. altmire: think about the competitive advantage that businesses have in this country. some are able to offer health insurance. some are not. less than half of small businesses in this country are able to afford to offer health care to their employees. and what we want to create is a system where everyone in america will be be covered and every business that chooses to do s will be able to afford to offer that benefit to their employees and to their potential employees to be able to recruit and retain the highest quality worker that might be a benefit that small businesses would like to offer. we want to give them the opportunity to afford that benefit if they so choose. but again we want to preserve

what's working in our current system. we want those who have coverage and like it to not be touched in this. and that has to be a part of this. but for those that want to have another option, those who want to make a change, maybe the family status has changed over time, the plan that you're in doesn't work for you anymore, we want to give them as many options as possible and we want to give them the ability as the gentleman indicates to do some comparison shopping. to compare apples to apples. to look at what the costs are for the family situation. across the different plans. right now you're unable to do that. if you're a federal employee and you ever the federal employee's health benefits plan, it's a little bit easier. that's a plan where you are able to look at some of the paperwork and get on the computer and do some comparison shopping. we want everyone to have that same ability that federal employees have today. i would say to the gentleman when we talk about this idea of

the employers being required in some way to either offer health insurance to their employees or to pay into the system so that those employees will have the ability to make that choice, we don't want to do that in a way -- i want to be very clear about this. we don't want to do that in a way that's going to incentivize employers to say, well, you know what, i'll just stop offering health care coverage and all my employees can go into the plan. that is not what this is about. and we don't want to add one more financial burden to half of the small businesses in the country, the ones i'm talking about that are already unable to afford health care. we don't want to add to their financial burden. we recognize that this is a very complicated issue and it's going to be very difficult to achieve these goals. mr. murphy: mr. altmire, we spend so much time with our business community, our chambers of commerce when we are back home and when they come visit us down here, that we know what the

reality is out there. that these folks that right now can't afford to give health care to their employees desperately want to do that. they want to do it first because it's the right thing. they are members of their community like anybody else is. they want to be able to provide health care to their employees whether they have two employees or 40 employees. that's just the kind of people that are out there running small businesses by the skin of their teeth across this country. but they also need to do it from an economic standpoint. they know that to the extent they can't offer health care or can't offer the kind of generous plan they'd like to, they are at a disadvantage against their competitors who can offer that type of health care. they are at a disadvantage against the big employers who can steal their employees away. so this is really -- this is an issue that all small business

men are waiting to be part of the solution. if we can offer them had whether it's through a public option or lower rates through private plans a more affordable health insurance option they are going to take it. they are going to grab t we don't want to set up any incentives where they are going to push people off to the public plan, but we know that the majority of folks are going to want to be part of this solution out there just for reasons of conscience but also for reasons of their own salvation as a particular business. mr. altmire: the gentleman hits the nail right on the head talking about bringing down the cost. that's where we started this discussion. we are going to pass a health care reform bill this year. i'm confident in saying that. the public support is there. the support in this congress is there. we need to certainly finalize the details and that's going to take some work. but this issue is too important. it's too important to this country. it's too important to families. it's too important to

businesses. and it's too important to every individual in this country for this not to become law this year. and i'm confident that that will happen. and we have to bring down the costs of health care. that's why this is so important. we have to bring down the costs for our families. we have to bring down costs for our businesses. we certainly have to bring down the costs for our government. as i started our remarks tonight by saying, what this is about is the structural deficit over the long term that we have in our budget and addressing the issues like energy and like education that have led to the skyrocketing deficit and debt that we have over the long term. and the only way you can begin to bring that under control is by bringing down the cost of health care for everyone in this country at every level, both in the private and public sector. that's what this bill is going to do. that's what this discussion is about.

so to close it out i would yield back to the gentleman. mr. murphy: i thank mr. altmire and ms. baldwin for joining us tonight. let's make no mistake about this. this is going to be a fight. this is going to be a fight because to do this right you are going to have to take on folks who have gotten real fat over this health care system. you are going to have to take on some ideologue that is just don't believe the -- ideologues that just don't believe the government ought to get involved. there is a polling going around essentially outlining in 28 pages how you stop health care reform from happening. that is the agenda of a lot of people in this town, a lot of folks on the other side of the aisle, that they do not want health care reform to happen. now, some of it is for good honest policy reasons. i believe it's an incredibly misshapen belief that the private sector can just fix this on their own. they haven't done it for the last 50 years. how are we going to expect they are going to do it over night.

some is very cynical politics. some is people who look back to 1994 and the failure of the clinton health care plan and the two years prior and believe that if folks can stand in the way of president obama or this democratic house passing health care reform, they will gain some electoral advantage out of that. i hope that is the minority of people that are standing in the way of this bill. make no mistake, there are people out there who simply see political advantage against democrats in general or against the president of the united states in stopping health care reform from happening. now, they may have succeeded back in 1993. and i wasn't here. mr. altmire wasn't here. so we can't speak to all the reasons that happened. but that's not going to happen this time. not because you got smart people in the house of representatives or you got necessarily a better strategy moving forward, but because the american people are not going to stand for the status quo. they know this economy is tough and they feel more conscious than ever of the fact they are just one paycheck away from

losing their health care and becoming one of the tens of thousands of individuals out there who are forced into bankruptcy because of health care costs. the status quo is not good enough for people out there. despite 28 pages of polling, telling the folks on the other side of the aisle how to stop this from happening, i believe that the will of the majority of americans is going to bringing us together to get a good bill passed. we are here as 30-something's in the democratic caucus talking about that tonight. but i believe that there is going to be a groundswell of public support that is going to force us, both parties, to come to the table and do something not small, not minor, not temporary but something big and permanent to fix all of the underlying problems in this health care system to make sure that more people have it and less businesses are burdened by it. so again i'd like to thank speaker pelosi for once again giving us the opportunity as the 30-something working group. remind folks they can email us at

30somethingdems@mail.house.gov. if you got any questions for us, any feedback on what you have heard this evening, www.speaker.gov slash 30something is where you find us on the web. with that i yield back the balance of my time. the speaker pro tempore: under the speaker's announced policy of january 6, 2009, the gentleman from missouri, mr. akin, is recognized for 60 minutes as the designee of the minority leader. mr. akin: thank you, madam chair. we get the flip chart set up here and be started in just a minute.

there was a sin erikal comment that was made by people who take a look at history. they say that one of the things we learn from history is that we learn nothing from history. i don't know that that's universally true, but certainlier for our subject today -- certainly for our subject today for this evening, that will certainly be the theme that we are not learning very much from history. we are going to be taking a look at the fruit of fiscal mismanagement and particularly what's going on in our country in terms of very, very important number, and that is unemployment. the unemployment numbers have

continued to rise in spite of all kinds of assurances that by spending tons and tons of money that we can turn those numbers around. the historic connector here i think is quite interesting. there's a fellow by the name of henry morganthau, probably you have not heard of henry morganthau, but he was an important figure in his own day. and here in this chamber, in this house, henry morganthau met with the ways and means committee in 1939. henry morganthau was f.d.r.'s secretary of the tresh youry. -- treshry. he -- treasury. he had had eight years working on a theory known as keynesian economics. he was one of the main arc text of keynesian economics. the idea was what the government needs to do is stimulate the economy. you have heard the phrase over and over, stimulate the economy and the purpose of splate stimulating the economy is --

stimulating the economy is to creater more jobs. that's like grabbing your straps on your boot lifting up and trying to fly around the room. it doesn't work. after eight years of failed experience, these were the words, the very quote of henry morganthau, here in this building before the ways and means committee. he says, we have tried spending money. we are spending more than we have ever spent before and it does not work. his words are echoing down through history. it does not work. i say of after eight years of the administration we have just as much unemployment as when we started. and an enormous debt to boot. these are the words coming to us , floating down through history by henry morganthau, the main architect of keynesian economics. franklin delano roosevelt,