and are willing and have the courage to try to get it. that's the progressive message for tonight. i want to thank everybody fortuning in and, mr. speaker, i yield back. . the speaker pro tempore: under the speaker's announced policy of january 6, 2009, the gentleman from illinois, mr. kirk, is recognized for 60 minutes as the designee of the minority leader. mr. kirk: thank you, mr. speaker, what we would like to talk about is a positive medical reform agenda as congress prepares to debate health care in the united states. i want to focus this discussion on what we should be for, a bipartisan and sentist agenda for the united states and compare our country to plans in other countries to make sure that we take the best of all medical care around the world, but don't replicate some of the

problems that we see both here and abroad. when we look at our comprehensive reform agenda that would receive widespread support both in the house of representatives and the senate, we basically unify around eight major themes. first, we want to make sure that we guarantee that medical decisions are kept in the hands of patients and their doctors and not a new government bureaucracy. second, we want to lower the cost of insurance to make sure that the competitive advantage that the united states could enjoy would be realized and that also, individual costs for all american families are lowered. we want to increase the number of americans who have health insurance, to make sure that more and more families have the peace of mind that they need to protect their family incomes, their health and most importantly, their lives. we want to allow americans to

keep the insurance they like, because we know that over80% of americans and especially voters, report that they are either satisfied or extremely satisfied with the health insurance plan they have. and we want to make sure that we replicate the doctors' principle that first we should do know harm and in the congress, we should follow that advice. fifth, we would like to improve quality and accountability and make sure that especially the cost of defensive medicine is reduced. and that we know exactly what we are doing with regard to health care outcomes to make sure that we are maximizing the treatment and cures provided when a patient presents in a health care facility. we want to increase personal responsibility, especially for many of the decisions that americans are making because we know if they lose weight, quit

smoking and stop drinking, their health care will improve dramatically. and we want to lower demand for more federal borrowing in a time when the united states is already reporting that it will borrow $1.8 trillion this year. it's difficult to argue that we should turn every family's health care over to the federal government, an institution which is already, as the president says, quote, out of money. when we look at health care across the world, we see the percentage of patients who wait more than two months to see a specialist is not a dramatic issue in the united states. but this is front-page news in both canada and the united kingdom. according to the commonwealth fund, an international health care survey, they report that about 10% of americans wait more than two months to see a specialist, but a third of

britains do and approaching half of canadians wait a long time for health care. we know that health care delayed is health care denied. and imagine, especially if the specialist that you need is an oncolingist, someone who treats can sar -- cancer, what a 42- week wait would be as compared to the united states. we asked americans, what is the most important thing you would like to see in health care and they said lowering the cost of health insurance. also, they say the number one priority is to expand health care coverage so that americans who do not have health insurance can get it. those two goals are very important, but the most important goal is to determine whether you live or die, to make sure that especially if you are facing health care challenges of the most severe degree, you have the greatest chance for you or a

member of your family to survive. this is most clear in the case of cancer. when a patient, when you or i or a member of our family gets that terrible diagnose from a doctor that you will be fighting cancer, the question asked, how much time do i have? will i be able to able to survive. "the "lancet" did a cancer survival study of cancer rates and found you are more likely to survive in the united states than you are in european countries. they looked at a number of different cancers. prostate cancer, 78% survival rate in europe, which is fairly good, but a 99% survafle rate if found in the united states. bladder cancer, 67% survive.

81% of americans. breast cancer, 79% of europeans will survive breast cancer, but 90% of americans. and uterine cancer, 78% of europeans will survive, but 82% of americans. why is it that americans are doing so much better against cancer than europeans? in canada and europe, advanced oncology medicines are restricted and imagery to find cancer either through x-rays, m.r.i. or ct scans are more available in the united states to find cancer at its earlier stage. americans have a greater chance of surviving cancer. when we look at five-year survival rates, overall, the picture is also stark. women fighting cancer have a 65%

chance of surviving if they are treated in the united states. that survival rate drops to 56% in europe. for men, the difference is even starker. 66% of american men will survive a cancer diagnosis. only 47% of european men. bottom line once again, we see across both men and women, you are much more likely to survive cancer in the united states than in european countries. and much of the reason why is because in countries in which the government controls more of the health care sector, they restrict access to oncoling medicine and to imagery. and cancer is found later and fought with less aggressive drugs, meaning that europeans will die at a higher rate than americans. when we look at high tech medical procedures in britain, canada and the united states,

many people would say that health care costs are driven by too much access to medical care. what we see here is that survival rates are higher in the united states, meaning that high tech is good. and the chance of your family member surviving improves when you have access to medicine and m.r.i.'s. we see the differences most clearly here, where britain had the longest record of socialized government-control medicine has very low rates of providing dialysis care than in the united states. in coronary bypass, rates are lower in canada and coronary angioplasty. the united states far outdistances other countries, leading to higher survival rates and better outcomes over a patient who pays socialized medicine. when we look at quality outcomes, this is another study

showing the amount of time you have to wait to see a specialist doctor. in this commonwealth study, they rated the percentage of people that had to wait more than four weeks to see a specialist doctor. this is not a critical issue in the united states, but once again, front-page news in the u.k. when we see the rate of patients that have to wait and therefore are denied care is three times the rate of the u.s. rate than in canada and the united kingdom, as opposed to the u.s. and only germany has a level somewhat equal to the u.s. record of getting you to see the specialist you need to see when you need to see it without a wait. this is another chart which shows that for patients having very long waits, that we see that in the united states, only 8% we americans have to wait more than four months to see a key specialist, but 41% of

people in britain. imagine getting a diagnosis of cancer, knowing it's in your body and being told that you had to wait more than four months before you can even see the specialist that you need to survive. this is why we are quite worried about the restrictions that would be caused and denial of care in the socialized system. if you give control of your health care to the government and the government is already out of money, how will it try to save money to rectify the deficit if it's in control of your health care it may do what the canadians and britains do if it controls your care. i'm pleased to be joined by congressman dent who is engaged on a number of these international comparisons. mr. dent: thank you for your leadership on health care. we have been working to come up

with alternative ideas and the charts you just identified in terms of cancer viewer sife built rates and health care costs drive home the point that americans across this country understand that we have a health care crisis and particularly in cost. and they understand that depending on how we engage in health care reform could impact the care they receive. americans are concerned about medical breakthroughs, innovation and quality and concerned about to get the care they need when they need it. if care is delayed, care is denied. and you pointed out some interesting statistics from canada. interestingly enough, there are a number of people in parliament , a great proponent of the canadian health care system. and what happened, she contracted breast cancer and for whatever reason she decided to get care in the united states and it created a controversy in

canada because it spoke to the issue in canada because the canadian system was good enough for the canadians but not to this member of parliament. it spoke of the two-tier system, those who can't get the care when they need it, they go south. so the second tier of canadian health care can be provided across the border and people pay top dollar. we have to talk about that quite a bit as we engage in this discussion. care delayed is care denied. people understand that costs are rising and i will talk about medical liability reform, why we need that and that is a major cost and why defensive medicine costs have gone up because of the tort system in the united states. there is too much money being spent in the courtroom and not in the operating room. we all understand that. and we are joined tonight by our friend and colleague, dr.

murphy., a background in psychology and has a great deal of interest in this issue. i yield to my friend and colleague from western pennsylvania. mr. murphy: i thank my friend from pennsylvania. one of the concerns that comes up repeatedly when talking about health care is the cost. and one of the things that happens as washington deals with it is two approaches. one if health care is expensive, let's have the government pay for it, which means you raise taxes. and the other, let's deal with insurance issues, perhaps tax credits, which means that taxes will pay for it. i understand in both cases we are trying to lower health care costs, but neither one gets to the root of that and that's dealing with the issues of improving health care to make it

affordable and accessible. i would like to address this issue of how we lower health care costs. as part of the plan that congressman kirk and congressman dent have led here in coming up with cost savings in health care, one of them has to do with trying to make sure we are providing health care to those who have -- are not able to afford it. currently the government provides assistance for those who have have low income through medicaid, for the elderly through medicare and veterans, v.a. but for those just above, that's the group we are deeply concerned about because we want to make sure they get the care they need. one thing that is important with that, is make sure they have a health care home. those who have a doctor or specialist they can go to when they have a illness are much more likely to have that illness treated in a timely manner and provide a cure for them.

care delayed, care denied. sometimes it takes an act of congress to get something done. let me give you a couple of examples of how there are problems with that. if you are in a suburban hospital and you receive a stroke, sometimes they don't a neurologyist on staff or radiologyist. what happens? wouldn't it be great and imagine that they could connect up with the patient looking at them on video camera, that doctor could be half a country away or 20 miles away or whatever that might be. doing the exam with the assistance of a nurse, look at the sign, look at the way the patient responds and offer does that patient get one type of treatment or another type of treatment? each one critically different,

life-saving treatments for that and it can make the difference between the patient who lives and dies and makes a difference in the patient who has years and years of physical therapy, occupational therapy and speech therapy or one with a shorter recovery time because when you have a stroke, time is there. . i know our friend and colleague 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. so how about this? if you are going to get something called home infusion therapy to provide an i.v. 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 a hospital where you have to go all the way to the hospital and your risk for problems can increase. the also going to take an act of congress to make it so that

hospitals actually have to state what their infection rates are. you can go online and you can find out if you're shopping for a new car everything about that car. you want to shop for clothes you can go all over the place, check on all the quality reports, consumer reports, if you want to look up the records on a hospital, am i more likely to get sicker or better when i'm there, you can't find out that information. for a number of years i put forth a bill to provide transparency in this area where could you look up the infection rate of hospitals. this is critically important because infections you pick up in a hospital clinic kill 100,000 people each year, cost $50 billion and affect two million cases. one of our colleagues in congress is suffering from a staff infection and there's many of our colleagues who have had a family member who has faced this same problem. it will be nice to know and the advantage of having that information out there is that you can look it up and you can find out and 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. mr. kirk: i think one of the key lessons that we want is we want americans to have health insurance as good as a congressman but we don't want them to have to call their congressman to get good health care. and one of the things that we've also seen is that the united states really stands out in a couple of areas that drive health care costs up. we have very little to no federal lawsuit reform in the united states for health care meaning the defense of medicine is the practice of the day in our country as opposed to other countries because doctors are so likely to be sued. another is that, yes, americans generally have a higher degree of obesity as compared to other countries. and so the president and us on a bipartisan basis, i think, will have a lot of common ground inworking and -- work -- in working and encouraging a reduction in weight by americans because this will lower health

care cost but one of our key experts on how lawsuits drive health care costs up is our colleague from pennsylvania as well, congressman dent. mr. dent: i thank the gentleman for yielding. in pennsylvania, of course, we have been a crisis state for some time with respect to medical liability. my colleague, tim murphy, remembers the great debates we had in pennsylvania about the need for joint and separate liability reform to make sure that rewards to be proportional to the degree of fault. that was absolutely essential. noneconomic damages, another area we were in great need of reform in pennsylvania. also the notion of a periodic payment as opposed to one big lump sum award. one could pay those payments out over a period of time. something that, again, was absolutely essential. in the city of philadelphia in particular we had a very real crisis. in fact, at the time there was a group called jury verdict research had done a study and the average jury award at that

time was somewhere around $1 million. the rest of the state on average was a bit less than a half million dollars. in fact, it got so bad one year that there were more awards in payouts out of the city of philadelphia than in the entire state of california. the city of philadelphia has a population of about a million and a half people. what we had to do was find ways to get cases out of the city of philadelphia, out of those courts and so we actually passed legislation, congressman murphy and i were supportive at the time, in harrisburg that would have essentially required the that cases be heard in the -- required that the cases be heard in the county where it occurred. that made complete sense. we tried to pass it legislatively but we had the courts -- the supreme court ruleto essentially provide that kind of remedy. what happened is we saw the number of cases heard in philadelphia drop dramatically as a result of that. so that was just another example of the problems. also we have many people in this

country who must go to an emergency room for care. they go to the emergency room and oftentimes emergency room physicians and staff are the subject of lawsuits. but those same physicians must provide care under federal law, something call and essentially what that means is they need to provide care and what we should do is provide medical liability relief to those emergency room physicians by treating them as federal employees. not that they're going to be on the federal payroll but for tort purposes and the federal tort claims act they would be relieved from those type of lawsuits because we've had situations across this country where trauma rooms have been forced to close down. it's traumatic. we've also had some places in our country, an obstetrician who was at one hospital and said the only reason that we provide, the only reason we deliver babies is to you train our students. we lose money. and there are many doctors who choose not to deliver babies these days because of liability

and in philadelphia at the time he know one hospital stopped delivering -- i know one hospitals stopped delivering babies. they only deliver so they can train their residents, they lose money and it's very costly to them. but they do it as a service and as a way of training physicians. that's a very sad state of affairs when we can't deliver babies because of the high cost of liability. mr. kirk: if the gentleman will yield. i think the gentleman's point is well taken. especially in comparing two states and the average premium for health care in these two states. in new jersey the average premium totals over $6,000 per person. a state that has very little lawsuit reform and a number of other of the reforms that we are talking about in our reform bill that will be outlining next tuesday from the g.o.p. centrists are not there in new jersey. in california a number of the successful reforms that we put forward are there and the average cost of our premium is just $1,885.

meaning that if you back the kind of reforms that will be in the outlined bill that we put forward next tuesday, you can drop the cost of health care by thousands of dollars per patient. i yield to the gentleman from pennsylvania. mr. murphy: i thank the gentleman. an important part of this is that the lawsuits themselves do not guarantee quality. but it is quality that's very important. i believe you have a chart up there about some tests and procedures and i was wondering if you could explain on that. mr. kirk: we also have, when we're looking at preventative care, which is so essential, in many countries with government-controlled systems, because these systems are generally out of money as governments generally are, they've restricted access to preventative care. particularly in a pap smear and a mammogram, two essential procedures in finding cancer in women early, we see that 89% of american women will have a pap smear within the last three years. but only 77% of britains.

in a -- and a mammogram as well. american women, 86% whereas in the united kingdom, 77%. all of these mainly industrialized powers, allies of the united states, have much lower access to care, even though they have government systems. i yield. mr. murphy: it brings up an important point of how in the u.s. system we handle such things in dealing with breast cancer and cervical cancer. one of the sad stories in this country, the u.s. handles lumps, etc., by providing mass ectmies to women. other countries may not do that. in part it may be that the tests come much more lower, 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. it pays for defensive medicine, not really workg on

prevention. let me read you an important quote. this comes from the "new yorker" magazine. it is about texas towns and it says between 2001 and 2005, critically ill medicare patients received almost 50% more specialist visits in mcallen, texas, than in el paso, and were more likely to see so 10 or more specialists, why? there's a different approach to care and that is providing more care, providing more surgical procedures, etc., 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 fan as itically high levels of this. but it's medicare spending is in the lowest 15% of the country. $6,000 per enrollee in 2006 which is $8,000 less than for mcallen, texas. i bring that up to say that in u.s. it is part of what you're describing, access -- patients

need access to these tests but we also need to make sure that physicians and nurses and all medical specialists are getting the information they need to make sure that quality is what we're driving here. and you're dealing with just issues of insurance or just issues of defensive medicine, you're not necessarily driving quality but you're driving more test. i yield back. mr. kirk: one of the other things we've been concerned about is the increasing price of medical mall practice insurance in the united states and especially if you look at between 2000 and 2002, for opt trigses and gynecologists, for physicians and internists in general, you have an explosion in the cost of buying insurance. we do not have 30% more malpractice in america in just two years. but what we may have is a 30% greater chance of being sued in america, the most la tishes society on earth. all of this drives health care costs up as physicians have to cover the cost of malpractice insurance and of course overprescribe tests and other

procedures. mr. dent: this is a very interesting and pertinent subject to this whole discussion of the cost of health care and why it's rising. defensive medicine costs in the u.s. as much as $126 billion per year and that was out of a 2003 h.h.s. study. opt trigses, emergency room doctors and plastic surgeons can expect to be sued in any given year. the data for 2006 shows that 71% of the medical liability cases are dropped or disease missed. only 1% of the cases result in a verdict for the plaintiff. mr. kirk: if the gentleman will yield. 71% are dropped but a payment is still made. because it's a settlement and that's going to drive up insurance rates anyway. mr. dent: and the physicians have to -- hospitals have to hire attorneys to defend themselves and so there's a lot of time and effort and money expended just to prepare and to fight this battle only to have

it dropped. so there's still costs incurred even though the case is dropped. mr. murphy: another issue with regard to this bill we've introduced has to do with allowing doctors to volunteer their service. here's something that only the united states can mess up in our government. community health centers which provide a great health care home for people with lots of different services, from primary medical care, dental, mental health, etc. but they are strapped for money and in many cases they have a 15% to 20% short and of family physicians, ob-gyn's, etc. if a doctor is covered under the federal torts claim act, they handle, but if a doctor wants to volunteer, they're not covered. they basically, the doctor says, i'd like to give my time and work a couple of days a month, offer my time, volunteer basis, the government -- the clinics have 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're covered by -- they have to cover their own insurance but if they volunteer they're covered. we have a bill we've been trying to get to allow doctors to volunteer. the advantage is, people have a health care home, it is a much lower cost, it even reduces the cost for medicaid patients that go there by some 30% and it focuses on getting the doctor near the patient and the patient near the doctor and eliminating any incentive of defense -- defensive medicine and any incentive to do lots and lots of tests just to make up for the losses. mr. dent: if the gentleman will yield, before we get on to the next topic, what's the point of this whole discussion? i was talking about the rising cost, but in philadelphia, premiums rose 221% for ob-gyn's, in philadelphia, between 2000 and 2008. premiums rose 149% for general surgeons in new jersey. premiums rose 348% for internists in connecticut over that 2000 to 2008 period. so