mr. kirk: if the gentleman will yield, does it mean, though, that doctors in connecticut were 300% worse two years later? mr. dent: absolutely not. and the point is, this drives up cost, not just in terms of the liability payments that the doctors and the hospitals must incur, many physicians are now working in hospital-based practices in part because they can't afford liability insurance so the hospital must pick up that bill and they're struggling to make these payments. the point is, it raises costs not just for the doctors and the hospitals but the tests that are going to be prescribed and administered and treatments perhaps just to protect themselves, this will drive costs up, they're protecting themselves against lawsuits. what's the other issue? access to care. is as a consequence there will be less access, doctors won't deliver babies in the city of philadelphia, that means people don't have access to an o.b. it drives up cost and it limits access and americans want access to health care and they need the care when they must get it.

mr. kirk: if the gentleman will yield. the bill we're going to be putting forward by the centrists on tuesday has a number of liability reform provisions authored by congressman dent and community health center and volunteer liability provisions authored by congressman murphy. one of the things we talk about is access to care and a critical issue coming up is the uninsured. the census bureau estimates there are 45.7 million, almost 46 million people in the country lacking insurance. of those, about 9.5 million are noncitizens and the question we have to ask is, should we provide taxpayer-funded care to those people who are not legally present in the united states? about 12 million of the currently uninsured are already eligible for public programs, because of their lifestyle or choice they haven't signed up for the health care the government will provide them. about 7.3 million have higher incomes than most americans. they make over $84,000 a year.

and about 9 million are only temporarily uninsured. as you can see here from the older chart showing 49 million uninsured, a large number of uninsured were uninsured temporarily, only five months. another 25% only for six months, leaving about 53% uninsured for a long time, a group we all agree should be addressed. when you take 45.7 million people uninsured, remove noncitizen, remove the people who haven't signed up for government programs they're already eligible for, remove people who have higher incomes than most americans and should buy it anyway and remove the temporarily uninsured, you get down to a number of 7.8 million this might not be a big enough number. mr. murphy: one of the interesting demographics, --

mr. dent: one of the interesting demographics, over half, 55% of the people lacking coverage in america are under the age of 35. many are insureable. college-age kids up to 35. they tend to be more insureable than much of the rest of the population. i believe we do have suggestions and proposals of ways to cover that population, get them into an affordable catastrophic coverage they need in the event something dramatic happens in their life. that's another statistic i don't think we talk enough about. also, there are a large number of people uninsured who are eligible for program, whether medicaid or the children's health insurance program. mr. murphy: many of the younger folks consider themselves inas a rule nearbies, they don't need insurance, they don't get sick. what happens is if they do get

sick, they do end up in emergency rooms, we pay for it. it is important we provide every incentive to purchase the insurance that many times an employer does offer. mr. kirk: we ought to allow small businesses, for example the libertyville state insurance health plan, right now prohibited under law. we know half of all americans work for small businesses and many don't have a plan through their employer that will be included in our legislation. mr. dent: that's an important point. there are so many people out there who need coverage. you mentioned allowing employers to reach across state lines but the other issue to help the uninsured is you know

employers receive federal tax rebates, that's beneficial to helping them provide health care coverage to their employees. that's a good thing. we want to protect that. it's about $-- about 16 a 5 million americans have insurance through their employers. what we should do is give the individual who lacks insurance, his employer cannot provide it or if they're un-- self-employed or on their own, give them the same kind of favorable tax treatment as an individual that we give to business. that would do a lot to help cover, particularly that younger population. mr. murphy: in addition it has to do with how they purchase. the federal government recognizes if we allow people of low income to pool together, the v.a. does this all the time, they combine the purchasing power of the v.a. to purchase for veterans across the nation. yet we don't let individual do that we don't let a small

business with only 20 employees do this. that wall placed by insurance companies and by the government leads to higher costs. we ought to allow business to do the same thing the federal government does and use that as a mechanism to drive down costs substantially. mr. kent: -- mr. kirk: one thing you mentioned is the need for public health. that puts forward a critical point missing in the debate. we know of the uninsured, 44.7 million, of the uninsured, 14.7 million are already eligible for public coverage. as we have found -- mr. dent: that's medicaid and schip. mr. kirk: that's right. as we found in the state of massachusetts, when a mandate that everyone has to buy health insurance is put forward, what they have generally found is that a technical and legal solution is not adequate. they thought by putting a

health insurance signup machine at the entrance of every emergency room at the state would register and collect the required number of people who hadn't yet signed up for public assistance that they were eligible for. what they found is, for a small percentage of the most difficult parktes, either because of alcohol, drug abuse, or law enforcement problems, these patients were not registering under similar names, not registering under similar addresses and were failing to report for appointments and other preventive care. meaning for that small percentage of american we need to provide an open public clinic. it's the most more -- it's the much more appropriate health delivery system. for this small percentage of americans, we have different names, different addresses, but we want to provide care. you need to do it through a public health clinic.

mr. murphy: as you describe, it brings the thought, too, of how people having this hodgepodge of a disjointed and difficult system that does not allow individuals to purchase insurance we look on other solutions and say, they're not purchasing it for other reasons, we artificially keep those things high and keep a system that incentivizes lots of tests and is dysfunctional. i bring my colleagues -- my colleague's attention to a study that said this nation wastes about $700 billion a year. all these inefficiencies have to deal with care delivery, beyond that of what we're talking here with the insurance. mr. kirk: one of the things i want to make sure is sometimes in this debate, when you hear about the uninsured, you have the impression the federal

government doesn't spend money already providing health care to low income and needy americans. as this chart now somewhat outdated from 2004 shows, it's a total of almost $35 billion in assistance given to cover the uninsured but one of the problems has been that some of the patients directly eligible for these government programs don't sign up. mr. dent: the gentleman pointed out an interesting point, he mentioned the massachusetts health care experiment. they had a universal mandate for coverage duh but did not do anything to deal with the cost issue. what happened in massachusetts is why -- while the number of those provided coverage through the programs, the costs rose. but the ability of the taxpayers to meet the rising costs was limited. what does the government do? it restricts care. it denies treatments. it denies service. it rations care. that's sort of a microcome.

that's what happens in massachusetts and perhaps other western european countries or canada. i'm not here to either praise or condemn those systems. in western europe, the united kingdom, or anywhere else. they're different systems. people need to understand that. what happens in those systems when the costs continue to rise for health care and there aren't the tax dollars to meet the costs they deny care. i think we all know that -- we know that people are concerned about cures, not treatments. they want to be treated like human beings, not numbers. unfortunately, that can happen in those systems when off single payer system, take a number, wait for dialysis, wait for hip replacement if you can wait that long. if you're canadian, if you have the money, come across the border and get the care you need when you need it. i think we have to have this sober discussion.

mr. kirk: the gentleman points out canada, a country with a two-tyre health care system, the canadian health care system, then when you're denied care, especially prevalent when you need imagery, we come to the -- they come to the united states. some doctors call it fargoing a patient. when care is going to be denied, they'll refer that patient to fargo, north dakota, where they immediately get care under the u.s. system. the concern i have is, if we have the government take over health care, where will we be able to drive? where will we be able to go? that's why in our legislation we'll be outlining on tuesday, it includes the medical rights act. it says this. we guarantee the right of patients to carry out the decisions of their doctor out without delay or denial of care

by the government. the legislation protects the right of each american to receive medical services as deemed appropriate by the doctor. i yield to the gentleman. mr. murphy: that's a great base to be moving from. there does need to be the basic rights outlined, because we have a system that stands with huge barriers between doctors and patients. much of that barrier is the government. the government handles, through medicare and medicaid, for example, handles cost controls by delaying care, denying care and denying or diminishing payment. physicians and hospitals paid 30% or 40% less or saying you're not allowed to do these other tests, we're not going to pay for it, end up promoting a situation more based on quality than quantity that increases many kansases and increases the chances for fraud and abuse. in pennsylvania today there was news in the paper of millions of dollars, again, of abuse in the system.

what is so important is if you have the patient and the doctor in charge of their care, you incentivize quality, make sure the doctor has the timely information through electronic medical records. those are things we are not doing. look at other clinic the mayo clinic, university of pittsburgh medical center, ones that are focused on we're going to change the quality of care you see the costs go down. that's part after the -- part of the focus we need to have. with that, i yield back to my colleague. mr. kirk: i want to talk about some solutions we're going to put forward. what's lost in the debate is we agree with the president we should lower cost. we agree we should expand health care. we think we have a better way. many times in the partisan debate, people can say we have no alternative. so we've spent about 90% of our time coming up with that

alternative. we want to make sure that we guarantee the rights of each patient in the doctor-patient relationship so you or a loved one in your family is allowed to carry out the decisions made by you and your doctor, and not be interfered with by a government entity. also we're focusing on lowering the cost of insurance. through alliances, through equalizing the tax benefit for individuals, so they get the same benefit employers get when they buy health insurance, and obviously what we've talked about here, lawsuit reform. i yield to the gentleman. mr. dent: that's a point i made about equalizing the tax treatment. the 165 million american, 60% of our population, has insurance through their employers. but those individuals who cannot afford insurance, and there are a lot of them out there, cannot afford their insurance but get no favorable tax treatment themselves. their employer receives i but

the me, the self-employed individual should get the same favorable treatment. that's a way to help, particularly the younger population, some of whom have the capacity to purchase health insurance, may be relatively health iy but decide not to purchase it. we can help that population afford a reasonable comprehensive plan. that's one of the major parts of the reform you and i worked on. i think there are plenty of people in this room who on both sides of the aisle would be willing to vote for this type of common sense reform that's going to help people get access to care and coverage. mr. kirk: we want to equalize benefits so if you buy your own insurance you get the same benefits an employer does. there are ideas building in strength in the congress and downtown that talk about cutting the tax benefit that employers get for providing health insurance to their

employees. one study by the lieu well in-- lieu well lynn group says luolen group is cut, 100 million americans will lose their health insurance. a health reform bill will cut the number of american who was their own insurance from 170 million to 70 million. our bill, our positive alternative goes in exactly the opposite direction. we're enhancing employer-provided coverage and making sure it's more available. i yield to the gentleman. . mr. dent:00 when you talk about 100 million americans losing their health care where will they go to get it? that employer exclusion, that favorable tax treatment is essential to making sure many americans are able to maintain their coverage. that's the first thing we have to protect in this whole discussion. we have to protect that first. and some of the proposals clote

floating around this capitol as you pointed out would either eliminate that exclusion or severely limit it as a way to finance whatever kind of program they are advancing. this is big money. so i just wanted to share that with the american people. make sure they understand that seems to be the primary funding mechanism that many are looking at to finance whatever kind of health care system we propose. whether it's a government option or some other proposal, single payer. mr. kirk: they are talking about maybe a $1 trillion cost of a government plan. so the most obvious response with such a cost is a huge income tax increase. we know most americans oppose that. some including emanuel, one of the heads of the president's advisory committee, has talked about a national sales tax on p of the other tax. but i think there's significant opposition to that. so they have talked about cutting back on the tax benefit that employers get when they provide health care to their

employees. by this estimate it could cost over 100 million americans their health insurance. mr. murphy: when you look at the government running a plan a cost of $1 trillion. that's several hundred more than the pentagon. i'm not sure the people would say for the pentagon, of all the pride we have for our sole soldiers, airmen, marines, i doubt people would say that's the model of economic efficiency. would they say the social security run by the federal government is the best investment system? would they -- pick pic a system the federal government runs and it's hardly seen as the best. we know we have a lot of dedicated employees there, oftentimes they are saddled and handcuffed by regulations. we have a system that is still after all these years, medicaid that has been around since 1960's, so fraught with inefficiency it invites waste, fraud, and abuse. it has not been revamped. an article that appeared in the "the new england journal of medicine" a couple weeks ago was

saying, we've got to fix these systems first, otherwise, i go back to the art youicle, providing health care is like building a house. the task requires experts, expensive equipment and materials and a huge amount of coordination. imagine instead of paying a contractor to pull a team together and keep them on track, you paid an electrician and carpenterer for every cabinet. would you be surprised if you got a house with 1,000 outlets, faucets, and cabinets at three times the cost and the whole thing fell apart? that's where we are with the health care system. it must be focused on quality and an outcome. i worry if we have a government-run system and this bureaucracy created, it's going to be a matter, it's going to be between you and your doctor to get anything done it's going to take an act of congress. all of people who say it's going to be less involved with regard to administrative costs, don't see how that is possible given the track record we have. mr. kirk: we also not only see other examples of the government

poorly running the bureaucracy that's already taken over, recently the government took over the largest bond dealer, bear stearns. the government has taken over the largest insurance company, the american international group. and the government has taken over the largest consider manufacturer, g.m. i don't think anyone would argue the government is running it better in their current states. i yield. mr. dent: if the gentleman would yield. to follow up on that point you were making about government ownership and autos and financial services and elsewhere, let's talk more about health care. there is an idea being floated about called a government option which needs to be i think fully understood, invented before the public. but that government option many fear may become the only option for insurance because a government option coverage will perhaps -- would be able to offer a much lower cost than any kind of private sector insurance product. and the fear is that you would have a backdoor government takeover of our health system

through this government option. very real concern. and again -- i just don't think we should lose sight of the fact that if -- this turns into a backdoor single payer system or government takeover of health care what, will soon follow will be rationed care. that is waiting lines, delays, denials of care. mr. kirk: i would emphasize the point the gentleman raised. not only if we create a government health care program will it compete and maybe the lowest cost option because it has a taxpayer subsidy, but that taxpayer subsidy may be paid for by ending some of the tax break that employers have in providing health care to their employees. mr. dent: the 165 million americans. mr. kirk: employers seeing they don't get a tax break anymore for giving health care will cancel your health insurance plan and the government will be your only option. mr. murphy: i believe government does have a role in turms terms

of pro-- terms of providing regulation, standards ever excellence, and pushing companies towards this. provide the oversight that says if you are going to spend the taxpayers' money on medicaid, medicare, v.a., we want to see quality measures. if the federal government is going to put up money for electronic medical records we need to see you driving towards intelligence systems, integrated systems, towards one that is are highly interactive with the physician, the federal government can play a role in pushing people towards higher quality. i worry if the federal government is the prime owner of this will the federal government itself push things towards that? that's where i have trouble recognizing that. mr. kirk: i want to keep this on the positive side because what we are doing is we are putting together a positive alternative. one of the other reforms that we will be outlining is to dramatically expand the number of americans who can have a health savings account. very much like an i.r.a. so that they can save, especially in their younger, more healthier years, in a tax deferred

account, that they will use to make up for their deductible expenses in their health insurance. over time as with our i.r.a.'s, an account balance will build up. and then if each of us reaches the age ever medicare at 65 with a balance in that account, that account can either become part of our retirement plan or eventually a part of our estate to our children. this is a much more flexible way of providing health care. more importantly it's owned by you. not by a government bureaucracy. i yield. mr. dent: well said. i think we should focus on solutions. we talked a lot about the challenges and the problems and the costs. but it does come down to solutions. i think to sum up what we have been talking about tonight in terms of our solutions, you congressman kirk, have been a great leader on the medical rights act and make sure that that sacred relationship between doctor and patient is not violated. you have to protect that

principle and that notion must be protected up front. as we lower the cost of insurance we talked about some ideas about making sure that businesses can reach across state lines. that they can reach across state lines, realize greater discounts, so they can provide more affordable coverage to their employees. that's a cost issue. medical liability reform, specifically given some specific examples of things we can do on medical liability reform to help lower the cost of care. absolutely critical. we want the states to be innovative. we want them to be innovative. many states, 34 states have high-risk pools. some work reasonably well and others are not effective. how can we help states innovate to provide ways to make sure people receive coverage? particularly that uninsured population? i think we are concerned about, that's that population that is chronically uninsured and maybe it's about 10 million people. i don't have the statistics in front of me. er somewhere around 10 million

people are chronically uninsured. they are not that under 35 population. but people who really need help and may have a pre-existing condition that prevents them from getting picked up or a person -- right now let's face it, a lot of people -- they are afraid of more than losing their jobs, losing their health care coverage. i think we have to make sure we take care of of that population, uninsured, who has a pre-ex-ising condition. that's where we can use the states to be very, very innovative. the other thing we have to talk about, too, we don't talk enough about it, people want to see medical breakthroughs in the united states. they want quality and they want innovation. and they don't want an average system. i have always been struck -- i visited the country of ecuador once with my family a few years ago, and i was struck. the tour guide was telling me about their national system. then we drove by the hospitals. they are right next to each other. the public hospital and the private hospital. you could tell which was which.

visually. the private hospital looked like a hotel. very inviting place. the public hospital, unfortunately, looked like a building that was someone run down. two tiers of care. this is a latin american countries, some might say third world, nevertheless that's what i saw. i never want to see that happen in america. mr. kirk: what you heard tonight is focusing on positive outcomes, making sure we reform health care. deploy health information technology. health individual savings account. we have spent far less crime criticizing the president. far more time outline agnew positive agenda. to close tonight i'd like to turn to dr. murphy who has been more in the health care system that -- than all of us. mr. murphy: when i look at this, i want americans and all of us to imagine a system that's based upon cures and outcome. a system where doctors are in charge of your health care not insurance companies, not the government. i know that both sides of the aisle are deeply concerned about

this. it is not the one side wants insurance companies to win. we all want patients to win. democrats and republicans alike. we must have a system that focuses upon this. not that creates incentives because we are paying people so low to do more. not to promote more medical procedures but focus on this outcome. we can do this three threw the things we are doing. the patient and doctor in charge. don't create more barriers. make sure we have all the efficiency there for equality. we can do those things. imagine what could happen. imagine the possibilities and let's not throw it out and say it's too difficult. with that i yield back to my colleague, congressman dent. mr. dent: just in conclusion i think we want to say a few things i think in our health care system. we certainly want our system to be focused on prevention not maintenance. we want cures. not treatments. the system should be about doctors not lawyers. we want patients to be treated like human beings. they want to be treated like

people. not some number. something abstract. we want to be treated like a human being. because at the end of the day we all want our loved ones to be cared for. we don't want them to wait. we don't want to see a mother like mine who is 80 be told she's contributed her whole life relatively healthy, we don't want to tell her we are sorry we are going to discard you because you have reached a certain age. that's what we are concerned about. we are going to try to work i think in a bipartisan manner. try to work in a way that embraces a lot of ideas that we can all share. short of of a government takeover of our system, i think we can do that. we have the compass to the do it. the american people expect it of us. i look forward to working with my colleagues to come to that kind of result. i yield back. mr. kirk: i thank the gentleman. we will be outlining a positive set of reforms that we think can attract tremendous bipartisan support. this tuesday from the centrist. with that i'd like to ask unanimous consent that members have five legislative to insert, revise and extend their remarks.

the speaker pro tempore: without objection. mr. kirk: thank you. mr. speaker, i yield back. the speaker pro tempore: i thank the gentleman. under the speaker's announced policy of january 6, 2009, the chair recognizes the gentlewoman from pennsylvania, ms. schwartz, for 60 minutes. ms. schwartz: thank you very much, mr. speaker. i rise this evening to begin what i hope will be a special order on a time with my colleagues. it's a little earlier than we thought so we are going to see as they make their way to the floor. hopefully they'll be joining me. as you know there has been a great deal of discussion about health care reform. we just heard a special order from my colleagues on the other side of the aisle talking about health care reform and some of their thoughts about it. and i think sometimes we focus very much on controversial issues and some of the difficult decisions we have to make as we move forward to make sure