to make these tax cuts and the only place we'll get the money is by borrowing it internationally to continue the level of services that we have in this country, otherwise we're going to the choice between tax increases or spending cuts is a political decision. i think the will -- role should be mutual and these rules are not mutual. thank you. >> in a few moments, an update on the condition of arizona rep the gabrielle giffords. in about a half hour, the house are representatives of the future of health care legislation. then, a discussion on medical malpractice liability. >> i have to practice to stay alive. >> sunday, our guest is author and atlantic monthly contributing editor christopher hitchens.

>> there are treatments i can't see that are out of my reach probably. "q&a".ay on c-span's this weekend on booktv, bill crystal discusses his late father's essays on the neo conservative movement. 52 women look back on the work of the civil rights movement. prime minister gordon brown on coming back from the economic downturn. find a complete schedule at booktv.org. at the schedule sent to your in box. >> arizona rep gabrielle giffords is scheduled to travel to houston friday to continue our rehabilitation. her husband spoke with reporters earlier today at university medical center in tucson. this is 25 minutes.

>> i would like to take an opportunity to thank all the people contacting us here at the hospital. it is amazing to see how many people in the country really feel about this event. what we are going to do at this press conference, i will turn it over to michael lemole in just a moment. captain mark kelly, ms. giffords husband, would give a brief statement. we will follow that with questions and answers. every day we are seeing improvement.

improvement in the first couple of weeks after injury is very significant of how she is going to do in the future. we are still doing the routine things with her. we are doing speech therapy as well as intensive physical therapy. she continues to participate and cooperate and make improvements. dr. lemole? >> the congresswoman continues to do well neruologically. she is standing with assistance. she is going through an ipad. this indicates higher cognitive function. i want to caution everyone that she has a long way ahead of her. we started the process here. we have to continue that process to the next facility she visits. from my point of view, we did

some minor procedures this week. one of them included one of her wounds. most of this is housekeeping. we are getting her into a position where she congratulate move on. with that, i will turn it over to her husband. >> secret notes. [laughter] good morning, everybody. the last 12 days have been extraordinarily difficult for myself, my family, but not only us. it has been difficult for the city of tucson, southern arizona, and our country. i do not think we will ever fully understand the why and how and the reason for what happened on the eighth of january.

it is a loss of innocent life. the injury of one dozen people. the death of a nine-year old girl. a federal judge and the serious, traumatic injury to my wife. we will never fully understand that. emotionally this has been a challenge for all bus -- all of us. what this has done, it has certainly shown me and, i think, not only our country, but the entire world what tucson is all about. it shows them a different side of tucson. i think all americans are very proud of what they have seen. i know my wife, gabrielle, would be very proud of help the

community has responded to this tragic situation. the memorial's outside this hospital, in front of her office has been a testament to what this community is all about. the love and support we have received is a bit overwhelming. it is actually a bit difficult to keep up with. we are very appreciative and i want to apologize for all those folks who have done so much for us that we have not recognized yet. one of the first thing gaby will want to do as soon as she is able is to start writing thank- you notes. [laughter] i think as gabby news and to the next age of for recovery -- moves into the next phase of her

recovery, she will continue to be strong and she will really appreciate the support of this community. this is our home. this is the place she loves. this is the place she represents. we look at a lot of places to move her to. we considered rehabilitation facilities in new york, in arizona, and in chicago, in new jersey, and washington, d.c., as well as houston. what the best rehabilitation hospitals in the nation and one of the closest of the bass isn't the city of houston. that is the -- and one of the best is the city of houston. it took a while to decide where to send her. there were many factors that went into that. some of those other places could certainly provide her excellent

care. we did consider them all. tier memorial is one of the top-rank rehabilitation hospitals for over 21 years. it has an outstanding, world- class reputation. the doctors and nurses there are among the best at treating penetrating head injuries like daddy has been dealing with. i want my wife to get the best possible care. i am convinced she can get that at tier memorial. it is also one of the closest, top-rank places to tucson. a critical factor in this decision is the fact that it will let me be there by her side as much as possible, every single day. i do not know how long this process is going to take, but if i want to address the situation

with our children who are teenaged girls and also be able to consider the possibility of returning to work, it makes the most sense that she is in houston, texas. i am extremely hopeful that daddy will make a full recovery. i told her that. she recognizes it. she is a strong person, a fighter. she is a fighter like nobody else i know. i am extremely confident that she is going to be back here and back to work soon. i have been telling the hospital staff that they should expect to see her walking these holes within the next couple of months. i am sure of that. one of the reasons she is going to beat that is because of the

excellent care she has received hear from dr. peter rhee and michael lemole, the other trauma surgeons, the other ne urosurgeons, and up and down the chain here at the hospital. she has received nothing less than perfect care. that is the reason she is in the situation she is in now with the fact that within two weeks of this serious injury, she is able to move on to the next phase. i also want to thank her nurses who have attended to her around the clock. tracy, amanda, joshua, jocelyn, and angelique have been by her side every step of the way. i also have very strong feelings for the support we have received

from the pima county sheriff's department and the tucson police department. there have been volunteer police officers in the intensive care around the clock since we arrived. they are making sure everything goes as planned and that we do not have any other issues to deal with. the capitol hill police had been with us around the clock as well. i also want to thank the ceo, the mayor, the president of the university of arizona -- i know each of them are deeply committed to this community. their kindness and generosity of them and their teams have been just phenomenal. but really the bottom line is i want to thank the people of tucson for their support that they have provided for me, my wife's staff, our family over

the last two weeks. it is really beyond what i would have expected of anybody. we are deeply and gratefully thankful for that. i would like to take a couple of questions if anybody has them. i think peter is going to do that. >> can you talk a little bit about the logistics of moving her? >> we are going to move for tomorrow. we are going through the planning process right now of how to do that. we are steer -- still in the first phases of putting that into place. by the time we move our, we will have a good plan. >> had she spoken it, yet? >> that is a good question. i feel she has made some attempts.

she has had a tracheotomy. intellectually, she knows that is there. she understands what that means. in my mind, she has made some attempts. this whole thing concerns me, from the time i got the first call to the time that she makes a fur -- a full recovery. we have a lot of concerns. >> did you know who will be leading the team in houston in terms of her doctor? >> dr. john holcomb and the neurosurgeon, doctor brian ho. she will smile at me. she will do a couple of things she only does brown made like a

slap me in the face. she used to do that before, very gently. you can look in her eyes and tell. she is well aware of who is around her. she is very aware of the situation. >> can you tell us exactly the moment when she stood and took a few steps on her own? >> i think standing and steps, what the general public or myself would think what that means and what physical therapists with a clinical definition of those two things -- i think they are a little bit different. she can bear her own weight, which is a big step. just speaking for the doctors here, i think she has made a remarkable recovery.

>> [unintelligible] >> every time i enter at with her there is something quite inspiring. -- interact with her, there is something quite inspiring. i imagine the next that is she will be walking, talking, and in two months you'll see her walking to the front door of this building. >> thank you.

>> if you have questions? go ahead. >> can you say specifically what they are going to do when she gets there? >> the therapist or their everyday working with her. it will be more of the same. obviously as she becomes more able to do more complex sequences of task, they will graduate heard there. >> can you talk a little bit about speech therapy? >> speech therapy is more of a therapy for speech. they consist of swallowing, gag reflex, repeatable simple communication. all that has currently been done to the extent it can considering her status.

>> [unintelligible] >> they are able to assess to her mouth and the muscles or working. did the best of our knowledge she is doing well in that regard. she is falling. we do not really challenger with complex things until we know she is ready to graduate. >> will she be transported in some special airplane? >> what was your question again? >> will she be transported to houston in a special sort of air ambulance or a regular airplane? >> it is not a commercial airplane, but it will be an air- ambulance airplane. she will probably go by air again to the hospital. she should be pretty easy.

we will do all of the lifting. [laughter] >> you will go along? >> we have not come to a conclusion about who is going to go. >> [unintelligible] >> we are going to drive the airplane and then go from houston to the hospital. >> [unintelligible] >> we do not know for sure exactly where she is. she is not at that stage. seee is evidence she can't -- she can see the object and the color. we have seen are moving her

lips. it is hard to say whether or not she is a melding of words. >> why did you choose to put in a tracheotomy [unintelligible] >> usually when we do it, we do it to protect the air way. when you put in one of the tubes you cannot speak with, the air goes back and forth through the mouth. in the beginning phase, you want to make sure the saliva does not get into the lungs. there is bacteria that gets into your mouth. >> [unintelligible] >> it will definitely be tomorrow. >> she stood on her own feet without assistance. has she done anything else that struck you as impressive? >> we are planning on giving her

some sunlight today. this is part of the physical and mental therapy and all the things that go into it. the physical therapy here is pretty aggressive. we were very active in getting her a mobile. the physical therapy is going to be continual. what she is going to do in houston is capable of being done here as well. of course, we have people with head injuries in our town all the time. the things that are going to take months and longer periods of time -- this is just my personal opinion -- i would like to see mark be able to be with his wife. that will involve many levels of logistics. that means he needs to be able to be at work and see his wife

regularly without flying around and so forth. i think that is very important for the entire human face. the rehabilitation can focus on getting her functions that as well as the everyday things for daily living. >> the first step, we got her into a chair and wheeled her to the window. the next step is to get her out to a deck where there is an open exposure to sunlight. when people start to see that day in and day out, it starts to bring them back to the lifestyle they had before. >> can you talk about how you know whether she is aware of her surroundings? does she know what is going on around her?

how do you know that? >> she will scroll through her ipad and look at pictures. she will pick out different stuffed animals. she will interact with mark in personal ways. there is no quantifiable way you can say that she has registered what has happened to her, but we do think a lot of that is getting through. >> we change the [unintelligible] >> we are contemplated it everyday, but it is probably better to wait. >> will the people from the other hospital come here to take her or will you go there with her? >> there are many options including putting her original bonds back in place or having a

prostatic made. that can be performed at any institution. we would be happy to do that here. it will be a timing issue and an issue for the family. of course, she will wear a helmet for safety that will protect the soft side of her head. >> the recovery here has been seemingly quick. can you give a perspective of how long the road is ahead? >> no question, months. we are very optimistic because a recovery here has been quick. if she had simply maintain simple commands, i would have been happy with that. every day we have seen improvement. still, i caution everyone -- months. it is not uncommon for people to initially improve and then plateau for a while. we have to gear our expectations to what she is

ready far as opposed to what we want. >> what is the best case scenario? >> it is speculation. the full range of functional recovery -- >> is it possible for her to come back in two months at what? >> if that is possible. >> can you talk about the importance of getting her into a rehabilitation program? how does that help her long- term? >> it is hard to say. once she no longer needs and acute care hospital and what it provides to the public and to people, there is no reason to maintain her in the hospital. that is why we have rehabilitation hospitals to take over the face of it. it is just a continuing. -- it is just a continuum.

>> could you repeat that? >> [unintelligible] >> i cannot and spain -- explain the factors of what happened on a particular day. we are trying to orient her from that aspect. >> would you be involved in her care at all? if so, what is the next big thing you might be looking for? >> doctor holcomb is a longtime friend of mine. we retired about the same face in the military. he went to houston. the system is fairly similar, but he does fantastic -- he

does have a fantastic rehabilitation facilities there. we -- the typist procedures she will require are fairly minor at this stage. it needs to be done. this is her home. between the two of us, we will be able to do just fine. >> the neurosurgeon there and i have communicated. that dialogue will continue. we have had several of these multiple phone calls between all of us. they know exactly her situation. we have been giving them information for the last 10 or 12 days.

>> thank you, everybody. hos[captioning performed by national captioning institute] [captions copyright national cable satellite corp. 2011] >> tuesday, president obama delivers the state of the union address. c-span's live coverage begins at 8:00 p.m. eastern. then, the republican response and your phone calls live on c- span, c-span radio, an online at c-span.org. you can also watch the address on c-span2 followed by remarks from members of congress. quite one day after voting to repeal the health care law, house republicans introduced a resolution for new health care proposals. they included an amendment

offered by jim masterson dealing with payment discrepancies for doctors treating medicare patients. this is 1.5 hours. tempore: for what purpose duds the gentleman from california rise? >> i ask unanimous consent to address the house for one minute and revise and extend my remarks. the speaker pro tempore: the gentleman is recognized for one minute. mr. dreier: let every nation know whether it wishes us well or ill, we shall support any friend, oppose any photoensure the survival and success of liberty. those are among the brilliant words that 50 years ago today were delivered by president john f. kennedy as he was inaugurated. in three hour, we are going to be marking that inaugural with a ceremony in the great rotunda. i think it's very important, madam speaker, as we do that, to remember not only john f. kennedy's commitment to our nation's security, but to once again underscore his passionate commitment to our economic

security by his implementation of pro-growth economic policies that were replicated 30 years ago today when ronald reagan was put into -- became president of the united states and pursued the same kinds of pro-growth policies that president john f. kennedy pursued. i hope very much, madam speaker, that we can learn from the lessons of both of these great presidencies. the speaker pro tempore: the gentleman's time has expired. for what purpose does the gentleman from georgia rise? >> to address the house for one minute. the speaker pro tempore: without objection, the gentleman is recognized for one minute. mr. johnson: thank you, madam speaker. yesterday's action of repealing the health care reform cynically called the job-killing health care act by my friends on the other side of the aisle, is definitely an ironic misnomer. job-killing.

when the health reform was poised to -- or is poised to create four million new jobs. the number of jobs created by repeal, zero. so we're not about protecting jobs on the other side of the aisle. we are about protecting insurance companies. bottom line. and i yield back. the speaker pro tempore: the gentleman yields back. for what purpose does the gentleman from massachusetts rise? >> to address the house for one minute. the speaker pro tempore: without objection, the gentleman from massachusetts is recognized for one minute. >> i rise to celebrate the life of ashley turpin. ashley was respected by many people of every political persuasion. she was a wonderful mother of three children and her depeth is especially difficult for those of us on capitol hill because we got to know her through her work as rosa delauro's chief of staff.

mr. mcgovern: she was part of our family. she was a woman of great skill and personality. we also know her husband who worked on the hill for many years and served as chief of staff to the rules committee and currently workers in white house. i attended, along with hundreds and hundreds of others, ashley's memorial service last friday here in washington, d.c. those who eulogized her captured her spiriting her determination and her great compassion. she was a remarkable woman and will never be forgotten and our prayers are with dan and ashley's family. i yield back my time. the speaker pro tempore: the gentleman yields back. for what purpose does the gentleman from california rise? mr. dreier: pursuant to house resolution 26, i call up h.res. 9 and ask for its immediate consideration. the speaker pro tempore: the clerk will port the title of the resolution. the clerk: house calendar number one, house resolution 9, instructing certain committees to research legislation prere-placing the job-killing health care law. the speaker pro tempore: pursuant to house resolution 26,

the resolution is debatable for one hour equally divided between the chair and ranking member of the committee on rules or their designees. the amendment printed in part b of house report 112-2 is offered by the gentleman mr. matheson or his designee shall be considered read and shall be separately debatable for 10 minutes equally divided and controlled by the proponent and an opponent. the chair recognizes the gentleman from california. . mr. dreier: i yield myself such time as i may consume. implementing health care reform is what we begin today. this resolution, h.res. 9, initialates the second step of a two-part process which as we all know with the vote last night saw repeal of the health care bill. having taken that action to wipe the slate clean, we are now moving on to the far more

challenging task of crafting real solutions for the american people to ensure that we can drive down the cost of health insurance and health care. this resolution instructs the four committees of jurisdiction to draft legislation that brings about meaningful health care reforms. furthermore, this resolution lays out 12 clear guidelines that deline what real reform is. some of these guidelines are simply commonsense principles such as the need for reform spending. if there is one overarching principle for reform is we cannot pick winners and losers. real reform must be accessible to every american. if a family is forced to give up a health plan that is working for them, can we call that reform? if a small business must lay

off employees to comply with new mandates, can we call that reform? if a doctor is forced to close her family practice because the cost of malpractice insurance is prohibitive, can we call that reform? if government bureaucrats make decisions that should be left to doctors and patients, can we call that reform, madam speaker? obviously not. our goal is to increase access to quality health care for every single american, including those with pre-existing conditions. h.res. 9 that we are going to be considering here today puts us on the path to do just that. as i said at the outset, this is a tremendous challenge. achieving the goal of meaningful health care reform which we all share will demand an open and collaborative process. the four committees of

jurisdiction have a great deal of work ahead of them. this is a process in which we all must contribute, democrats and republicans alike. we have good ideas that are coming from both sides of the aisle and i believe that they will be considered through this deliberative process. these ideas must be shared, analyzed, and debated. if we all participate in -- if we all participate in this open and transparent process, i believe that we can address the health care challenges that we face in an effective and meaningful way. ultimately we all hope to arrive at the same place. we all share the same goal. that is access, access to quality care for all. that's what house republicans want a cheeve and that's what my democratic colleagues want to achieve as well. and that's what president obama wants to achieve.

we all have our own views on how we get there. in this body alone we have 435 views on the best way to reform our health care system. we owe the american people nothing short of a rigorous and thorough debate. but if we conduct that debate in good faith, madam speaker, grounded in the recognition that we all hope to achieve the same outcome, i believe that we in a bipartisan way, democrats and republicans together, can come up with real solutions. now, we saw the day before yesterday that the president said that he is willing and eager to work with republicans on the issue of health care. that's the sentiment that i and i know my colleagues on this side of the aisle share wholeheartedly. this resolution, h.res. 9, puts us on a path towards doing just that. it will begin this critically important process. so i hope very much that we'll

have strong bipartisan support for this resolution and we'll say that we have an amendment that will be coming forward, a democratic amendment, that the rules committee has made in order. i'm happy to say will add to that list that our friend, mr. matheson, has provided, and i will also say that contrary to the argument that has been put out there, that we don't have solutions, there are a wide range of proposals that exist and we look forward to having this committee process vigorously pursue just that. with that, madam speaker, i reserve the balance of my time. the speaker pro tempore: the gentleman reserves the balance of his time. the gentleman from massachusetts. mr. mcgovern: thank you, madam speaker. i yield myself four minutes. the speaker pro tempore: the gentleman is recognized for four minutes. mr. mcgovern: i rise in very strong opposition to this resolution and very strong opposition to the very closed process in which we are discussing this resolution. once again i am deeply disappointed that instead of working to create jobs and strengthening the economy, the new republican majority continues to focus on reopening old wounds and fighting old

battles. the resolution before us today is allegedly the replace component of the republicans repeal and replace strategy. i say allegedly, madam speaker, because this resolution is not a serious legislative effort. it is a series of talking points. it is a press release. what this resolution does is ask the committees of jurisdiction to hopefully, maybe someday, if they would be so kind, to report legislation to the house that meets certain vage goals. -- vague goals. instead of repeal and replace, this is repeal and relax. trust the republicans to do the right thing. no thank you, madam speaker. yesterday this house voted without a single hearing or markup, without a single amendment to eliminate the affordable care act in its entirety. the members who voted for that bill voted to return to the days when insurance companies could discriminate against people based on pre-existing conditions. they voted to eliminate the ban

on annual and lifetime limits on care. they voted to eliminate the ability for young people to stay on their parents' insurance plan up to the age of 26. they voted to reopen the doughnut hole in medicare, basically they voted for a tax increase on senior citizens who need prescription drugs. they voted to eliminate tax credits for small businesses who want to do the right thing and provide health insurance for their workers. all of that, madam speaker, would have the force of law. all of that was done with real legislative language. but not the resolution before us today. instead of real language that would provide real benefits to real americans, this resolution is simply a collection of empty promises. and the ironic thing is that most of the provisions included in the resolution were actually addressed in the affordable care act. according to this resolution, we should, quote, lower health care premiums through increased competition and choice.

well, the affordable care act already does that. many of us argued for a public option which would have lowered premiums even further with increased competition and choice, but my republican friends didn't want to have anything to do with that. this resolution -- the resolution before us today says we should, quote, preserve our patient's ain't to keep his or her health plan if he or she likes it. well, the affordable care act already does that. increase the number of insured americans, well, we did that by 30 million people. protect the doctor-patient relationship, we did that, and so on and so on. on the critical issue of people with pre-existing conditions, however, it's interesting to see the language my republican friends use in this press release that they call a resolution. they say, they support, and i quote, provide people with pre-existing conditions access to affordable health coverage, end quote. that sounds nice. but what we did in the affordable care act was to actually ban insurance

companies from discriminating against those people. i'll be very interested to see how my republican friends handle that critical issue and how much influence the big insurance lobby has around here now that they are in charge. and the doughnut hole? the resolution absolutely silent on the doughnut hole. madam speaker, health care is a vital importance to every single american. it is a big deal. and to treat health i shurens reform as just another -- insurance reform as just another opportunity for happy talk and wishful thinking is not the way to do business in the people's house. i urge my colleagues to reject this resolution. i reserve the balance of my time. the speaker pro tempore: the gentleman reserves the balance of his time. the gentleman from california. mr. dreier: madam speaker, i yield myself 15 seconds and i do so to say to my friend that i appreciate his very consill torrey -- conciliatory remarks. everyone has acknowledged this is flawed. we have had the courts already throw the mandate out.

we need to deal with the problem even before this measure is being implemented. so it seems to me -- the speaker pro tempore: the gentleman's time has expired. mr. dreier: we proceed with this work. with that i'm happy to yield two minutes to a hardworking member of our rules committee, the gentleman from lawrenceville, georgia, mr. woodall. the speaker pro tempore: the gentleman from georgia is recognized for two minutes. mr. woodall: thank you, mr. chairman. madam speaker. i have been a member of this body for two weeks and two days and i could not be prouder to be on the house floor today in support of the chairman's resolution. for the entire last year in my district, we have been focus the on one thing and one thing only, since march of 2010, and that is the repeal of the president's health care bill. before march of 2010, my district cared about health care reform. we talked about tort reform. we talked about putting patients back in charge of decisions. we talked about ending the tax preference businesses get so we can purchase insurance on our

own and own those policies. but the moment this bill was signed into law, the moment the president's bill was sign into law, that discussion stopped. and the repeal discussion began. and with the repeal yesterday, we now begin anew the discussion of how properly to reform the system. i'm anxious to have that discussion. we learned a lot in our time in the minority. one of those things we learned is that bringing simple straightforward resolutions to the floor is better for the process, better for the american people. the speaker's made that commitment. we continue that commitment today with these instructions to go back to the drawing board and bring things forward one at a time. i sat through 10 hours of hearings in the rules committee where folks came forward and said, go ahead and repeal the bill but save this one provision. let's have this one provision. keep this other one provision. we now have that opportunity. we have now repealed the bill here in the house and we have the opportunity to bring those

provisions forward one by one. i'll tell you what. i'm not going to like those provisions. some will pass the house. and that's the way it ought to be. you shouldn't have a one-size-fits all take it or leave it kind of system. you ought to be able to have that discussion on both sides of the aisle. and i have no doubt that provisions are going to come forward from our committee that i'm going to vote no on, but my colleagues on the left and right are both going to vote yes on and it's going to pass. that's the way the process ought to be. one provision at a time. one idea at a time. the speaker pro tempore: the gentleman's time has expired. mr. woodall: insurance reform. putting patients back in charge of those decisions. the speaker pro tempore: the gentleman's time has expired. the gentleman from massachusetts. mr. mcgovern:00 madam speaker -- mr. mcgovern: madam speaker, i yield myself 15 seconds. the speaker pro tempore: the gentleman is recognized. mr. mcgovern: madam speaker, i think our objection is not with the idea of having a serious debate on these issues. there are areas we can come together and hopefully make

this bill better. our objection is the fact my friends on the other side voted to repeal everything. voted to allow insurance companies to once again discriminate against people with pre-existing conditions. i yield 15 seconds. they voted to take away the been fit for senior citizens that we put in there to help try to close the doughnut hole in the prescription drug bill. and what do they do in terms of replacing it? they come not with an alternative a press release. that's not serious legislating. that's politics as usual. madam speaker, i yield two minutes to the gentleman from new jersey, mr. pallone. the speaker pro tempore: the gentleman from new jersey is recognized for two minutes. mr. pallone: thank you, madam speaker. i'm amazed, i listened to the gentleman from georgia who just spoke, and he said that in his district all of the focus is on health care and health care repeal. i don't know, when i go home all i hear in my district is jobs and the economy. people are concerned about the economy. they wanted us to create jobs. they want us to focus mostly on that issue. not on repeal of health care. the other problem i have with

the gentleman from georgia's comments is because he seems to think because the house passed this repeal yesterday that the health reform is repealed. let me tell everyone, it's not. and this is just a ruse. this bill -- this health reform wasn't repealed. the senate isn't even going to take it up. the president has said he would never sign a repeal bill. so the republicans are just wasting their time rather than focusing on what we should be focusing on is the jobs and economy. they keep talking about this false repeal that is never going to happen. now, i also wanted to say something about what mr. dreier said before. he talked about increasing access, increased choices. that's not what goes on if this bill was ever repealed. the choices now for people who have pre-existing conditions, they can't get insurance. they can't -- they have to pay more if they try to get it. or the kids on the policies that would be taken off if we have repeal, or the people that would again face lifetime caps. you don't have choices under

the old system because you were denied care through the insurance companies' discrimination. the only way you have choice and access is under the health reform that this house and this country put into law where you're guaranteed you get insurance even if you have a pre-existing qun. you don't have to worry about lifetime caps. you can put your kids on the policies. don't talk to me about choices and access. people don't have choices and access with those discriminatory policies that would be put back in place by the insurance companies as they continue to raise premiums, more and more people will not have access to health care and have access to health insurance. the only way you have access and choices is if we keep the health reform in place. . the speaker pro tempore: the gentleman's time has expired. the gentleman from california. mr. dreier: i'm pleased to yield two minutes to the dean of our delegation, mr. lewis. the speaker pro tempore: the gentleman is recognized for two minutes. mr. lewis: i appreciate my

colleague yielding, and madam speaker, i think the entire public knows that america has had in place, for a long time, one of the finest health care delivery systems in the world. it's the envy of many. that's not to say it's perfect. that's not to say we don't have major challenges, like pre-existing conditions and questions of portability. but indeed if the people who put in place a health care plan last year had their way, they would have taken the next step, to have a centralized, government-run health care system. that's the pattern of their future. at this moment, great britain, which has had such a thing in place for some time is attempting to back off their system and have more relationships between physicians and their patients. indeed, they're doing that because their system does not work. it's very important that we not allow the former majority to take their next step, that is, to have government-run health care and with that, yesterday we passed a repeal that will take us to conference with the senate

and in turn, today, we're beginning the process of examine re-examining where we have been to make certain we put in place health care that is positive for all americans, not health care run by the i.r.s. i yield back the balance of my time. the speaker pro tempore: the gentleman from massachusetts. >> i yield two minutes to the gentleman from new jersey, mr. andrews. the speaker pro tempore: the gentleman is recognized for two minutes. mr. andrews: thank you, madam speaker. i thank my friend from massachusetts, well, we could have a bill on the floor today that expands fair trade for american companies, but we don't. we could have a bill on the floor today that finds ways to stop sending a billion dollars to the middle east to buy oil every day and instead create jobs producing energy in america. but we don't. we could have a bill on the floor today talking about ways to regenerate our real estate market and get people buying and selling houses again. but we don't. what we have is an empty

promise. that someday, somehow, the new majority will come to our floor with a bill that will fix the health care problem. and i quote, instead of focusing on new health care mandates that will increase costs and employers and swell the ranks of the uninsured, senate democrats should focus on providing access to health insurance for the 39 million americans who remain without health coverage. this should be our first priority. i'm quoting from speaker john boehner. he said this on june 18, 2002. so at a time when the republicans had a majority in this house, a president in the white house, and for most of the time, the majority in the senate, their first priority, which was to deal with the health care problem, they didn't do. that's the standard against which we should measure today's promise.

doesn't leave for much -- doesn't leave room for much optimism. i would say instead of focusing on yet another empty promise, let's focus on putting americans back to work. i yield back. the speaker pro tempore: the gentleman from california. mr. dreier: i yield myself 30 seconds. the speaker pro tempore: the gentleman is recognized. mr. dreier: everyone has acknowledged that the legislation that has passed is flawed. everyone has acknowledged that. the president of the united states, when he said that the 1099 issue imposing mandates on small businesses, needed to be rectified, in his first news conference after the election, recognized there are problems. we had, day before yesterday, the distinguished assistant majority leader, the former majority whip, mr. clyburn say, he believes republicans and democrats should work together to improve this bill. we've already had a federal court determine it is unconstitutional to impose this mandate. madam speaker, we need to work together to resolve the very, very great challenges that we have ahead of us.

with that, i reserve the balance of my time. the speaker pro tempore: the gentleman from massachusetts. mr. mcgovern: i yield two minutes to the gentleman from texas, mr. doggett. the speaker pro tempore: the gentleman is recognized for two minutes. mr. doggett: with last year's important health insurance reform law, we provided real guarantees to american families against insurance monopoly abuses. today, republicans tell these families, forget the binding guarantees. we have 12 platitudes for you. this isn't a republican prescription, this is a placebo and for the american middle class, it's a very bitter pill indeed. yesterday, house republicans in a remarkable measure, with one vote, decided to increase the national debt, reduce the solvency of the medicare trust fund, raise insurance premiums and charge seniors more for their health care. during the last 12 years that these republicans were in

charge, six of them with near total come domination of government here in washington under the bush-cheney administration, they failed to enact one of these 12 platitudes in this flimsy, two-page excuse of a bill. 12 health care platitudes, missing in inaction for 12 years. they're broad platitudes that propose something they apparently kept hidden under a bushel for the last 16 years and now will unveil. i think it'll just be the same old tired rejected, retread, republican proposals to get more -- give more income tax breaks to those at the top and if you believe they've got something new to offer to genuinely reform the health care system in a way that will help middle class americans instead of health insurance monopolies, i think you'll want to buy some of that republican ice cream that helps you lose weight. our families don't need republican platitudes they need real help. i think the tea party types are

right about one thing. there are dangers from soaring debts, dangers they forgot for a decade. there are dangers from big government. but you know, that's not the only threat our families face. they face threats from big banks. from big insurance monopolies. do you have another minute or half a minute? mr. mcgovern: i yield the gentleman an additional minute. the speaker pro tempore: the gentleman is recognized for an additional minute. mr. doggett: our families face challenges from big pharmaceutical companies that charge more than any place in the world from the giant insurance monopolies and sometimes our families need government to come down on our side because otherwise those giant economic forces will take advantage of our families. by writing out the very protection the sick and injured need the most, protection they write into the fine print of an insurance policy that no ordinary person can understand, where they are told that they're

not covered anymore. that they have a pre-existing condition. that you have reached your policy limits and cannot get the care that your doctor says is vital to sustain your life. that this policy just doesn't cover sick people or that it can be rescinded. i say we need to provide people genuine protection. that's what we did last year. that's what they want to eliminate this year. let's side on the side of the people, not the 12 republican platitudes to benefit the insurance monopoly. i yield back. the speaker pro tempore: the gentleman's time has expired. the gentleman from california. mr. dreier: madam speaker, with that, i'm happy to yield one minute to one of the hardworking members of this brand new class that's come in carrying a strong message, the gentleman from columbus, ohio, mr. stivers. the speaker pro tempore: the gentleman is recognized for one minute. mr. stivers: thank you, madam speaker. i thank the gentleman for

yielding. i voted for the repeal of health care bill yesterday because i think doing otherwise would have been supporting the status quo and that's unacceptable. i believe there are some good ideas that were in the original health care bill that can be used and improved but, you know, some of those ideas are in h.res. 9 today. that instructs the committees on next steps on health care. however, there is one idea that i think we need to be -- need to add to that list. i think we need to add the allowing of young folks to stay on their parents' insurance to h.res. 9. in this tough economy, many students are unable to find jobs right out of school. as a member of the state senate, i sponsored a bill that would allow those up to age 30 to stay on their parents' plan and i just heard from a constituent whose 23-year-old son justin is back on his parents' insurance. moving forward, i'm committed to working with my colleagues in a bipartisan manner to support reforms we agree on like allowing young adults to stay on

their parents' plan. this was included in the republican alternative last year and should be included in the replacement bill this year. the speaker pro tempore: the gentleman from massachusetts. mr. mcgovern: i want to thank the gentleman for his comments in recognizing the fact that the provision that allows children -- parents to keep their children on their insurance is a good idea but he voted yesterday along with all the republicans to take that away. this press release they're now saying is a bill on the house floor doesn't address that issue. i wish the gentleman would have actually voted the way he -- with his convictions yesterday and voted against repeal. because what he did, if this bill becomes law, will take no i will -- it will deny parents to be able to keep their their kids on their insurance until they're 26. i yield two minutes to the gentlewoman from florida, ms. wasserman schultz. the speaker pro tempore: the gentlewoman is recognized for two minutes. ms. wasserman schultz: i rise to

oppose the republican cynical attempts to replace the health care reform law. yesterday's decision to repeal the affordable care act was dangerous to the american people, but today's actions to tout these provisions as republican ideas, is baffling. this these were the republicans' priorities, they would have left the affordable care act intact because all these provisions exist in the current law. if we all agree on the importance of keeping young adults on their parent's insurance, prohibiting insurance companies from dropping coverage for the sick and strengthening medicare this spectacle is a colossal waste of time we don't have. if they want to guarantee consume brother texts for the american people, they would not stage partisan antics. even when republicans had control of the entire government for six year, they did nothing to reform our nation's health care system. and during that time, premiums skyrocketed, the number of uninsured americans grew to 47

million and those with insurance saw their benefits decimated. of course it would have been great to have the republicans as willing partners in the last two years as we work hard to pass the patient protection and affordable care act. no i will not yield. unfortunately, they insisted on being the party of no. even as we incorporated so many of their party's ideas into the law. rather than roll back the hard fought consumer protections and freedoms that unshackles americans from the whims of private insurance companies, as former republican senate majority leader bill frist said, republicans should be working with us to build on and improve the health care system. not to mention every potential minute spent in committee focusing on redundant legislation is another minute wire not spending working to get out of this recession. unfortunately, the republican majority's hasty vote to repeal the affordable care act failed on all such counts. the american people deserved and

got real reform. this vague resolution stating so-called republican principles on health care reform is like giving the american people a wish sandwich. there's nothing between the bread but we wish there was. thank you and i yield back. the speaker pro tempore: the gentleman's -- gentlewoman's time has expired. the gentleman from california. mr. dreier: the fact of the matter stherk republicans sent associated health plans to make sure small businesses could drive the cost of health insurance down to the senate and our friends in the other party killed that measure. we put in place access for affordable prescription drugs so we have worked dill jebtly to make this happy. i'm mape to yield a minute to my good friend from fort myers florida, mr. mack. the speaker pro tempore: the gentleman is recognized for one minute. mr. mack: i thank you, madam speaker. yesterday was a great day for democracy and freedom in this country. yesterday, the republican-led

congress voted to repeal a health care law that was passed by the democrats that would mandate, that would force people to buy something, even if they didn't want to. it's unconstitutional, it's un-american, it is not what this country stands for. now we're hearing a lot of our colleagues on the other side talk about how we want to strip away this and we want to strip away that and we're playing games and this resolution is a game. let me remind you that it was -- the president of the united states in his state of the union talked about tort reform, which was not included in obamacare. we intend to include tort reform in the next -- in this congress. we also believe that association health plans are very important to ensure that more people have access to health care, something your side of the aisle failed to do. there is real ways to do common sense reforms. it is not by having government mandate what you have to buy as

a citizen of this country, it is unconstitutional, it is un-american, thank you. . the speaker pro tempore: members are advised to address their comments to the chair and not members within the -- in the second person. the gentleman from massachusetts. mr. mcgovern: thank you, madam speaker, for maybe taining decorum in the house. at this time i yield two minutes to the gentleman from new york, mr. weiner. the speaker pro tempore: the gentleman from new york is recognized. mr. weiner: madam speaker, we are seeing today that after 75 or so hours of markup, hundreds of hours of hearings, 16 months of long debate, thousands upon thousands of meetings and town halls the republicans come to washington and don't know what they want to do in health care yet. my constituents should understand and the speaker should understand that this resolution says go back and figure out what we want to do. ladies and gentlemen, i would remind you that last year during the health care debate

the republicans had a chance to offer an alternative, they didn't. now they come to washington and say, oh, let's have the committees try to figure this all out. yesterday they were the party of no and today they are the party of we don't know how to go. who are these republicans? after months and months and months of the national debate, you can go into any coffee shop, any church basement, just about any card game in this country and people have solid ideas about what they think about health care, but not the republicans. they've got a resolution today that says, hey, committees, go try to figure this stuff out. it's complicated. by the way, i don't know, madam speaker, if i read it correctly, i don't think there are any deadlines. i don't think there are any deadlines. i will eat this rostrum if they come back with legislation that actually accomplishes the things that they just repealed yesterday. it's not going to happen. ands in the fundamental problem that i believe -- and this is the fundamental problem that i

believe the majority party now has. they have the campaign slogans all down. i heard the gentleman from florida do one. unconstitutional. they have the campaign slogans, and i got to give them credit, they were successful with them. they came here we are against, against, against. now here it is. unlike past congresses come up geared up for the things they want to do, they are geared up with a resolution saying, hey, go figure out what it is we should do. the american people deserve a lot better than this. they deserve comprehensive health care that saves them money. that's what was repealed yesterday. the speaker pro tempore: the gentleman's time has expired. the gentleman from california. mr. dreier: i yield myself 15 seconds to say to my friend from new york it's very interesting that the president of the united states the day before yesterday said that he was willing and eager to work with republicans to ensure that we rectify this flawed bill. the distinguished assistant majority leader, the former majority whip, mr. clyburn, said he's willing to work with republicans in a bipartisan way

to address this. with that, madam speaker, i yield one minute to my good friend from allentown, pennsylvania, mr. dent. the speaker pro tempore: the gentleman from pennsylvania is recognized for a minute. mr. dent: yesterday the house voted to repeal the misguided health care law of 2010 which is seriously flawed both in its structure and practical implementation. i keep hearing discussion about the affordable care act. if one believes the affordable care act will not add to the deficit, i think one is apt to believe just about anything. today we have the opportunity to direct to the committees to produce practical and effective reforms. i urge my colleagues to join me in supporting this resolution and commit to working together to enact meaningful reforms that will lower health care costs, expand access to affordable insurance coverage, and foster economic growth and jobs. the current law is simply unwise and unsustainable. i believe we must replace the misguided policies of the current law, reforms that will address rising health care costs, specifically i support medical liability reforms to reduce the practice of defensive medicine. i believe congress must provide americans with more options for

affordable health coverage such as low cost catastrophic plans for individuals, patient centered health care savings account. cross state purchasing, and effective high-risk pools. i urge my colleagues to support this resolution and let's get on with this today. i yield back. the speaker pro tempore: the gentleman from massachusetts. mr. mcgovern: 10 seconds to the gentleman from new york. mr. weiner: i want to respond to the distinguished chairman. the president did not say anything about thistardly flawed bill. he said we should implement and improve. that's the way we build important legislation. he didn't say look forward to republicans -- mr. dreier: would the gentleman yield five seconds? madam speaker, let me just say to my friend that the president did say that he is willing and eager to work with republicans to rectify the problems that are here.

right after the election he said he wanted to correct the 1099 -- the speaker pro tempore: the gentleman's time has expired. members will suspend. who yields time? the gentleman from massachusetts. mr. mcgovern: i yield two minutes to the gentlewoman from maryland, ms. edwards. the speaker pro tempore: the gentlewoman from maryland is recognized tore two minutes. ms. edwards: thank you, madam speaker. i'm actually disappointed i'm standing on the floor of the house of representatives today yet again defending and protecting the rights of the american people to health care. it's such a shame that yesterday and the day before for seven hours our members on the other side spent their time deciding for the american people to take away the ability of parents to provide health care for their young people up to age 26. they spent seven hours other than finding jobs, trying to make sure that small businesses who are providing health care don't get a tax credit anymore for the health care that they

are providing for their employees. they spent seven hours trying to strip away the ability of our seniors to make sure that they don't have to reach into their own pocket, deeper pockets, not deep anymore, to pay for prescription drugs. yesterday they spent seven hours a and the day before debating whether it's a good idea for insurance companies to be able to deny people health care for pre-existing conditions when they know that at least 129 million of us, 65 or so percent of us, have pre-existing medical conditions. it's disappointing here we are yet again where the republicans say we took it all away in one day. and now we are going to think about some of it that we might replace again. well, we have created a health care law for the american people that's about affordability and accessibility. i know that the democrats are going to stand on the side with the president and implement the

law. thank goodness for the american people, they should know that the republicans didn't do anything yesterday other than put a whole bunch of stuff on a piece of paper that has no chance of going anywhere. the paper is not even worth the ink that's printed on it. the speaker pro tempore: the gentlewoman yields back. the gentleman from california. mr. dreier: thank you very much, madam speaker. the native of the show me state, i'm pleased to yield to my friend from st. elizabeth, missouri, one minute, mr. luetkemeyer. the speaker pro tempore: the gentleman is recognized for one minute. mr. luetkemeyer: i'm proud in support of this resolution. a bill that would help committees and our country back into the right direction. it will entail more than tweaking the law, it means replacing the health care bill real reform. last august 71% of missourians went to the poll and said no. as i go about my district and talk to my employers, they tell me instead of premiums going

down they have gone up 25% to 40%. instead of improving access to care we actually have doctors retiring in record numbers. true reform should be passing significant laws through reforms so doctors can perform their jobs ever taking their of their patient. i also support increasing access to insurance by allowing small business to pool together to get the best plan for the employees. all along republicans have offered a commonsense approach to approving our health care system in a way that controls costs and provides the quality of care that americans deserve. today's vote is important in realizing that goal. i yield back. the speaker pro tempore: the gentleman yields back the balance of his time. the gentleman from massachusetts. mr. mcgovern: could i inquire how much time remains? the speaker pro tempore: the gentleman from massachusetts has 12 1/4 minute remaining. the gentleman from california has 16 1/4 minute. mr. mcgovern: we reserve. the speaker pro tempore: the gentleman from california. mr. dreier: at this time i'm happy to yield to one of the

other new members who come with a very strong message here, she's a nurse and she's from tennessee, two minutes. the speaker pro tempore: the gentlewoman from tennessee is recognized for two minutes. mrs. black: i thank the gentleman for yielding. madam speaker, i rise on behalf of the people of middle, tennessee, who spoke loud and clear this last year that they do not want the federal government dictating their health care. the plan that was signed into law by the president was supposed to increase access health care and lower costs for american families. however in the months since the bill passed it has been shown to do neither. we now know that the health care bill not only increases premiums for families, but hinders job creation and is filled with unintended consequences that not only diminishes the quality of our health care system but also do great damage to our economy and increase our deficit. this new congress was sent here to follow a more responsible

path. through commonsense, market-based solutions we can replace a flawed health care bill to have the best health care system in the world. i'm eager to take part in drafting the new republican plan and focusing on rolling back the individual mandate, eliminating the onerous demands on small businesses, and actually lowering the costs for families and increasing access to quality, personalized health care. i also look forward to a thoughtful discussion that includes solutions that went ignored before like tort reform, increasing competition, and tax breaks instead of tax hikes. as a nurse for over 40 years, my top priority will be making sure our plan honors the doctor-patient relationship that is so sacred in medicine because there is no place for a government bureaucrat in an individual's health care decision. as a member of ways and means committee, i am excited to work with chairman dave camp and my

fellow committee members on a new way to forward responsible health care reform. let's do the work that the american people sent us here to do. madam speaker, i yield the balance of my time. the speaker pro tempore: the gentlewoman yields back. gentleman from massachusetts. mr. mcgovern: we continue to reserve. the speaker pro tempore: the gentleman from california. mr. dreier: madam speaker, may i inquire of my friend if he has any further speakers on his side? mr. mcgovern: we do have further speakers. but there is a time discrepancy. we'll let you catch up. mr. dreier: let me say we don't have other speakers here yet. we are others on the way over to the floor. so i'd like to reserve the balance of my time. i understand the disparity that exists in the timing, but -- i can talk for all that period of time but i don't want to have the gentleman suffer through that. mr. mcgovern: i'm happy to suffer through it if you use your time. at this time, mr. speaker, i'd like to yield two minutes to the gentleman from california, mr. garamendi. the speaker pro tempore: the gentleman from california, mr. garamendi, is recognized for two minutes. mr. garamendi: madam speaker,

as i'm sitting here listening to this, i'm thinking this must be something like "alice in wonderland." this is the most bizarre debate i have heard in a long time. we need jobs. we need to be focusing on the american economy. this particular resolution has no sense of reality. i have heard debates here and discussions on the floor about association health plans. i know about association health plans. i was the insurance commissioner for eight years in california having to deal with these noninsurance programs that let hundreds indeed thousands of people holding the bag when the association health plans went belly up. it doesn't make any sense. california's had tort reform for 30 years. we have in the law today in america a protection for every individual in america from the

onerous hands of the insurance companies that have continued over the years to deny benefits, to make the doctor decisions, and to literally put people's lives at risk. it's called the patient's bill of rights. it's the law in the land. and our republican colleagues want to repeal that? we have a law that's in place. it should be implemented. the cost issues that have been discussed here on the floor are really a discussion about what has taken place in the past. the law has yet to be implemented with regard to cost containment. the oversight of the insurance companies. all of those things are in the days ahead and a market system is available with the exchanges. you want to talk about market, that's how you get there with exchanges. replace, repeal, how bizarre is that? americans have a protection. yesterday our republican colleagues voted to remove their protections. they caved to the insurance

companies once again the power to regulate their lives. we cannot allow that to happen. this step today is just "alice in wonderland." i yield back. the speaker pro tempore: the gentleman's time has expired. the gentleman from california. mr. dreier: i'd like to ask unanimous consent that all members may have five legislative days to revise and extend their remarks on h.res. 9, and i'd also like to ask unanimous consent that my distinguished vice chairman of the committee on rules, mr. sessions, be able to insert a statement in the record at this point. the speaker pro tempore: without objection, so ordered. mr. dreier: i'd like to yield one minute to my hardworking colleague from lincoln, nebraska, mr. fortenberry. the speaker pro tempore: the gentleman from nebraska is recognized for one minute. mr. fortenberry: i thank the gentleman for the time. madam speaker, health care reform, the right type of reform, is important to me, important to every american. and the right type of reform will actually reduce cost and improve health care outcomes while we protect vulnerable persons. .

however, this health care law is an -- is a complicated mess that will increase spending and reduce health care liberty. americans deserve better. i believe it's important to craft a new, commonsense policy that provides new insurance models for families, farmers, and small business owners, but any model we craft must continue to build upon a culture of health and wellness. allow newly insured persons to keep their current coverage, and also retain protection for pre-existing conditions. this will be important. so now the hard work begins. but this time, we have the opportunity get it right. i yield back. the speaker pro tempore: the gentleman yields back. the gentleman from massachusetts. mr. mcgovern: i yield two minutes to the gentlewoman from wisconsin, ms. moore. the speaker pro tempore: the gentlewoman is recognized for two minutes. ms. moore: thank you so much,

madam chair and thank the gentleman for yielding. i rise as the incoming co-chair of the congressional women's caucus to talk to you a little bit about the impact that repealing this health care law will have on women. as you all may be aware, women are twice as likely to be dependent upon their spouses for health care and they're less likely than men to have employer-sponsored insurance. as single female heads of household, this has a devastating impact on the entire family when there's no health insurance. all of us have heard stories from our dict about how the repeal of this law will have on women and i heard such a story just yesterday. meet nicole lipski, she's 25 years old, working part time and going to school part time

because because of the health care law was able to remain on her dad's insurance and lucky for her, because just last week, she had an infected pancreas and had to have her gallbladder removed in an emergency surgery which cost $13,000 that fortunately, was covered by her parents' insurance. you know this law outlaws gender rating, and insurance companies of course charge women higher premiums than men for coverage and it also has a disparate impact on women with respect to pre-existing conditions when you consider that being a victim of domestic violence is considered a pre-existing condition. now, you don't have to be a harvard economist to know that this law is not a job killer. but we do have a harvard economist to back us up. david cutler, professor of

applied economics at harvard, released a study on january 7, finding that repealing the health care law would destroy 250,000 -- can you yield 15 seconds? mr. mcgovern: i yield the gentlelady 15 seconds. ms. moore: would grow 250,000 jobs annuallymark of them are women's jobs, x-ray techs, nurses, and even the cleaning person wo who cleans up the emergency room. the speaker pro tempore: the gentlewoman's time has expired. the gentleman from california. mr. dreier: at thistime i'm happy to yield one minute to my good friend from north carolina, many mchenry. the speaker pro tempore: the gentleman is recognized for one minute. many mchenry: last night, house republicans took a major step in our pledge to america by passing a repeal of obamacare. now we must work to replace this

budget-busting law with sensible, market-placed policies that lower costs for families and small businesses and expand access to affordable care. small businesses are the job creators that hold the key to our economic recovery. they cannot afford the hundreds of billions of dollars in new taxes in the obamacare law and the new employer mandate as well. our small businesses need certainty in the tax code, certainty in regulations coming out of washington and obamacare only makes matters worse. i look forward to an open and transparent debate in this congress on alternative, affordable insurance. that's what the american people want and what my constituents desire. i would also challenge my friends on the other side of the aisle to listen to the american people and join our efforts to work toward better solutions to our nation's health care challenges. the speaker pro tempore: the gentleman's time has expired. the gentleman from massachusetts. mr. mcgovern: i yield one and a

half minutes to the gentlewoman from texas, ms. jackson lee. the speaker pro tempore: the gentlewoman is recognized for one and a half minutes. ms. jackson lee: thank you, madam speaker. thank you to my good friend from massachusetts for yielding. let me say the good news is that the only thing that occurred last evening was simply a vote because the law of the land is still the patient protection and affordable care act and i hope that the president's words are not twisted, because i agree with him, we are all willing to work together to do the right thing, which is to amend the bill. i don't understand the understanding of my friends on the other side of the aisle. repealing the law of the land has nothing to do with questioning the provisions. frankly they're not even listening to a distinguished doctor, senator fritz, the former majority leader who said this bill, our bill is the law of the land and it is a platform, the fundamental platform on which all future efforts to make that system better for the patients and families will be based.

what is there not to understand? amend the bill, don't repeal. senator fritz said if the bill was on the floor, he would have voted for it. i spoke to some students the other day and they asked about doctors. this bill had in it scholarships for medical professionals, the bill that we have. the issue of course is one that you cannot dispute. this bill saves lives. so much so that the republican majority leader ran to the media to promise seniors that they wouldn't lose the $250 that our bill, the patient protection bill, guaranteed them so that they would have some cushion for their prescription drugs. so my friend, i know we're doing the right thing. we're all willing to amend. but how ridiculous it is that you would repeal the law of the land or attempt to do so and i know the president still has his veto pen. this law will save lives. the speaker pro tempore: the gentlewoman's time has expired this egentleman from california. mr. dreier: i yield a minute and

a half to one of our new members from oklahoma city, mr. lankford. the speaker pro tempore: the gentleman is recognized for one and a half minutes. mr. lankford: thank you, madam speaker. thank you for yielding time. the repeated diatribe from members on the other side of the aisle that somehow they're the only individuals in the chamber that care about the health of the american family demonstrates again the deep-seated partisanship that we must defeat. we all want to help the american people. the people don't like obamacare but they want something to be done. we must have tort reform to reduce the cost of defensive medicine. we must deal with the f.d.a. approval process that covers any new discovery in paperwork costing a billion dollars to get it through the process. we must open up more options for insurance carriers, allowing someone frustrated with their service to fire them and get a new insurance provider. we must reject price fixing as a

cost-cutting solution. we must allow every american to choose their own doctor, even pay their doctor directly if they choose to do that. we must give senior americans more choices in physicians who accept medicare patients. we must provide states with greater flexibility and deal with portability, high risk and pre-existing conditions. republicans have friends and family dealing with the same medical issues the democrats deal. with suffering, disease, and pain have no respect fb political affiliation. we just believe that if you're sick and hurting, you should contact your doctor, not washington, d.c., to see what to do next. let's surprise america. let's work together and get something done. let's show them that even with the divided house and senate, we can reject the gravitational pull of hol picks and put aside our differences for the good of those most vulnerable. the speaker pro tempore: the gentleman's time has expired. the gentleman from massachusetts. mr. mcgovern: i want to respond to the gentleman who just spoke.

we hear distortions other and over again. we heard them during -- over and over again, we heard them during the campaign, that were perpetrated by our friends on the other side of the aisle and their friends in the insurance industry. that somehow what we passed was a bill that wouldn't allow you to keep your own health insurance. we passed a bill that provides competitions. i'd like to yield two minutes to the gentleman from minnesota, mr. ellison. the speaker pro tempore: the gentleman is recognized for two minutes. mr. ellison: madam speaker, repeal and replace? what about protect and improve. what about improving the bill that is there right now, rather than repealing and replacing? you know, the fact is, the republican caucus is talking about replacing a bill and yet whether it's pre-existing conditions or filling in the doughnut hole, i've heard several of them say, we want to keep that. yet they don't want to protect and approve -- and improve, they want to repeal.

why? to protect the insurance industry. i can't see any other reason why they're doing this. the affordable care act is a good bill. can it be bet her of course. but that's not what we're talking about today. we're talking about taking away benefits that americans have in their hand. the republican caucus is snatching away people who want to get their children on the health care insurance who are under 26 years old. -- years of age. snatching away. -- snatching away free preventive care for seniors, snatching out of the hands of families whose children are trying to be able to get care who may have pre-existing condition. snatching out oaf thnds half seniors filling in the doe -- out of the hands of seniors filling in the the doughnut hole. this is wrong and it's a shame. the fact is the democratic caucus, when we had the white house and the -- and both houses of congress, within two years, we brought to the american people a health care bill.

when the republican caucus had the house for six years, between 2000 and 2006, they don't do anything other than do a big fat giveaway to pharma. this is what we get. mr. dreier: will the gentleman yields on that point? would the gentleman yield? mr. ellison: i think i'm out of time. mr. dreier: will the gentleman yield. mr. ellison: i'm out of time. the speaker pro tempore: the gentleman from california. mr. dreier: i yield myself 15 seconds. the speaker pro tempore: the gentleman from california is recognized. mr. dreier: the gentleman's time did expire. i yield myself 15 seconds to say, as i said to my friend earlier, it's interesting that they continue to say we did nothing. associated health plans which democrats and republicans like, designed to drive down the cost for small businesses to provide health insurance, was submitted from this republican house to the other body, the democrats, in fact, killed that measure,

attempts were made to put into place real reform. with that, back by popular demand, the rules committee member from lawrenceville, georgia, for two minutes, mr. wood yawl. the speaker pro tempore: the gentleman is recognized for two minutes. mr. woodall: thank you for yielding, michigan. i return to the well because i wonder if folks have the same small business people in their district i have in my district? i wonder if folks are doing the same listening in their district i'm doing in my district? we are here today to respond to what folks have been asking for. to give credit where credit is due, last year, before the last congress expired, democrats and republicans came together to extend for one year, i would have like to see it extended longer, but to extend for one year the tax cuts our small business men and women were demanding. but the second part of the indecision there in the business community, the anxiety and

uncertainty that was there, is what's going to happen with the health care costs? what's going to happen with the health care plan? we have not solved that anxiety. we have not solved that indecision. because we've only gotten half of it done. we've gotten it passed in the house. but we've still got to take it to the senate and to the white house. in the spirit of giving credit where credit is due, i told folks throughout my campaign that i thought the president identified exactly the right two health care challenges. rising costs and access. then came up with exactly the wrong solutions to those problems. we talk about what's going to happen to folks when the doughnut hole change goes away. didn't we have a chance last year? i'm new to congress, did we have a chance in the last congress to vote on that stand-alone doughnut hole closure? i don't believe we did. did we have a chance to vote on the pre-existing condition solution?

i don't believe we did. did we have a chance in the last corning to talk about the kids up to 26 issue? i don't think we did. but now we have the opportunity to vote on this one by one. the only option congress had last time under democratic leadership to vote for a doughnut hole solution to vote for pre-existing condition solutions to vote for insurance for kids under the age to have 26 was to do it with the unconstitutional mandate a trillion dollars of new spending and hundreds of new bureaucracies. i yield back. the speaker pro tempore: the gentleman's time has expyred. the gentleman from midwest. -- from massachusetts. mr. mcgovern: i remind the gentleman, we could have had a chance to vote on those individually. he did have a chance to vote on whether or not we could vote on them on the floor but he and republicans voted each and every one of those protections down. they voted against protecting people against pre-existing conditions, they voted against people, putting people on the

doughnut hole. the speaker pro tempore: the gentleman's time has expyred. mr. mcgovern: they voted against everything. mr. dreier: would the gentleman yield. the speaker pro tempore: the gentleman's time had expired. mr. dreier: i yield 30 seconds to our rules committee colleague in the name of comity and civil discourse to respond. . mr. woodall: i would say to my friend i absolutely voted no on every single one of those amendments in the name of repealing the bill yesterday. and now today i have returned to speak in favor of this resolution so that you can work with the committee leadership to bring each and every one of those provisions to this floor for a vote again for the very first time. for the very first time. i'm glad to support you in having that opportunity and i'm pleased to be here to support this resolution. the speaker pro tempore: the chair must ask members to bear in mind the principle that proper courtesy in the process of yielding and reclaiming time in debate and especially in asking another to yield must

foster the spirit of the comity that elevates our deliberations over and above mere argument. with that the gentleman from massachusetts is recognized. mr. mcgovern: i yield -- i reserve the balance of my time. the speaker pro tempore: the gentleman reserves the balance of his time. the gentleman from california. mr. dreier: may i inquire of my friend if he has further speakers? mr. mcgovern: i'm the final speaker. mr. dreier: madam speaker, with that i reserve the balance of my time. the speaker pro tempore: the gentleman reserves the balance of his time. mr. mcgovern: may i inquire how much time i have left? the speaker pro tempore: the gentleman from massachusetts has four minutes remaining. mr. mcgovern: madam speaker, i want to -- i have one additional speaker. the gentleman from virginia, mr. moran, would like to be able to speak for 30 seconds. mr. dreier: the gentleman told me he was the closing speaker. and now he has one additional speaker? mr. mcgovern: i was misinformed. the speaker pro tempore: the

gentleman from virginia is recognized for 30 seconds. mr. moran: i appreciate the lenience of the chair of the rules committee. thank my very good friend from massachusetts. what troubles me with this debate, and i would have particularly address myself to my colleagues on the other side of the aisle, is that we took two votes yesterday. one was to provide coverage for ourselves, the next, really, to deny it to our constituents. that i find troubling because we all have the right for guaranteed coverage regardless of pre-existing conditions. we have a choice of easy to compare health insurance plans. we have coverage for early retirees. women have equal premium coverage. we have access to affordable care, low cost preventive service. all these things. the speaker pro tempore: the gentleman's time has expired. mr. mrian: voted to deny it to our constituents. thank you. the speaker pro tempore: the gentleman from california. mr. mcgovern: thank you, madam speaker. the speaker pro tempore: does

the gentleman from california seek recognition? mr. dreier: i don't seek recognition. i continue to reserve the balance of my time. the speaker pro tempore: the gentleman reserves the balance of his time. the gentleman from massachusetts. mr. mcgovern: i yield myself the remaining time, madam speaker. the speaker pro tempore: gnat is recognized for 3 1/2 minutes. -- the gentleman is recognized for 3 1/2 minutes. mr. mcgovern: this is not a serious legislative effort. it's a series of sound bites that mean nothing. committees don't have to do anything. speaker boehner is quoted in the hill basically saying he's not going to hold any of these committees accountable. they can do it if they want to, whatever, if they don't, so be it. what we are dealing with here today is kind of a political ploy. not a serious legislative effort to replace anything. my friends on the other side of the aisle have got up over and over again said we are really with you on pre-existing conditions, on the doughnut hole, allowing parents to keep their kids on their insurance until 26. yet they are really not.

because if they were they wouldn't have voted yesterday to repeal all those protections. and if they were really with us, we would be talking about today coming to the house floor with a series of initiatives that would actually continue to protect those benefits for consumers. but they voted to repeal all of that. i want to know how could anybody in this house, how can anybody in light of the protections that have been put in place, go back to an individual who has been -- who is now able to get health insurance because we prohibited insurance companies from discriminating against them for pre-existing conditions, how can you go to them and say we are going to change our mind, we are not going to do that anymore? how do you go to senior citizens who are struggling with that doughnut hole and we have begun to close it, how do you begin to say we are going to raise your taxes? how do you do that? how do you go to a parent whose child can remain on the health

insurance because we have extended it to allow them to stay their until they are 22 to say that doesn't matter anymore? it doesn't make sense. that's not what people voted for. they didn't vote for you to repeal all those things. what they voted against was this distortion of a health care bill that you put out there, my friends on the other side of the aisle, that was very well funded by the most expensive advertising campaign funded by the insurance company in the history of our country. this distortion out there. everybody was against that distortion. that is not the reality. and as the months have gone by and the reality has become clear to people, as they have seen the benefits and protections, as people have been able to wrest control of their health care from the insurance industry, as consumers realize they have more and more rights, there are more and more protections built into the law to protect people of all ages, people say we don't want you to change that. we want that to be saved. i'll just say one thing, when my friends say we can do a

little bit of this and little bit of that, you can't. because it's like a domino effect. everything has an impact. so this is a serious debate. and there's indignation on this side of the aisle it is because we no that this is a big deal and real people have -- who have real challenges affording their health care and dealing with the complexities of a health care system and the inequities of the health care system are getting some relief and they will be hurt by what you are doing. so let's be honest here. what happened yesterday was my friends on the other side of the aisle went on record as saying we are against everything. today they were -- we are going to pass a resolution, i guess, that doesn't do anything, doesn't even require committees to do anything, but just says we are for all these nice feel good sound bites. that's not a serious legislative effort. that's why people are cynical. we can do better. i urge my colleagues to vote no on this. the speaker pro tempore: the gentleman's time has expired. the gentleman from california. mr. dreier: madam speaker,

there was a very powerful and resounding message that came last november 2 and that is the imperative for us to create jobs and get this economy growing. the american people are hurting. in my state of california we have a 12 1/2 percent unemployment rate, part of the area i represent has a 15.5% unemployment rate in the inland empire in southern california. it is essential that we focus our attention on creating jobs. and i believe, i believe that the step that we are taking today is going to be very, very important as we pursue that goal. why is that? when we look at what passed last year, was signed last march 23 by the president, it was a measure that imposes mandates on small businesses.

jeopardizing their ability to hire new workers. it's a measure that imposes dictates on doctors, on doctors, a regulatory structure which undermines their potential to hire new employees. it is a measure which in many ways jeopardizes our potential to grow the economy because it is a dramatic expansion of the entitlement programs which democrats and republicans alike say need to be addressed if we are going to create jobs and get our economy back on track. one of the things that i think is important to note is that people have said that repeal of the health care bill in fact is going to cost $230 billion based on those c.b.o. numbers that came out. only in washington, d.c., can

one cut a $2.7 trillion expenditure and have it labeled as a cost. as a cost. why is it a cost? it's a cost because the measure that was signed last march 23 imposes a /4 of a trillion dollar -- 3/4 of a trillion dollar tax increase on working americans. now, what does that do to create jobs and get our economy growing? obviously it undermines, it undermines our shared priority of creating jobs and getting our economy back on track. we know that with the $14 trillion national debt that we have and deficits down the road, we need to do what we can to rein in that spending, tackling entitlements, and dealing with issues like the one that we are facing today. now, having said that we all know that democrats and

republicans alike want to ensure that every single american has access to quality, affordable health insurance so that they can have access to quality health care. and i underscore the word quality because if one looks at the important research and development that takes place in the united states of america, i believe that the measure that was signed last march 23 and that we voted in this house to repeal yesterday, that that measure undermines the very important pursuit of research and development to deal with many of the diseases that are out there. so, madam speaker, i've got to say that we all say that we want every american to have access to quality, affordable health care, and everyone has acknowledged that that bill that was signed march 23 is flawed. in his news conference right after the election the president of the united states said he believed we need to address the so-called 1099

provisions that impose, again, and onerous mandate on small businesses. undermining their ability to create jobs. exactly what i was saying earlier. i quoted the distinguished assistant minority leader, the former majority whip, mr. clyburn, who on a program earlier this week said republicans and democrats need to work together to rectify some of the problems that exist with this measure. and as i said, it was two days ago that the president of the united states wrote his editorial in which he talked about in the "wall street journal" the need to reduce the regulatory burden that is imposed on the private sector so that we can get our economy going and create jobs and he also said on that same day that he is willing and eager, madam speaker, willing and eager to work with republicans to rectify some of the problems that exist in this measure. now, i heard my friend, mr. matheson, this morning on national public radio state

that there was not a plan out there, and that's the reason having voted against the bill he did not vote for repeal because there is not a plan out there. i heard that at 7:35 this morning on wamu. and mr. matheson made that statement but the fact of the matter is, unlike the plan that was signed into law march 23 of last year, that did not include the kind of bipartisan participation that we believe is essential, i've got to say that we are planning to proceed with this direction to the four committees that will allow virtually every member of this house to be involved. we have 12 items and i'm happy to say that under this rule we have made in order, mr. matheson's amendment that we'll be considering in just a few minutes, that will add a 13th item to deal with the so-called doc fix. so that again underscores our desire to work in a bipartisan way to address some of the

concerns that are there. what is it that we say needs to be done? and frankly the president of the united states has indicated some of these he supports. we need to make sure that people do have a chance to purchase insurance across state lines which is now denied. we need to make sure that we have put into place associated health plans. a provision that passed a republican house but was killed by democrats in the senate when we lats were in the majority. we need to do everything that we can to allow for pooling to deal with pre-existing conditions. we need to make sure that we expand medical savings accounts that provide incentives for people to put dollars aside to plan for their health care needs. and one of the things that the president of the united states said in his state of the union message one year ago right here in this chamber, we need to deal with meaningful lawsuit abuse reform so that we can have atension focused on

patients and doctors and not on trial lawyers. so i would say to my friend from utah, those are five items that are part ever our plan that i believe can enjoy strong bipartisan support. so, madam speaker, i urge my colleagues to support h.res. 9 so that we can proceed with a bipartisan consideration of this very important goal that we share of creating jobs, getting our economy back on track, and ensuring that every single american has access to quality, afford and health insurance. with that i yield back the balance of my time. the speaker pro tempore: the gentleman yields back. all time for debate has expired. for what purpose -- for what purpose does the gentleman from utah seek recognition? mr. matheson: i have an amendment at the desk. the speaker pro tempore: the clerk will designate the amendment. the clerk: amendment printed in part b of house report number 112-2 offered by mr. matheson of utah. the speaker pro tempore: pursuant to house resolution 26, the gentleman from utah,

mr. matheson, and a member opposed each will control five minutes. the chair recognizes the gentleman from utah. mr. matheson: thank you, madam speaker. i yield myself such time as i may consume. the speaker pro tempore: the gentleman is recognized. mr. matheson: i rise today to offer an amendment to h. resolution 9. i did not support repeal legislation but i do believe there are bipartisan improvements that could be made to the existing law. and i think now is the time for all of us in congress to roll up our sleeves and work together. the goal of this amendment is pretty straightforward. it is set up to maintain adequate health care service to stabilize the business practice of doctors and to take into account the long-term economic health of this country. we all agree that the doctor-patient relationship's a fundamental part of quality health care, but we have found that we have a flawed formula when it comes to setting reimbursement levels and every year threatens the ability of doctors toer care for patients and threatens the ability of patients to see their doctors.

. members on both sides of the aisle, stake holders throughout the health care community, citizens, have all recognized we have a flawed policy. how many times have we come together to provide a temp care -- temporary patch to this problem without fixing the underlying problem. in 2010 alone, congress took five different votes to delay a scheduled cut without stepping up and dealing with a permanent fix to the problem. by an overwhelming vote a few weeks ago, congress supported a one-year delay to a looming 25% cut in physician payments. my amendment is very straightforward and clear. it adds an additional instruction to the committees of jurisdiction over health care legislation to replace the flawed sustainable growth rate formula used to set medicare parmentes -- payments for doctors and instructs congress

to find a permanent fix. it's the right thing to do on behalf of physicians as we look to make health care more sustainable and predictable and as we begin the yearing looging at this extremely complex yet highly personal issue, i think that adopting this amendment would be a good step to move in that direction. i ask my colleagues to support this amendment in a bipartisan way. i'll reserve the balance of my time. the speaker pro tempore: the gentleman reserves the balance of his time. for what purpose does the gentleman from california rise? mr. dreier: i'd like to claim the time in opposition to the amendment. the speaker pro tempore: the gentleman is recognized. mr. dreier: i claim time in opposition to say i support the amendment, madam speaker. i believe that as you look at the list of 12 items that we have in h.res. 9, they are not to be limited at all. i think that by virtue of our making the matheson amendment in order to deal we the so-called doc fix issue, we have made it

clear we are already beginning at this juncture to work in a bipartisan way in our quest to create jobs, get our economy back on track and ensure that every single american has access to quality, affordable health care. so this is again the beginning of a very important process. and i'm very pleased that mr. matheson has been able to play a role in fashioning h.res. 9 and i hope very much that with the president of the united states saying that he is willing and eager to work with republicans, to rectify the problems that exist with the past health care bill and the fact that mr. clyburn, the assistant minority leader said he wants to work in a bipartisan way to deal with these issues, will lead to strong, bipartisan support for mr. matheson's amendment and for the underlying resolution. with that, i yield back the balance of my time. the speaker pro tempore: the gentleman yields back. the gentleman from utah.

mr. matheson: i yield one minute to my colleague from new jersey, mr. pallone. the speaker pro tempore: the gentleman is recognized for one minute. mr. pallone: thank you, madam speaker. i rise in support of mr. matheson's amendment. i do want to point out, though, that the democrats, when we were in the majority, many times tried to pass a permanent fix and did not receive support, i believe, from many republicans, except i believe we did have dr. burgess' of texas, his support. we passed a permanent fix, the doctors fix but because we could not get any real republican support, we had to continue to rely on short-term fixes. we did, however, as you know, at the end of the last session, pass a one-year fix which is in effect now. i do think this is a commendable response that mr. matheson has

and i certainly intend to support it, but the difficulty is, that the many years when the republicans were in the majority, they had the opportunity to pass a permanent fix and to deal with this issue and they always kicked the can down the road and did not cooperate with us on a bipartisan basis when we were in the majority to try to achieve a permanent fix. i certainly intend to work with the republicans to do that, but they are the reason we don't have it now. the speaker pro tempore: the gentleman's time has expired. mr. dreier: the gentleman from california. i was mistakenly under the impression that the gentleman had exhausted his five minutes. i'd like to reclaim the remaining time i have. the speaker pro tempore: is there objection? mr. dreier: i reserve the balance of my time. mr. mathston: i have no further speakers, i ask for the support of my colleagues, i yield back my time. the speaker pro tempore: the gentleman from california. mr. dreier: as we know, i have claimed time in opposition to the amendment but i will state

once again, i am supportive of the matheson amendment. i urge my colleagues, democrats and republicans alike, to come together and vote for adding what will be item number 13, which will be the beginning of wide-ranging reform to ensure that every single american has access to quality health insurance so we can, again, get our economy back on track and focus on job creation and growth and with that, i again urge >> house members and then approved the matheson amendment and past the underlying bill directing committees to come up with new health care proposals. >> this new law is a fiscal house of cards carrot >> has any family in america, any single mother, annie's house, any child, any grandparent met a

more bureaucratic system and the american health insurance system? >> watch this week's health care debate from the house floor any time on line with c-span's congressional chronicle. see what your representative said, track timelines, and read transcripts. congressional chronicle at c- span.org/congress. >> in a few moments, a hearing on medical malpractice liability. in two hours, house leaders on next week's agenda that includes proposed cuts in federal spending. after that, a discussion on the agenda of the house oversight and reform committee. later, we will uigher today's house debate on the future of health care legislation -- we will reair today's house debate on the future of health care legislation. house democrats are meeting in cambridge maryland. we will have their news conference at 11:30 a.m.

eastern. shortly after that it 12:15 p.m. eastern, more from the annual conference of mayors. we will hear from shaun donovan and the trade representative. >> i have to practice staying alive and preparing to die at the same time. >> sunday, our guest is a "vanity fair" columnist christopher has since. >> it is a tantalizing time to have cancer. but because there are treatments i can see that are just out of reach, which is both encouraging and annoying. >> sunday on c-span's "q&a". >> madam speaker, the president of the united states. >> by congressional invitation, the president outlines his agenda for the next year and reflects on the previous in the annual state of the union. watch every address since 1984

online at this season and a video library. all searchable on your computer any time. >> now a house judiciary committee hearing on the relationship between medical malpractice liability and health care costs. this is a little more than two hours. [captioning performed by national captioning institute] [captions copyright national cable satellite corp. 2011] >> the do-sure the committee will come to order. it is nice to see -- the judiciary committee will come to order. one quick announcement as most members know but not everybody else may know is that we are expecting votes and about 15 minutes. however, we are having to votes, so we will be taking a recess

for 20 minutes and we will return to resume the hearing. i will recognize an opening statement for myself and then turned to the ranking member for his opening statement. the purpose of this hearing is to discuss the need to reduce the waste in our health care system caused by defensive medicine. system caused by defensive medicine. this practice occurs when doctors are forced by the threat of lawsuits to conduct tests and prescribe drugs that are not medically required. according to a harvard university research study, 40% of medical malpractice lawsuits filed in the united states lack evidence of medical error or any actual patient injury. but because there are so many lawsuits, doctors are forced to conduct medical tests simply to avoid a possible lawsuit. taxpayers pay for this wasteful defensive medicine which adds to all our health care costs without improving the quality of patient care. a survey released last year

found defensive medicine is practiced by nearly all physicians. president obama himself acknowledged the harm caused by defensive medicine stating "i want to work to scale back the excessive defensive medicine that reinforces our current system and shift to a system where we are providing better care simply rather than simply more treatment." yet the health care legislation he signed does nothing to prevent defensive medicine. in fact, it makes matters worse by allowing trial lawyers to opt out of any alternatives to health care litigation proposed by the states. by exposing doctors to even more lawsuits if they fall short of any of the many new federal guidelines the law creates. the encouragement of lawsuit abuse will not only make medical care much more expensive, it will also drive more doctors out of business.

t the judiciary committee will model california health care reforms. those reforms have a proven record of reducing medicine, reducing health care cost and increasing the supply of doctors. there is a clear need for reform at the federal level. many states supreme courts have nullified reasonable litigation management provisions enacted by state lennel slate tgislaturleg. that may be the only means of addressing the state's current crisis in medical professional liability and restoring patient's access to quality health care. we need to stem the flow of doctors from one state to the other as they flee states to avoid excessive liability costs. doctors should feel free to practice medicine wherever they want and patients should be able to obtain the medical care they need. last year, the congressional

bulgt office determined the package would reduce the budget deficit by an estimated $54 billion over the next ten years. that was a conservative estimate. another cbo report estimate that is premiums for medical malpractice insurance would be an average of 25% to 30% blow what they would be under current law. rising litigation awards are responsibility for skyrocketing medical professional liability premiums. this report state that is the gao found losses on medical malpractice claims which make up the largest part of insurer's cost appear to be the primary driver of rate increases in the long run. the gao also concluded that insurer profits "are not increasing indicating that insurers are not charging and profiting from excessively high premium rates." the national commission on fiscal responsibility and reform which was created by president

obama also supports health care litigation reform in his 2010 report. "many members of the commission also believe that we should impose statutory caps on punitive and noneconomic damages and we recommend that congress consider this approach and evaluate its impact." as a usa today editorial concluded one glaring omission from the health care law was the significant tort reform which was opposed by trial lawyers. i look forward to hearing from our witnesses today who will help us access the extent of the current health care litigation costs. i'm now pleased to welcome the remarks of the ranking member, congressman john calliers. >> thank you, chairman smith and members. this is our first hearing in the 112th session, and i would like

to just add for your consideration my recommendation s that we review, in connection with health care, the antitrust exemption that health insurance companies enjoy. mccarron ferguson exemption, and the sunshine litigation act that ensures and prevents secret settlements from being used to endanger the public safety are sealed, those who may be guilty of fraudulent acts, including the medical community, that in turn would protect all patients and protect professionally responsible doctors from abuse

of claims of wrongdoing. and then you remember the act that me and a former member, campbell, introduced that empowers doctors to negotiate and even playing field with health insurers. so i'd like us to kindly consider those measures that might be more important in an oversight hearing on a subject matter that members of congress have already announced that they're going to introduce, namely hr 5, which i expect will be coming down the pike one day next week.

the letters are already circulating on it, and so i find an oversight hearing on a -- for a bill that's being written to be the subject will come straight to our committee. it isn't exactly reverse, but there's a certain irony in the way this is coming off today. i just wanted to put it in the record. now, legislative hearings should be held prior to the oversight hearings. but also i hope that we can get into the issue of the shortage

of doctors in rural areas, which is critical and which many of us view would be increased by a cap on medical liability. this $250,000 cap, most of our witnesses here today realize that that may have a perverse effect but it's all over with. now, about the large number of cases file d, one out of every eight cases filed that ever results in a lawsuit, and that's

because, with the statute of limitations, attorneys have to include in the filings, many people who are -- may not be involved and are usually excluded from any trial liability, but they get counted as the ones that are sued. so i'm looking forward to a discussion about that. now, we have states that constitutionally preclude any limitation on medicare damages. kentucky and iowa limit the damages. dr. hoven is from kentucky. dr. weinstein is from iowa.

kentucky is one of the four states that constitutionally prohibit limits on damages, but there are other states, arizona, pennsylvania, wyoming, including the trauma center that provided such excellent care to our colleague, gabby giffords, are all, i think under some danger presented by some of the trends that we're expecting in hr-5. i think it's something we ought to consider. i close with just a comment about the real costs of medical malpractice claims. there are only a fraction of the real costs, and i end on this note. the sixth largest cause of death

in the united states of america medically are malpractice cases. so i hope that as this discussion rolls out this morning, we will be considering what we do with the hundreds of thousands of people that could be adversely affected whose live time costs, even though they're innocent and the case is supported by the court and judgments are entered but with a $250,000 cap, as many of us know on all the hearings we have had prior to now, that this would be very minimal indeed. i thank you for the time. >> i thank the ranking member

for his comments. we're now going to take a short recess so members may vote. when we return, i will recognize the chairman and ranking member of the constitutional law sub committees for their opening statements. they have jurisdic the committee will resume our hearing and i'll now

to the ranking member of the constitutional law subcommittee. >> well, thank you, mr. chairman. mr. chairman, the medical liability litigation system in the unit states, think, by all accounts is broken and in desperate need of reform. the current system is as ineffective a mechanism for adjudicating medical liability claims as it can be, which leads to increased health care costs, unfair and unequal awards for victims of medical malpractice and recuduced access to health care for all americans. unfortunately the massive health care overhaul that president obama signed into law last year did not meaningfully address medical liability reform. thus we are here today to examine this continuing problem and evaluate national solutions

to this, what i believe to be a crisis. one of the largest drivers of this crisis is the practice of defensive medicine. defensive medicine leads doctors to order unnecessary tests and procedures, not, mr. chairman, to ensure the health of the patient, but out of fear of malpractice liability. the cost of defensive medicine is indeed staggering. according to a 2003 department of health and human services report, the cost of defensive medicine is estimated to be more than $70 billion annually. additionally, medical liability litigation increases the cost of health care by escalating medical liability insurance premiums. this, in turn, leads to higher costs throughout the entir health care system and reduces access to medical services. however, mr. chairman, despite the increased costs medical liability litigation imposes, this litigation fails to accomplish its ostensible

purpose, tort law first place, that is fairly compensating the victims and deterring future negligence. the system fails to compensate victims fairly for several reasons. first, according to the studies, the vast majority of incidents of medical negligence do not result in a claim and most medical practice claims exhibit no evidence of malpractice. so, victims of malprtice or most of them uncompensated and most of those who are compensated are not truly victims. mr. chairman, medical mal practice awards vary greatly from case to case, even where the claims and injuries are virtually identical. finally, attorneys regularly reduce damages awarded to victims by more than 40% through fees and costs. moreover, there appears to be little evidence to suggest the current medical liability system deterz neggence, but the

available evidence seem oz to suggest the threat of litigation causes doctors not to reveal medical errors and to practice defensive medicine. and this, of course, subjects patients to unnecessary tests and treatments once gain. so we must reform the medical liability system in the united states, mr. chairman. among other benefits reform could do some of the following, could lead to a significant savings on health care. it could reduce the practice of defensive medicine. halt the exodus of doctors from high litigation states and medical specialties, improve access to health care, and save the american taxpayers billions of dollars annually while increasing the affordability of health insurance. mr. chairman, meaningful medical liability reforms have worked in states such as california and texas and it is time for action at the federal level to extend the benefits of reform to all americans. and i thank you for the time and yield back. >> thank you, mr. franks. the gentleman from new york, mr. nadler, the ranking member of

constitutional law subcommittee is recognized for his opening statement. >> thank you, mr. chairman. mr. chairman, i've not prepared an opening statement because i didn't know we were going to have opening statements for rankings and the chairman of the subcommittees, but i'll make an opening statement nonetheless. i have always believed that this problem is the wrong problem and it is a solution in search of a problem. if you look at the evidence over many years and i've looked at the evidence since 1986 consideration of reforms to this problem in theew york state assembly when i was a member there, i've been involved with this off and on for 25 years, you find that the real problem is not the excessive costs of malpractice or that -- the excessive costs of malpractice insurance is not caused by lack of the so-called tort reforms that are being advanced here and that have been advanced over the years, namely making it harder to get attorneys capping fees or capping recoveries. but these recoveries -- capping the recoveries would simply be

unfair to people who are very seriously injured. first of all, we know that most people who suffer real damages as a result of medical negligence never sue. so the amount of recovery is very small compared to the amount of costs. secondly, study after study has found that the real problem is that the states, some people might say the federal government should do it, but that's a separate discussion, but the states in any event whose job it is under current law are not disciplining doctors that something like 90 or 95% of th claims dollars that are awarded come from 2% or 3% of the doctors. those 2% or 3% of the doctors are hurting patients, killing patients and should not be practicing medicine. they should be stripped out of practice and if they did, everyby else's malpractice premiums would go down because the amount of costs would go way down and the other 97% or 98% of doctors would find the

malpractice premiums much reduced. now what do we find from the kinds of proposals that we consider? number one, in may 2009, wellpoint, a major malpractice insurance, said liability was not driving up health insurance premiums. the -- an economist at harvard university, in an article malpractice lawsuits are a red herring published by bloomberg in june of last year concluded that medical malpractice dollars are red herrings. there is so many other sources of inefficiency. we know that preventable medical errors kill as many as 98,000 americans each year at a cost of $29 billion. and this -- these proposs would do nothing about that. we're told that the densive medicine is costing us huge amounts of money and incleesing the cost of the medical system as a whole.

the gao, the government accountability office, issued a statement saying the overall prevalence in cost of defensive medicine have not been reliably measured so we don't really know. studies designed to asure physicians defensive medicine practices examined physician behavior and specific clinical situations such as treating elderly medicare patients with certain heart conditions. given their limited scope, the study's results cannot be generalized across the health care system. multiple gao studies concluded eliminating defensive medicine uld have a minimal effect on reducing overall health care costs. but the proposals that i assume will have before us, the proposals introduced by the colleague on the other side of the aisle every single year, all have in common putting a $250,000 or so-called -- limit on noneconomic damages, that is to say on damages other than direct medical costs and los wages, which may be the main

damages for someone whose wages you can't measure, lik a college student or a child because you don't know what his wages are going to be or would have been. $250,000 is not very much. they felt that $250,000 was a reasonable amount then. in today's dollars, or rather in 1975 dollars, that's worth $62,000. would they have enacted a $26,000 cap in 1975? and if we wanted to take the 250 and inflate it to keep it at the same value, it would be over a million dollars today. so if we're going to be -- if we're going to pass this kind legislation, which i hope we won't, at the least we should put in an inflation factor and start at a million dollars if we want to duplicate wh micra did in california. they did not prerhee dureduce ts at all. only after insurance reform was enacted in 1988 by california did the insurance premiums level off and actually go down a bit.

but for the 13 years, the perfect experiment for the 13 years, which california had the tort reform, but not the insurance reform, the premiums went up 450%. when the insurance refo was enacted, premiums went down 8%. so maybe we should be talking about insurance reform instead of tort reform, but unfortunately that's not in front of this committee. so i think we're off on the wrong track if we're concentrating on this. and i see the red light is on. i apologize for exceeding my time. i yield back whatever time i don't have left. >> thank you, mr. nadler. with that objection, other members opening statements will be made part of the record and now i'll introduce our witnesses. our first witness is dr. ardis hoven, chair of the american medical association board of trustees. prior to her election to the board, dr. hoven served as a member and share of the ama council on medical service. she was a member of the utilization review and accreditation commission for six years and served on its executive committee. most recently she was appointed to the national advisory council

for health care, search and quality. we welcome you. our second witness is joanne doroshow, executive director of the center for justice and democracy. miss doroshow is the founder for the center of democracy and americans for insurance reform. she is an attorney who worked on issues regarding health car lawsuits, since 1986 when she directed an insurance industry and liability project for ralph nader. welcome to you. our third witness is dr. stuart weinstein, a physician spokesman for the health coalitionon liability and access. dr. weinstein is a professor of orthopedic surgery and professor of pediatrics at the university of iowa. he is a former chair of doctors for medical liability reform and we welcome you as well. just a reminder, each of the witnesses' testimonies have been -- or will be made part of the record. we do wa you to limit your testimony to five minutes. and there is a light on the

table that will indicate by its yellow light when you have one minute left and then the red light will come on when the five minutes is up. so we look forward to your testimony and we'll begin with dr. hon. >> thank you, and good morning. chairman smith, ranking member conyers and members of the committee on the judiciary, as stated, i am dr. ardis hoven, chair of the american medical association board of trustees and a practicing internal medicine physician and infectious disease specialist in lexington, kentucky. on behalf of the ama, thank you for holding this hearing today to talk about this very important issue. this morning i will share with you results from ama studies that prove how costly and how often unir our medical liability system is to patients and physicians. most importantly i will talk about a solution. that solution is a package of medical liability reforms based on reforms that have already been proven effective in states like california, texas, and

michigan. our current medical liability system has become an increasingly irrational system driven by time consuming litigation and open ended noneconomic damage awards that bring instability to the liability insurance market. it is also an extremely inefficient mechanism for compensating patients harmed negligence where cost courts and attorney fees oftenonsume a substantial amount of any compensation awarded to patients. let me share with you some of the alarming statistics from an august 2010 ama report that shows how lawsuit driven our system has become. nearly 61% of physicians aged 55 and older have been sued. before they reach the age of 40, more than 50% of obstetricians, gynecologists have already been sued and 64% of medical liability claims that closed in 2009 were dropped or dismissed.

these claims are clearly not cost free and let's also not forget the emotional toll on physicians and their patients involved in drawn out lawsuits which is hard to quantify. out of fear of being sued, physicians and other health care providers may take extra precautionary measures known as the practice of defensive medicine. a 2003 department of health and human services report estimated the cost of the practice of defensive medicine to be between 70 and $126 billion per year. every dollar that goes toward medical ability costs is a dollar that does not go to patients who need care, nor toward investment in physician practices, a majority of which are all sinesses that create jobs that benefit local and state economies. the good news is there are pren examples of long-term reforms that have kept physicians liability premiums stable, but more importantly

have ensured and protected patients' access to health care. back in 1974, california was experiencing many of the problems we are facing today. in response, california's legislature enacted a competencive package ofreforms called the medical injury compensation reform act of 1975, over 35 years ago, which is now commonly referred to as micra. while total medical liability premiumsnd the rest of the u.s. rose 945% between 1976 and 2009, the increase in california premiums was less than one third of that, at just about 261%. recent publicpolls found a majority of americans support reasonable limits on noneconomic damages, and believe that medical liabily lawsuits are a primary reason for rising health care costs. we look forward to the introduction of the health act that mirrors california's

reformand also protects current and future medical liability reforms at the state level. by supporting patient safety initiatives along side enacting meaningful liability reform, congress has the opportunity to provide access to medical services, reduce the practice of defensive medicine, improve the patient physician relationship, support physician practices and the jobs they create, and curb a wasteful use of precious health care dollars, the costs both financial and emotional of health care liability litigation. on behalf of the ama, i would like to extend our appreciation for the leadership of the committee and the ama looks forward to working with you all to pass federal legislation that would bring about meaningful reforms. and thank you. >> and dr. hoven, thank you. and miss doroshow. >> thank you, mr. chairman.

mr. conyers, members of the committee, the center for juste and democracy of which i am executive director is a national public interest organization that is dedicated to educating the public about the importance of the civil justice system. this is the fourth time i've been asked to testify before a congressional committee in the last nine years on this very important subject of medical malpractice and i'm honored to do so. i also spoke at two different informal hearings chaired by mr. conyers which featured families including children from all over the country whose lives were devastated as a result of medical negligence. one of those hearings lasted four hours as victim after victim told their stories and pleaded with congress not to cap damages and enact tort eform. they're all paying rapt attention today from afar and i will do my best to represent them, but i do hope this committee decides to hear from them direcy because these families are always the forgotten faces of the debate about how to reduce health care and insurance costs. while i understand this is an oversight hearing and we do not

know what bills may b considered by the committee, typically the push has been for caps on economic damages and other measures that force patients who are injured by medical negligence or the families of those killed to accept inadequate compensation. meanwhile, the insance industry gets a pocket money that should be available for the sick and injured and they force many to turn elsewhere, including medicaid, for further burdening taxpayers. and by the way, with regard to the california situatio rates did not come down in california for doctors until 1988, when insurance regulatory reform was passed. it was not due t the cap. these measures will reduce the financial incentive for hospitals to operate safely which will lead to more costly errors. in fact, when congressional budget office looked into it, they looked at several studies that looked at the negative health outcomes of tort reform and one of them found -- would lead to a .2% increase in mortality in the overall death rate in this country. that's another 4,000 killed.

now while i cover many issues in my written statement, i want to highlight a few other points. first of all, there is an epidemic of medical malpractice in this country. it has been over a decade since the institute of medicine study finding 98,000 dieing in hospitals every year, costing 17 to $29 billion and experts agree there has been no meaningful reduction in medical airers in the united states. in fact, in november, just last november, hhs reported that one in seven hospital patients experienced a medical error, 44% are preventable. second, medical mlpractice claims and lawsts are in steep decline according to the national center for state courts and the insurance industry's own data. to quote from the harvard school of public health study that the chairman mentioned, portraits of a medical malpractice system that is stricken with frivolous litigation is overblown and only a tiny percentage of victims

ever sue. this is the press release issuing that study that said study casts doubt on claims that the medical malpractice system is plagued by frivolous lawsuits. premiums have been stable and dropping since 2006 and if you read the industry trade publications, you'll find out that insurers so overprice policies in the early part of the last decade that they still have too much money in reserves and that rates will continue to fall. and this has happened whether or not a state has enacted tort reform. as far as texas, health care costs did not come down when caps passed at all. applations for new licenses are only part of the picture. when it comes to physicians engaged in patient care, in other words, considering physicians who retire, lee state or stop seeing patients, the data shows that the per capita number has not grown. in fact, the number grew steadily through 2003 and leveled off. this is not a pattern you would expect of 2003 tort reform law

is responsible. when competing for physicians, texas is more hampered by the extraordinary size of its uninsured population, which exceeds just aut every other state. in terms of defensive medicine, cbo found that it was not pervasive. .3% from slightly less utilization of health care services, but even this is too hi. we what we don't -- what cbo did not consider, for example, are what happens -- the burdens on medicaid, when there are no lawsuits, or the fact that medicare and medicaid liens and subrogation interests. if a lawsuit isn't brought, they can't be reimbursed. all the costs need to be added in. finally, these bills all ignore the insurance industry's major role in the pricing of medical malpractice insurance premiums, an industry that is exempt from antitrust laws. this needs to be repealed. we need to do more to weed out the small number of doctors

responsible for most malpractice and reduce claims, injuries and deaths and lawsuits. thank you, mr. chairman. >> thank you, miss doroshow. dr. weinstein. dr. weinstein, if you'll push the button on the mike, we can't quite hear you. there, thank you. >> thank you, chairman smith and ranking member conyers for holding this important hearing to consider fixing our country's broken medical liability system. i'm stuart weinstein, the ponseti chair and professor of orthopedic surgery and professor of pediatrics at the university of iowa. i've been practicing for more than 35 year and the past present of the american academy of surgeons. i would like to begin today by asking each of you to put yourself in someone el's shoes. imagine your young pregnant mother living in rural america with no practitioner or your local hospital is closed its door to obstetrics or imagine

your young doctor saddled with debt trying to pick a specialty. despite the great need for obgyns and general surgeons, you choose a safer specialty because of risk of lawsuits. and imagine being an orthopedic surgeon but you're facing high costs for liability insurance and the threat of potential litigation. to reduce your liability, you decide to avoid high risk cases like trauma cases or maybe you decide to retire altogether. dilemmas like ese play out across america every day as medical lawsuit abuse undermines both our health care system and the doctor/patient relationship. moreover, medical lawsuit abuse is driving up health care costs at a time when we're still reeling from one of the worst recessions in modern times. i'm here today to ask youo create a climate for patient centered care by reforming the medical liability system that continues to put eryone's health care at risk. the current system is clearly broken and there is widespread agreement among lawmakers, health care policy experts, opinion leader and the public

that reform is needed. today more than 90% of obgyns have been sued at least once. neurosurgeons, once every two years on the average. and as you know, most claims are without merit. this toxic litigation environment is fundamentally changing thedoctor/patient relationship. it is driving doctors to get out of medicine or to practice defensive medicine. defensive medicine is the antithesis of health care reform because it increases health care costs and has the potential to less access tocare and quality of care in two ways. first, doctors practice avoid assurance behavior including ordering tests, particularly imaging studies or referring patients in order to provide an extra layer of protection against abusive lawsuits. a recent gallup survey found the fear of lawsuits was the driver behind 21% of all tests and treatments ordered by doctors

which equates to 26% of all health care dollars, a staggering $650 billion. defensive medicine includes avoidance behaviors where doctors eliminate high risk procedures like head injury, trauma surry, vaginal delivees or procedures prone to complications and they avoid patients with complex problems or patients who seem la tithous. in 2008, half of america's counties had no practicing obstetrician. this shouldn't be happening in america. there are remedies to fix this broken system but it is imperative we act now before defensive medicine practices and costs associated with it becomes the standard of care. before health care costs go high are an unemployment along with it, before doctors shortages change the very nature of our health care system. successful reform efforts in states, especially california and texas have given us a blueprint for federal medical

liability reform legislation. hicla outlined several legislative proposals that preserves state laws working effectively to make medical malpractice systems fair for both patients and health care providers and broaden coverage across the nation. i'd like to close by telling you about maryland gynecologist dr. carol ritter who stopped delivering babies in 2004 when her liability premiums hit $120,000 a year. she couldn't deliver enough babies to pay the trial bar's tab. today, dr. ritter maintains a gynecology practice and still delivers babies, but does it in haiti, and honduras and dozbosn. shsays she does it for the sheer joy of what she does best, but she can't do it in maryland. i would say to you today, that something is very wrong when a caring, committed physician like dr. ritter can't bring an american baby into this world for fear of frivolous lawsuits. ladies and gentlemen, you have

the ability and i think the responsibility to help right that wrong. thank you very much. >> thank you, dr. weinstein. and i'll recognize myself for questions and dr. hoven would like to address my first question to you. you heard mention a while ago and you know, of course, that the congressional budget office estimates that we would save $54 billion over ten years if we reduce the cost of defensive medicine. there are other studies, for instance the pacific research stitute says that defensive medicine costs $191 billion. pricewaterhousecooper study puts it at $239 billion and newsweek reports that all told doctors order $650 billion in unnecessary care every year. i don't know which of those figures is correct, but they all point to the same direction, which is defensive medicine is expensive and costs, let's say at a very minimum tens of billions of dollars, probably

every year. my question is this. who pays for the cost of all that defensive medicine? >> thank you. we all pay for the cost of that defensive medicine. at the end of the day, patients pay for it, we pay taxes that pay for it, we all pay for the cost of that defensive care. now, it is very important to realize, in the culture of fear in which we are all practicing medicine now, i use that term because i think it is very real, this most physicians want to practice medicine the best possible way they can. they want to do the best job they can, but what ty recognize is that their clinical judgment is not allowed to carry any weight in the court of law. so that in fact we do these things for assurance, to protect ourselves. and at the end of the day, that's where those costs do come around. >> okay. >> thankou, dr. hoven.

dr. weinstein, the congressional budget office estimates that if were to enact medical liability reform, premiums would drop 25 to 30%. who benefits from a drop in premiums of 25% to 30% or maybe i should say is the benefit limited to the physician and medical personnel or not? >> i think ultimately, mr. chairman, is that when medical liability premiums begin to drop, the culture of fear amongst physicians eventually will change. it is a cultural change that will have to occur over time. and once thatultural change occurs, then the practices of defensive medicine which you've heard about over and over again will eventually change as well and our health care costs will go down. so ultimately patients and the american public will benefit. >> patients and the consumers benefit. my last qution is to both dr. weinstein and dr. hoven. i want to ask you all to respond to a point that miss doroshow made that where he had said is wasn't medical liability reform that reduced premiums it was

insurance reform. and she gave the example of california. who would like to respond, either california or texas, drhoven? >> i'll go first. it takes eight to ten years to see the effects of these reforms when they are enacted. there really is not firm, hard evident that in fact the insurance change was the result. it was the fact that across the country it takes eight to ten years to begin to see the evolution of change when these reforms are put in place. >> okay. and dr. weinstein? >> i think all would agree that the system in california compensates the patients in a much more rapid fashion, and also more appropriate so patients who are injured get the majority of the reward. >> okay. and dr. weinstein, or dr. hoven, respond to this, if you would, in regard to the california insurance reform, i'm looking at a newspaper arcle that said thatroposition 103 that required a rollback of insurance premiums and not california's

health care litigation reforms have controlled medical professional liability premiums. that's the assertion. accord to the orange county register, "a rollback under proposition 103 never took place because california supreme court amended proposition 103 to say that insurers could not be forced to implement the 20% rollback if it would deprive them of a fair profit." it is hard to see the correlation therefore between the insurance reform and the drop in premiums and clear the drop in premiums were a result of the medical liability reforms. i thank you, all, for your responses and i'll recognize the ranking member for his questions. >> thanks, chairman. and i thank the witnesses. where are we now in terms of the health care reform act, which sometimes is derogatorily referred to as obama care.

i use the term because i think it is going to go down historically as one of the great advances in health care. but didn't the health care reform act, which still, by the way, is the law of the land and will be until the president signs the repeal, which i wouldn't recommend anybody to hold their breath on, we provided money for this very -- for examining this very same subject, section 10607. does anybody know anything about that here? >> yes, sir. >> i do. >> mr. conyers, are you referring to the demonstration projects? >> yes.

the $50 million for five-year period that demonstration grants for the development to states for alternatives to current tort litigation. that's right. >> if i could address that question, i would say that the way the demonstration projects, which haven't been funded, i don't believe yet, the way the demonstration projects are outlined, i believe that the patients can then withdraw at anytime and choose another alternative. and i'm a full-time educator clinician scientist and when you design a research study, which allows patients to cross over or change, you don't get good information at the end of the day. it is not the good scientific method, if you will, if you want to find out whatorks best. so i would argue that the wa that is designed has a flaw to also there have been demonstration projects across the states for a number of

years. >> if i could comment? >> could i? >> sure, you can. >> actually, in conjunction with therovision in the health care bill, hhs has actually awarded now a number of grants to many states, up to $3 million to develop alternative procedures and other kinds of patient safety oriented litigation reforms. so those grant proposals were already given. there was money. and these demonstration projects are in the process of being explored now at the state level. i live in one state where that is true, new york. >> well, are we here -- can i get a response from all of our witnesses about the whole concept of providing health care

for the 47 million or more people that can't afford it? and are any of you here silently or vocally in support of a universal health care plan? >> i may speak to that, sir. >> sure. >> the american medical association recognizes this is not a perfect bill, but it is a first step in getting us to where we need to be in this country. medical liability reform, alternative mechanisms for dispute resolution that are to be funded through that legislation are under way as we speak. we in no way support a mechanism that does not recognize that every person in this country needs affordable care and access to quality health >> well, the bill that was just

repealed yesterday provided for millions of more people getting health care cause we raised the ceiling on medicaid and we allowed the inclusion of children in the parents' health care plan until age 26, a seven-year increase. did that help any? >> we'll wait and see. >> we'll wait and see, you mean you wait to see if there are any parents that want to keep their kids included for seven more years? i haven't found one yet that doesn't want that provision in the bill. >> let me go back to my earlier comments. access to care for everyone is what we want and need in this country. >> well, i know it. yeah, that's a great statement. that's what i want, too. and that's why i was asking you

about some of the provisions of the bill tt was just dunked last night by the 112th congress. but i thank you, mr. chairman. >> okay. thank you, mr. conyers. the gentleman from new york is recognized for his questions. >> thank you, mr. chairman. i thank the witnesses for appearing toda i'll ask dr. weinstein, when i looked at the national commission on fiscal responsibility and reform, the president's commission to explore ways to reduce the deficit, it was recommended in there that health care litigation refor as a policy could save money and go to limit the deficit. deficit is a huge issue and a priority for many new members of congress, of which i am one. do you agree that lawsuit reform could and would reduce the deficit? >> yes, sir, i do. i think that's been shown. i think the cbo report that

senator hatch had requested information on showed it reduced it by $54 billion over ten years and depending on what study you look at, i think there's been widespread discussion in the media by members of congress and also by various groups who have looked at this issue, senator kerry and senator hatch this week, and i think both felt it uld be a significant step forward addressing the medical liability issue. i think to us there's no question that this would indeed reduce health care spending. >> dr. hoven, would you agree? >> i most certainly would agree. i think clearly that's not chump change we're talking about. we clearly need to move ahead and that's a conservative estimate. it may even be greater than that. >> and would you agree or disagree, miss doroshow? >> i disagree with that. i think what cbo did,

unfortunately, avoided a number of very important issues that will end up increasing the deficit, burdening medicaid and medicare in particular. three things in particular. one is when you enact these kind of severe tort reforms, there are many people with legitimate cases that cannot find attorneys anymore, cannot bring cases. this is well documented as having happened in california. in kt fact, you had a witness before this committee in 1994 testifying to that effect and it is certainly happening in texas. so you have many people that are going end up going on medicaid that otherwise would have been compensated through an insurance company. second, as i mentied, there are liens and subrogation rights that medicare and medicaid have when there is a judgment or verdict in a lawsuit. in other words, they can get reimbursed. if there's no lawsuit, that reimbursement is gone so they lose money in that regard.

third, these kinds of measures are going to make hospitals more unsafe. there are going to be many, many more errors. even the cbo in its letter to senator hatch talk about one study that would increase the mortality rate in this country by .2% and that doesn't even include the injuries. so you're going to have more people hurt, more expense taking care of those people and frankly, when you enact any kind of cap on non-economic damages in particular, those have a disproportionate impact on senior citizens, children, low income earners and certainly senior citizens, what has happened in texas with the cap, those cases really are not being brought anymore. so senior citizens who are on medicare who should have a right to seek accountability from a

hospital that caused negligence, no longer are bringing those lawsuits, so medicare is paying. there are lots of coststhat are going to end up increasing the deficit. >> but my understanding is that we're not looking to discourage legitimate lawsuits. we're allowing economic damages to be fully compensate in the subrogation rights that you refer to are derived from the economic damage calculation, because those are medical bills, past and future, the subrogation rights are derived from. what we're talking about is focusing in on the frivolous lawsuits that are there. i guess i don't follow your logic saying that's a reason why -- >> no, i think that's actually not what history shows. history shows when you cap non-economic damages, there are certain classes of cases that are no longer brought. that is what has happened in california and that is what this individual -- insurance defense

lawyer testified, before this very committee in 1994. entire categories of cases can no longer be brought. those that involve primarily non-economic damages. for example, one of the people we brought to washington a couple of times, a woman named linda mcdougle, she was the victim of negligence -- >> i think my time has expired there. thank you, mr. chairm. >> thank you for your questions. ms. doroshow, if you want to finish the sentence, you may do so. >> well, she had an unnecessary double mastectomy because the b misdiagnosed cancer when she didn't have it, and she came down to testify a few times but her damages were entirely non-economic in nature. a cap would have only affected cases, her case. >> okay. thank you very much.

the gentleman from virginia, mr. scott, is recognized for his questions. >> thank you, mr. chairman. one of the problems we have in this discussion is a lot of the problems are articulated and then solutions are offered and very little effort is made to sehow the solutions actually solve the problems. mrs. hoven, did i understand your testimony that physicians are routinely charging for services that are not medically necessary to the tune of $70 billion to $126 billion? >> i'm talking about defensive medicine. >> i asked you, are those services that are not medically necessary? >> they are services that are medically indicated and medically necessary if you look at guidelines and criteria.

however, what does not happen is my clinical judgment whether to employ that test is disregarded. >> are you suggesting that the services are not medically necessary if liability were not a factor, would the services be provided or not? >> it depends on the case. it depds on the situation. it depends on the environment of care. >> you're suggesting that in $7 billion to $126 billion worth of cases, services were rendered that were not medically -- were not needed? >> that'not what i said, congressman. >> what are you saying? >> i'm saying health care delivered in the examining room, in the operating room, is driven by what is based on clinical judgment and based on assurance testing which is documentation and proving that in fact, that is what is wrong with the patient. when we talk about cost control

in this country, we' talking about the fa that -- and this goes to the whole issue of cost containment, which is if, fact, you would recognize my medical judgment and allow me to decide when it is important to do a test or not, then our patients would be better served. >> by not providing the services? >> if in my judgment, they don't need it. >> and you're not able to -- and you charge for services that in your judgment, are not needed to the tune of $70 billio to $126 billion? >> i do not do that. however, let me -- >> i mean, your testimony was that physicians are charging $70 billion to $126 blion more than necessary and then blaming it on liability. now, is that your testimony? >> yes, that is my testimony. >> that it is not necessary, you're providing services that are not necessary. either they're necessary or they're not.

>> we're practicing at a culture of fear and that culture of fear lends itself to protecting oneself. i have been sued, congressman. let me tell you -- >> wait a minute. i just asked you a simple question. $70 billion to $126 billion. i just want to know what that represents. >> that is costs for tests and procedures which, if you look at guidelines, would be medically necessary, but my medical judgment is discounted. >> that based on your medical judgment are not -- should not have been provided? >> not necessarily. >> okay. well, i'm not getting -- miss doroshow, if physicians are charging for services that are not necessary, how is that different from medical fraud? >> that's a good question, because in order to get reimbursed, to file a claim with medicare and to be reimbursed, physicians have to file a form

and certify that the test and procedure, the services that they provided, are medically necessary for the health of the patient so it does raise a question whether or not some claims may be false, if the physicians are not -- >> if someone were to do a survey to say why did you provide the service when it was not necessary, what would be the convenient answer? if they asked you why did you provide the services that we not necessary, what would be -- >> you say they -- >> because they're afraid of lawsuits so they can charge for serves tt weren't even needed. mrs. hoven, did you indicate that you supported a fair determination for medical malpractice issues so that those who had bona fide cases could actually recover? >> most definitely, congressman. >> you're aware that it's estimated 5,000 to 10,000

wrongful death cases are paid every year? >> if you look at the statistics which are obviously very familiar, we are talking about apples and oranges he in many situations. we're talking about errors a adverse events aspposed to true malpractice and negligence. i think you have to be careful about the terminology. >> so what would be th barrier to 90% to 95% of the cases that were caused by medical errors from recovering? >> they should be able to recover. what the health act would do would allow them to recover. so that they would be appropriately rewarded for what happened to them in their loss. the health act talks about that in terms of all of the economic elements that are involved, including their health care. >> mr. chairman, my timeas expired. >> thank you, mr. scott. the gentleman from pennsylvania, mr. marino, is recognized for his questions. >> mr. chairman, i yield my time. thank you.

>> all right. we'll go to the gentlewoman from florida for her questions. miss adams. >> thank you, mr. chair. miss doroshow, i was looking at this institute of medicine study and you cited it in your opening statements and in your packet and it says that as many as 98,000 patients die annually due to medical errors, and what we found was it has shown to be exaggerated and unreliable. isn't that true? because based on shortly after its release in 2000, the study came under heavy criticism for imprecise methodology that greatly overstated the rate of deaths from medical errors. for example, the study data treated deaths from drug abuse as medication errors, and dr. troy brennan, the lead harvard researcher, who compiled much of the data upon the report, which was based, later revisited his

methodology and determined that the actual figure could be as little as 10% of the oim's estimate. is that true? >> well, what's true is that many other studies since then have found far more than 98,000 deaths. many other institutions that have looked into it, and just in november, hhs took a look at thisssue again and they found that one in seven patients in hospitals are victims of an adverse event and 44% of them are preventible. also, there was a study just also released in november of north carolina hospitals, north carolina is supposed to be a leader in patient safety, basically finding that since the stitute of medicine report, patient safety has not improved at all and it really kind of shocked the authors of this research study and they found that the errors that are causing deaths