there is no fundamental disagreement and i think the point and bob casey has a great interest in the subject matter and i have had over the years. the one area that, in fact, there hasn't been in a race to specialization is in the pediatric area and esso anomaly in a way that has been obviously an the other is a plan from the area of pediatrics has been the opposite case paramount so the sweeping statements we made which have a lot of accuracy is about correct. we have all made the point on some occasions over the last nu

you know, sheltering children, as bob casey said, that's important.just modified schip and rejected a senate amendment that would have covered all of those kids and not raised taxes at all. yet we've got 16 million kids out there today that are eligible for schip and medicaid and they're not on the roll. why? because we're not listening to the patient. we're not listening to what we're doing wrong and we're getting ready to make the same mistake again. 16 million of them. so why are e.r.s loaded with kids with an ear infection when they're already medicaid-eligible? because we haven't oversighted and neither have the states in terms of enrolling those people to where they have a primary care. and we have a medicare payment system that says, if you're a medical student you graduating in this country, you don't want to go into primary care because there's a 300% payment differential versus you spending another year or two in training, you'll make 300% more. so only the most altruistic of our physicians go into primary care. it's obviously not about mone

if you have a child who plays baseball, much like bob casey plays baseball, gets hit on the head with a baseball, every one of those kids now that hits an e.r. in the united states gets a ct. why do they get a ct? because the e.r. doctors are absolutely afraid even though they have a totally normal neurologic exam, even though they have good parents at home, even though they think they will follow signs of onset of coma or change in behavior, even though they know that, they get a ct. now, multiply the number of kids in this country that get hit on the head with a baseball every summer in this country and add to it $1500 of which less than 1% are indicated, you're coming up with hundreds of millions of dollars just for baseball in this country. whereas the prudent man would say parents, here are the things you have to watch in this child. there is absolutely no neurologic sign that your child has been significantly injured, but if any of these five things start happening, i want you to come back here immediately. that's not good enough anymore. in a court of law. why didn't you do the