that national academies of clinicians. >> senator, can i finish my point?>> please go ahead. >> guidelines are important, but they're just that. they're guidelines. and when -- if, in fact, you pass this bill out here with this, you are going to raise the cost of@@@arragrr")rráb individual and guidelines are just guidelines, and we create a situation where physicians now have another step in the process, here's the government guideline so now i have to back up what i'm doing with all this other stuff because i know from my clinical experience and what the patient is telling me that she doesn't fit the guidelines. and so i'm going to spend a whole bunch of money because i'm not about to expose myself again to a classy lawyer that's going to come in and say you didn't follow the government guidelines. so if, in fact, we're trying to save money, you're actually going to increase the cost. for everybody who doesn't fit the guidelines. what's wrong with us saying we're not going to allow this to mandate the care and get in between a patient and a doctor. >> i do

health care programs and services, meaning it can hire the appropriate number of doctors, nurses, clinicians, and support staff to meet the demand for high quality care for our veterans. anything less is unacceptable. i'd also like to acknowledge and commend chairman david obey and -- for putting in an advanced appropriation for v.a. health care in the fiscal year 2010 military construction and veterans appropriations bill. i enthusiastically support h.r. 1016, and i once again want to thank chairman filner for drafting a bill that would ensure the v.a. has sufficient, timely, and predictible funding. mr. speaker, i urge all my colleagues to support this legislation. i yield back the balance of my time. the speaker pro tempore: the gentleman from arkansas. mr. boozman: thank you, mr. speaker. having no more speakers on the bill, i continue to reserve. the speaker pro tempore: the gentleman reserves his time. the gentleman from california. mr. filner: we have no further speakers. i would conclude if you yield back. the speaker pro tempore: the gentleman from arkansas. mr. boozman: since the g

of bankruptcy, by the way, does not pay doctors and pharmacists and ambulance drivers and nurse clinicians -- pardon me -- clinical lab folks and home health care providers, almost every health care provider that you can name. they don't pay them enough to cover their costs unless these providers have a nonmedicare patient population from which to recoup their losses, they cannot stay in business and their patients lose out de facto rationing of health care. now, as a member of both the finance and health committees and the cochair of the senate rural health care caucus, i am able to participate and have been participating along with staff in this complex and very difficult effort. we must reform our health care system into one that guarantees meaningful access for all americans and guarantees that patient-doctor relationship. however, this effort to date has been a tale of rhetoric versus that of reality. the promise of cooperation contrasted with the unfortunate real fact of parsonship, something i do not like to say. let me explain. president obama, who ran as a postpartisan candidate,

i have great respect for clinicians and the tremendous responsibility that they experience and their training and their dedication. if you are looking at how to do that, i would like to ask them how it is best done rather than the back and forth here. >> then you will agree there may be exposure -- >> i think based on what we did in the american recovery package and a somewhat weaker doing here -- and based on what we are doing here, that we have met that need. whether their pediatricians are cardiologists, if they think they have a better way, i would be open to hear it. right now, i do not want to change what we have in the law based on back and forth. there were also some other legal things that were suggested. >> mr. chairman? i'm going to ask unanimous consent on page 323 of the bill, line 5, where's his recommendations and not be construed as -- where it says recommendation should not be construed as mandates --that it be stricken. -- that it be stricken. i think that satisfy a lot of the concern. >> that exactly the suggestion by senator hawkinrkin. and what i said is that i w

the alternative as a clinician is that temperatures in the planet are caused by solar activity. you have a correlation of warming on other planets, principally a mars, that correlates with the temperature changes on earth. i'm wondering if the progressive gentleman can provide me with the press was the argument that rebuts this, or perhaps just point me to upset. guest: i would tell you about the most renowned body of international experts on the issue of global warming that has come to determination that the signs is in and we need to take immediate action to address a. it is not this inter- governmental body alone, but nasa, and a whole body of u.s. experts who have all determined that this is real, happening, and you need to take action to confront the fact dead man is causing further emissions that degrade our environment and potentially will cause huge ramifications for our weather patterns and all the kinds of resources we pay into try to avert them as in hurricane katrina, though fires and the west, and so on. these issues must be confronted and they happen more and more.

so i was sitting there listening and trying to listen as a clinician, as a doctor because i don't think that we as a medical profession than thinking or doing the research to understand why was this woman successful in all aspects of her life, doing things that she didn't want to be doing and doing it in any way knowing that it wasn't good for her? what was going on? what was going on clinically, what was going on scientifically and how was the journey the last seven years of wanted to understand so with colleagues a number of great institutions, let me give you four pieces of the science. and then try to put together this proposal, this mystery. why does that chocolate chip cookie have such power over me? that really is the question. i could relate to the woman on oprah. i have suits in every size and i probably gained and lost my body weight over my lifetime several times, over. what was going on with that woman? colleagues at the university of washington published an article recently bought the typical scientific title for a scientific journal, it was called to constructing the fun a

the alternative as a clinician is that temperatures in the planet are caused by solar activity.ou have a correlation of warming on other planets, principally a mars, that correlates with the temperature changes on earth. i'm wondering if the progressive gentleman can provide me with the press was the argument that rebuts this, or perhaps just point me to upset. guest: i would tell you about the most renowned body of international experts on the issue of global warming that has come to determination that the signs is in and we need to take immediate action to address a. it is not this inter- governmental body alone, but nasa, and a whole body

he also writes that a public plan might allow clinicians who form accountable care organizations to keep portion of the the savings they generate. as opposed to the public auction -- option -- help it would allow all private insurance is to compete -- they can and they should. here is an opposite viewpoint. his against a public plan and he says it could give the true the uninsured vouchers that would allow for choices and help to account for retirement. he also writes that in the name of cost cutting what is really going down is a major knock down a profit. he says liberals have always ruled against the excess -- excess profits of insurance firms and pharmaceutical companies. what do you think? our next caller comes from memphis on the democrats' line. caller: i do believe in would be beneficial. one, i am a single parent and thank god my children hardly ever get sick, but the cost through my employer is well over 3000 hrs per year -- $3,000 per year. the cost to go to the doctor, the additional co-pay -- it cuts down on the things i need to do for my family. i would help people like mys

reports, almost a version of consumer reports on comparative effectiveness or health outcomes and for clinicians or others, it's news that they can use. it is one source of the news. there's the institute of medicine, there's the national academies of pediatrics or cardiology, et cetera. so and it is -- in the agency for health care research and quality which has been around for more than 20 or 30 years. >> let me just say this. nothing in the bill prohibits cms from using cer to contain costs and it's peter orszag who is the omb director, obviously, said cer's principal purpose to is to retain cost,s a direct quote. the acting nih dector said costs will be a key factor in cer it just seems to me that we need this amendment to ensure that cer is not used to ration health care. >> peter orszag is not a member of congress. no matter what they might think. >> i'm going to do a hatch thing but i'm much louder than hatch so people don't listen to him. he's been doing this for a lot of years. now, i used to be a bucket toter, i was a bucket toter here in the senate for two year, went to the house, i w

and any research, evaluation, communication, activities performed must reflect the principle that clinicians, doctors and providers and their patients should have the best available evidence upon which to make the choices in health care. items and services, drugs, treatments, devices. but that it is -- research must recognize that patients sub populations and patient physician preferences may vary. all given the same outcome. and so if we have the assurance that this isn't meant to rationing care, and that our purpose in doing this is to find out what we think is best most of the time for the average patient and we want to put that out, then fine. but if we're going to tell doctors what they're going to do and patients what they're going to do, it isn't fine. because it's not based on the best care. it's based on the best -- the average based on cost as well as outcome. so without this amendment, i would like to know what section of the bill prohibits the government from using cer to decide what treatments the patients can and captain have. what section of the bill prohibits the government f

we're convinced after spending time with physicians and hospital leaders and clinicians, if for exampleon the outpatient basis, if a practice were to perform at the highest level in our contract in these areas, they would have built the infrastructure to deal especially with chronic illness, which for our plan, 5% of our members account for 50% of our spending and we know that that's part of the solution to affordability, so who's working with us? it's a whole range, this contract began in january of 2009, by may we had seven groups signed up. they range from 40-physician practice in the western part of our state to tufts medical center, which is academic medical center in boston with affiliated physicians, across eastern massachusetts. there are community hospitals, there are urban hospitals, there are hospitals outside the city. we expect three other groups to come into this contract within the next four to six weeks. collectively, these organizations and the new ones we expect in are -- account for almost 1,000 primary care physicians, almost 2,000 specialists, and 20% of our mements