when you consider the future of someone who develops diabetes so young. and certainly the future, the fiscal -- physical future is very important. but i'm also very concerned about the fiscal future of our youth. i'm very troubled today, a constituent came to me today from the oil and gas industry, was discussing with me the problems that already are emerging with the loss of tax incentives to invest in exploration that's going on in my district and districts around. mr. speaker, i think that looking down the line here at the fact that we yet have not developed an energy policy, i know my side of the aisle, we republicans, attempted to get to the floor a no cost stimulus bill which would have, i think, been a very innovative and certainly revolutionary in getting our energy costs down. but having said that, as gas prices now are approaching $3 a gallon, and we are still in a severe recession, just think that even $4 a gallon pretty soon is probably going to be bypassed very quickly. with that i just want to reiterate what my friend also from louisiana, mr

diabetes, all 50 states are currently funded for dives prevention persisted $2 million. you think of all the money we spend in health care 62 million for prevention of diabetes. arthritis, nutrition -- 13 million, of physical activity, obesity 42 million in 23 states health department's. at cdc is $104 million and all that these days just on tobacco. and smoking. comprehensive school health, cbc provides $54 million to all the schools in the u.s. oral health for kids and current funding of $12 million a year and i to go through, there's a whole lot of others and give you some idea what of the amount of money that we put into prevention. now the other thing is the community transformation grants. those of go by the wayside also. but the trust for america's health last year issued a finding title prevention for health care american investment yield significant savings and their studies showed that a return of $5 and $0.60 for every $1 investment in community-based prevention and cited in number of different communities around the u.s. that have done certain things and then

they are consulting on a regular basis with a diabetic educator. so they are doing all improvable, demonstrative steps. but they still have it. who decides, is it secretary of hhs? is it the employer? is it the person who is -- the self-injured. by the way, i want to promote these employer based initiatives. i think they are outstanding. but you see who decides whether someone is in compliance or making "a" for effort. >> the differential is 20% and the employer sets up the procedures where the person gets prescreening, stops smoking, who pursues healthy lifestyles, gets an economic benefit from the differential. >> we heard one employer talking about -- >> but the decision process won't be any different. it will mean that differential can go up to 30% with the potential of going to 50% if the secretary sets out certain standards that will be met. >> i think the goal here is to reduce the health care premiums for everybody. and so if you can incentivize a huge number of people that are currently not getting screenings, are not, you know, just doing

i did not ask to have diabetes. -- it seems like discriminating. guest: is it adult onset diabetes?aller: yes, type 2 and i try to watch my weight, diet, exercise, but they say they cannot accept me. i am not asking for free. i'm willing to go up to a certain amount per month that i could afford. i am having a difficult time. i do not know that people in congress, the people in the senate -- they do not have a problem. we put them there. they are set for life with their insurance. host: here is a story on the front page. it says two things. 85% of the respondents said the health care system needed to be fundamentally changed. 77% said they were somewhat satisfied with the quality of their own care. caller: yes, but i don't know where the get those numbers from. i have talked to many people. i work in retail. i am in contact with customers. i speak to them about it. i hear their comments about health care. no one is satisfied. guest: dorothy, let me say a couple of things. first of all, i understand your dilemma. i do not know if you can retire at 62, frankly. i wish that i could ret

these traits suggest continued pitcher differences in diabetes. notably with the prevalence of metabolic systems inevitably declines with higher household income and educational attainment. attention is likely this a most treatable and controllable risk factor however controlling hypertension and to define operationally as reducing blood pressure to 140 over 90 is a problem particularly african-americans and are reports of a widening disparities and the success of hypertension control between blacks and whites. the control rates are much less than desirable from african-americans and this is seen as the figure in the text. nationwide wall 70 percent of whites who are treated for hypertension and gone could control only about half of african-americans do. and data from the jackson hard study on the slide demonstrate and that are interesting to contrast of the national data. the percentage of african-americans who have hypertension who are under control in our study is exactly the same as the national average which is 70%. therefore national data sh

i am a diabetic. i am a long-time diabetic. i have been diabetic for over 30 years. it was so hard for me to get my shivers down. i tried for 30 years. -- it was so hard for me to get my sugars done. i tried for 30 years. i met a man from italy who has been here about 30 years. we're going to have to get more aggressivprogressive. i have already emails barack obama about this same subject. i got my sugars down. my a1c was 15 at one time. everybody in america wanted to be at least six or seven. i almost died. with insulin and the chemical medications combined, i started taking some herbal products. we have to get with it. i saved my kidneys. i saved myself from going on a dialysis machine. i have gone from 15 down to 6.1. my cholesterol -- host: i'm going to have to stop you. that is a lot of information. do you want to summarize in a question? guest: i need to sit down and talk to somebody. i need to show you the evidence and proof. -- caller: i need to sit down and talk to somebody. i need to show you the evidence and proof. i do not have the kidney or heart disease

to forestall the onset of diabetes. as you know right now, medicare, for example, will pay for nutrition are counseling once you have diabetes. >> right. >> but they won't do it if you're pre-diabetic. so to just say you've got to have a chronic disease before you can get in this i think defeats kind of the purpose of it. now, regarding the 200% of federal poverty level, again, we tried to structure this sort of almost like community health centers, that people do have to pay, but they pay on a sliding scale for these services, depending upon where they are. so that's in the bill to pay for that. we had it at 350% because that was sort of the schip guidelines in two of our more populous states, as i might say. >> right. but should we be going to the most populated states and using that as our criteria, or is it not more reasonable to go with the criteria that we see more of our states utilizutilizing, whi around 200% of poverty? >> well, if we're going off that group of people, obviously they live in the most populous s

one employee has diabetes. and also extends coverage to her husband who is a dairy farmer without health insurance coverage. because of their high medical costs, it would have been very difficult for me to find new health insurance without facing even higher rates. health insurance is becoming steadily less inclusive and more difficult to keep. and it's no wonder that in today's economy families count health care costs as one of their top pocketbook issues. madam speaker and colleagues, the stories illustrate why affordable, quality health care for all is so important and so necessary. universal coverage is both a moral and economic imperative. if we are to succeed in the 21st century. for the first time i firmly believe that health care for all is within our grasp. we must act now. and i want to again thank my colleagues, my friend, congressman murphy, and friend congressman altmire, for taking this fight up and bringing us together to address this important issue. mr. murphy: thank you very much, ms. baldwin.

it is not just about this condition, not just about mental health, but when you link it to diabetes, certain people are expanded greatly in giving people something, it is quicker to understand the idea. they did not -- do not think everyone knows when you say chronic care that everyone knows what's that mean -- knows what that means. the doocy people have conditions that are treatable but cannot necessarily be cured like these in june not know about the way you interact with these different groups, the message to other people that the more you have of these examples, the more is inclusive and the more they understand. >> let's take one last question here. >> when you talk about cost saving, by see cost savings at one level as a really good discussion, but at the state level it is actually a little frightening to be talking about cost savings because it is almost like you're giving them permission to take money away from mental health services when you say we can save you money if you do this and this. now, i would say across the country, but certainly in georgia or mental health is a

there's hundreds of millions of dollars on streak prevention. >> there's diabetes, that's tobacco, even school health, oral health. then there's environmental health programs injury prevention programs that we do fund. what i'm trying to do in this bill is get a new frame work, most of which goes obviously through the center of disease control and i might add. cdc is the center for disease control and prevention. and to get through this and pull this together under one regime. and that's why just to say we're doing it in some other area, a lot of those again are discretionary. they're not funded. that's why i argued for a mandatory program. >> and i take your argument in face value. and, in fact, let's move all the rest of the programs to the cdc so we have one source, one place to do it, one management team we can hod accountable that gives us metrics and say we spent this money, what did we get. instead of saying here's hrsa, here's this, here's this, and here's cdc. why not put it all in one place? why have competing programs doing exactly the same thing? what is the sense of that? w

i think to say we have problems in america due to diabetes and obesity and we are going to solve it with a government solution is a terrible mistake. >> dr. tsou, what your solution be? >> thank you for the opportunity to address a complex issue. people have thought about this as the guy edna lakner roof of a lot about organizing the care. a lot of it comes down to frankly as jerry said before setting up prevention. there is something that is missing and health care system today which i believe is a lot more community-based health care service. if i were the king of the world i would actually try to organize within neighborhoods based on a database that was available where we know the prevalence of diabetes or high blood pressure or other major conditions. we would organize neighborhood class is where we would teach people about restrictions and improving diet and how to take medicine properly and we would try to have individuals like public health nurses who would check in on people have difficulty with compliance -- >> dee dee single-payer would facilitate that -- >> we would actually

diabetes which modern medicine can now treat and manage adequately. hypertension in african-american lead to 80% stroke mortality rate, 50% rates of disease and 32% higher rates of renaturl disease. when we initially look at these datas we thought access to care was the suspected reason, however, even in veterans hospitals where access is not as much of an issue, major health disparities continue to exist. studies have shown that physicians are less likely to refer african-american african-american forbes cardiac catheterizations. and current theories on cardiovascular disparities is racial discrimination in treatment, genetics, environment and demographics. there are new theories emerging about the health disparities. first there is epigenetics or changes in the dna by consistent exposures from diet to stress that can be passed from one generation to next. it underscores the cumulative effect of poor socioeconomic conditions, discrimination and inequality of education of opportunities. the second theory is the owl static load which the body experienc

it's much more cost effective to treat diabetes than it is to treat the results of diabetes untreated and undiagnosed, for example, if somebody suffered from kidney failure or stroke. those are extraordinarily expensive thing, much less expensive and so much better for the live of americans if we can address these problems before they get to that case. yet insurance companies have fought at the state level the covering of testing for diabetes and even in a couple of states successfully the coverage for the supplies for the treatment of diabetes that has been diagnosed. we worry, too, and, you know, this is one of the topics i'm sure that those of you who have been visiting have heard about the strain of the baby boomers on medicare. but we know many of the people entering medicare have as many as five chronic conditions, some of them untreated because they said i don't need to get health insurance, in three years i'm going to be on medicare. so something ends up not getting treated, and by the time they get in medicare, we're talking about a much more expensive treatment than we might

care, so as you move down this list, looking at each of the elements of how diabetes should be treated and scoring that and then through minnesota community measurement, making that visible to the consumer on line, where you can go and see how one clinic versus another is performing. and this is just a quick depiction of what that would look like, given that i'm presenting in washington, d.c., i didn't put anybody's name on this, but literally in minnesota, you can go and look and the names of the clinics are on there and you can see how one compares to the next through an element called health score and this is just a valuable piece of data for the reform of the system. when we look at minnesota and think about it as a model, a potential model for the country, a lot of it is built around how integrated the delivery system is, so the hospitals in the twin cities in particular, have the physicians are employed by the hospitals, ancillary services employed by the hospitals, and these are very tightly integrated systems, so they're in position to take on a global payment and to manage tha

even after they've become diabetic, if we are working with them to manage their regimen of treatments in a steady way, then it might cost us $150 when you prorate the costs for a counselor to call the diabetic on a regular basis to make sure they're taking their meds. and as a consequence, we don't pay $30,000 for a foot amputation. all right? so there are all sorts of -- [applause] >> -- all sorts of ways that i think that we want to improve care. and that helps us manage risk. now, people are still going to get sick. and going to still be really catastrophic costs. and there have been a lot of ideas floated around in congress or the ways that we can help to underwrite some of the catastrophic care that takes place. so that would help lower premiums. i'm open to a whole range of these ideas. and one of the things -- one of the approaches that i've tried to take is to not just put down my plan and say it's my way or the highway. first of all, one of the things it turns out is congress doesn't really like you to just tell them exactly what to do. [laughter] >> i think keegan can testif

, will discuss research and finding a cure for diabetes. second, i would like to present mr. branson with the traditional npc mug. >> thank you very much. >> okay. for our last question, let's see, so someone is asking in this time of economic uncertainty, what do you look for in individuals to hire. [laughter] >> stay away from from business people. i think the key to, if we are taking on managers at virgin, what we look for is people who are great motivators of people, people who look for the best in people, people who praise and don't criticize, and if you can find those kinds of people, you have a happy company. and do we look for entrepreneurs? i don't believe in competition and so we don't look for them. [laughter] thanks very much. >> thank you very much for coming today. [applause] i'd like to thank you all for coming and also like to thank national press club staff members melinda cook, pat nelson, joanne booth and howard rossman for organizing the lunch and also to the npc library for its research. video archive of today's luncheo

we spent, in 2000, $7 billion on drugs for diabetes ii. today we spend $13 billion. diabetes type to i could write excess weight in the medical chart because that is the mechanism that contributes mildly to the disease. we all want health reform. no one in this town is not talking about health care reform, but how are we going to be able to get a handle on these costs when we can't get a handle on something as basic as excess weight? what's going on. i asked my friend, kathryn, at the center for disease control now has weight change over the decades, a little weight? tell me that in the 60's was going on and what's going on today and what was different and when she sent me the draft when you saw and what i saw was back in the 60's you entered your 20s and you may gain a few pounds until your forties and fifties but are relatively stable. a few pounds and then you plateau and then you lost a few pounds and you're 60's and 70's and in your senior years. the wait is relatively stable over an adult lifetime. today, you entered your adult years and the weight keeps on ris

it creates diabetes. and, you know, it's -- and, therefore, you know, turning that into fuel is a good thing. and a good thing unlike ethanol which is that it doesn't freeze at 15,000 feet, it works fine at 35,000 feet, and if you're in a jet liner, it's quite good to have a fuel that doesn't freeze at 15,000 feet. and, and it works. so, you know, so investing the profits from our airlines into trying to develop clean fuels like that shouldn't put us at a disadvantage because, obviously, we hope that those fuels themselves will become profitable businesses in themselves and, therefore, ultimately the virgin group will be as strong as it is today. i think that, you know, why are other airlines not doing more in this area? i mean, i've, i've been fortunate. i mean, i've had time meeting people like al gore, i've read, just read james lovelock who's a 90-year-old absolutely brilliant scientist and essential reading for everybody, i think. tim flannery's book, the weather makers, and, you know, read a lot abo

if we can get somebody, first of all, who is overweight to lose weight so they do not become diabetic, we save tons of money. even after they have become diabetic, if we are working with them to manage their regimen of treatments in a steady way, then it might cost us $150 when you break the costs for a counselor to call the diabetic on a regular basis to make sure they are taking their methods. as a consequence, we do not pay $30,000 for a foot invitation. so there are all sorts of ways -- for a foot amputation. there are all sorts of ways to improve footca health care, andt helps us manage risk. people will still get sick, and there will still be catastrophic costs. there have been a lot of ideas floating around in congress for ways that we can help to underwrite some of the catastrophic care that takes place that would help lower premiums. i am open to a whole range of these ideas. one of the approaches i have tried to take is to not just put down my plan and say it is my way or the highway. first of all, one of the things it turns out is that congress does not like for you to just

diabetes is a most monstrous of diseases.i wrote a letter and sent it to michelle and barack obama on march 17 and i have not heard anything of to now, nearly the end of june. and i know kathleen sebelius, but she was just appointed about a month and a half ago. i'm so glad that you had linda douglass on because i wanted her to go and look for my letter. how can i get her direct number or e-mail or fax number? host: you can call the white house. by the way, you can go to whitehouse.gov. we're talking about the white house health-care plan and ronald is joining us from raleigh, north carolina. caller: good morning, first, let me sarah on vacation and i do not want everyone to -- let me say i am on vacation and i do not want everyone to think that federal employees are the only ones on the phone. my question is, what does what does the government think it has the right to pay for health care when they cannot even do it for their own federal employees? every year for the past 10 years or more, federal employees insurance costs,

how do we deal with these chronic diseases like diabetes? >> there is a new grant that we just made available which actually focuses specifically on areas with the highest rates of diabetes and chronic disease in terms of providing incentives and additional resources to not only coordinate care but also do much more effective monitoring of conditions. there is no question that preventive care at a much earlier stage helps but also what helps to prevent hostile stations and amputations is to make sure that those suffering from diabetes actually are on an appropriate regime. . . have proven to be very effective and my guess is your area is likely to be, unfortunately, rising high on the list of an area that's likely to be one of the -- i think there are 133 communitieses that will have additional resources to focus on this effort. >> thank you, madam secretary and i yield back my time. >> thank you. mr. walden? >> thank you, mr. chairman. madam secretary thanks for being here today and the work that you're doing. i have some questions. like ma

, but if you're pre-diabetic they won't provide for nutrition counseling so you don't get diabetes. tell me how much sense that makes? medicare will pay for one colonoscopy when you go on medicare and won't pay for any others. that doesn't make sense either. so there is a clinical basis for prevention, but there is also the basis in our schools, in our workplaces and i say to my friend, that we've been many times with steve berg, and quite frankly, i believe what we have in here corresponds quite well and not some of it is in here and some of it is in the bill because there are tax credit and things for businesses to provide those kind of incentives to the payroll. so it's not all in our bill. some of that is also in the finance committee. so it's -- it's clinical. it's schools, it's workplace and it's communities. the trust for americans' health did a great study and they came out with it last year showing that small investments in community wellness programs had an immediate payback, an immediate payback in the first and second years afterward. you didn't have to wait 10 or 20 yea

maybe the diabetes comes first and then the high blood pressure. and then ar that develops coronary artery disease and then all of a sudden the company goes out of business. and that individual is out of work, out of insurance and desperately needs it. but because of these pre-existing conditions, once cobra runs out, how are they going to get health insurance? how are they going to afford, struggling maybe to find a new job, but how are they going to be able to go out with no tax deduct -- deductibility and purchase a health insurance plap that's three and four times the amount of a standard plan for everybody else? what i would say, madam speaker, to the association of health insurance plans, why don't you grant those individuals credible coverage just like we did in medicare part d, the prescription drug benefit? if you have a credible insurance plan that covers prescription drugs, say on a supplemental plan, and then you lose that after four or five years, then you shouldn't be penalized when you get into part d and indeed the law says you won'

maybe by avoiding the bypass operation, or reducing the level of complexity of diabetes or preventing it in the first place, it might be a better way to get the better health and lower cost. if you just focus on episode not going to incorporate that. very important element of getting to higher value in health care. so some efforts are focusing more directly on paying for higher value. i'm going to spend a few minutes talking about accountable care organizations and accountability for getting this goal met, getting better outcomes for a population of patient, better health for population of patients at a lower overall cost. and that can be done through a shared savings, so this can be added into current payment systems without radical change to give providers an opportunity to share in the savings that they create when they take steps. they currently are reimbursed or not enough or are being reimbursed exactly for the right patient. whatever it takes to get better outcomes and reduced the average cost of the patients they are treating, should provide better support. it should be channe

president usually use the example of will we invest money to treat somebody said they don't get diabetes rather than paying a reimbursement for an amputation of part of a leg that is normally the result of diabetes? that is the type of change and positive health outcomes that will benefit -- that will greatly benefit consumers of medical care and make the system cheaper for everybody. thanks, guys. [captioning performed by national captioning institute] [captions copyright national cable satellite corp. 2009] >> earlier today, president obama made remarks on the energy bill scheduled for debate tomorrow in the house. it would cap greenhouse gas emissions emission credits. this is about five minutes. >> >> good afternoon. right now, the house of representatives is moving towards a vote of historic proportions on a piece of legislation that will open the door to a new, clean energy economy. for more than three decades, we have talked about our dependence on foreign oil. we have seen that dependence grow. we have seen our reliance on fossil fuels jeopardize our national security. we have se

if you have diabetes, you should be paid well by how you treat the overall disease. we need to create incentives for physicians to team up, because we know that when that happens, it results in better results. we need to give doctors bonuses for better health outcomes for better health care. we need to rethink the cost of a medical education and do more to reward medical students who choose a career as a primary care physician who choose to work in underserved areas. [applause] that is why we are making a substantial investment in the national health service corps that will make medical training more affordable to primary care doctors and nurse practitioners so they are not drowning in debt when they enter the workforce. [applause] in debt. [laughter] the second structural reform we need to make is to improve the quality of medical information making its way to doctors and patients. we have the best medical schools, the most sophisticated labs, the most advanced training of any nation on the globe. yet we are not doing a very good job harnessing our collective knowle

supposedly has universal health care -- and reported that patients with chronic illnesses, such as diabetes, heart disease, were not taking their medicine or not getting the treatments that they needed because they couldn't afford the 25% copay. and massachusetts has almost everybody covered. so when we talk about the health care crisis, it's not just the number of people who have no health insurance; it is people who are underinsured. and you add that together, we have huge numbers of people who are not getting the medical care that they need, when they need it and the result is not only personal suffering; the result is, they end up going to the emergency room, costing the system far more than it should, or they end up in the hospital at highly inflated medical cost. this makes zero sense. and, it is a manifestation of a dysfunctional health care system. but in the midst of all of this, you know, somebody may say, well, you got 46 million uninsured. more underinsured people are dying. but at least we're not spending a lot of money. you know, if you bought an old, broken-down car and you s

- illness the cost goes down and it is a powerful argument. >> i know from my mom who lived with diabetes and depression, when she was not taking care of the depression there was no way she would take blood sugar levels. no way. this goes from me to something else that may be is premature t

and required weekly trips for refills and diabetes supplies. christine shared the story with me after watching her mom's anguish as she struggled to afford medication and make it to the doctor week after week. madeline in pawtucket cannot afford health insurance coverage despite working two jobs. her family has a history of colorectal cancer but she cannot afford to get a colonoscopy. without insurance, madeline waits and hopes that she doesn't get sick. because that's the only option she has. for these rhode islanders and millions more americans silently suffering all over the country, we must now be a voice. we must improve the quality of our health care. develop our health information infrastructure. and invest in preventing disease. we must protect existing coverage when it is good. and improve it when it is not. and the president has said, if you like your health care plan, you can keep it. we must dial down the paperwork wars. and dial up the information to consumers. and we must speak for the 46 million americans, 9 million of whom are c

it is swamped by the fact that at least when you look at diabetes care, it looks like again and again, minority patients, because of the way they live, providers are having real trouble delivering high quality care. >> the right way to clarify this in terms of full spectrum, there are a variety of issues, we have to not find the unilateral or silver bullet solution. if we look at the data, cultural confidence is very important. if you look at the full spectrum of data, we find much of what dr. chandra and peter have published, to understand there are quality of care issues in terms of delivery care, but if it was just a linear situation where it was just that, as dr. chandra pointed out, it would be 60/forty, 100% correlation. to understand the importance of workforce diversity and all of that is truly what we're trying to get at in terms of understanding the disparity. that is some of the work that dr. chandra and peter have published have been instrumental in understanding the rules of geography and the full spectrum of datapoint to other factors which are important and cultural com

they pay more when it gets better compliance with diabetes medication or better results and other specific aspects. the challenge is there are some dimensions of important quality of care that even if you get improvements in some specific areas and can be hard to have an impact on overall cost and our overall health outcomes for a population so and many of these demonstrations when we have seen is an impact on specific aspect but may be less of an impact on overall cost because additional payments offset savings that might occur because you've got improved performance. more of an emphasis on trying to bring cost and reducing unnecessary cost directly into the performance incentives. a lot of effort is underway to implement the episode based payment when there is a payment based on a particular procedure like bypass operation and the hospital care, the physicians' services and may be a case based piven for diabetes and these might be adjusted for the illness for the patient but the idea is you get paid the same amount or more if you deliver better quality care and those payments can be righ

the second is the juvenile diabetes program we are building. this is something terribly important to us. it is one of the centerpieces of all the foundations. the third big thing is our relationship with the boys and girls club of greater washington, specifically we work with the chapter closes to the ballpark, but we reached out to all of them. we are proud to do all this work. the three anchor programs are all four children or for d.c.. d.c. children. that is what we are spending our time and effort to achieve to benefit. they also do some little things. let me give you a list. arlington little league, centro neosho, center city schools, children's cancer foundation, d.c. rbi, the everybody wins program, hispanic scholarship funds, living classrooms foundation, the diabetes center, rebuilding together programs, and the tyler elementary school partnership fund. that is just a partial list of the grants that are foundation had given out in the last year or two. in addition, the steps we do with our players and with their coaches and managers in

are 50% and more likely than whites to suffer from diabetes and incidences of diabetes, and with native americans, that number come as welcome is twice that. they are much more likely to suffer from hepatitis b and liver cancer, as compared to the general population, so we have seen over the past many, many decades of health disparities and the emergence and we confirming of data in terms of the impact of disease prevalent, morbidity, and mortality on minority populations across the board. i want to mention that one of the significant challenges that we face in documented health disparities are data gaps when we look at specific populations, so we face the challenges in collecting data on native american and specific pacific islanders and the populations as well as some specific hispanic populations across the board, but from the data that we have seen and have seen over the past two or three decades, we have seen a continued confirmation in the existence of health disparities in minority populations. what is the cause of these disparities? it is certainly multi factorial. there is the

treatments for diabetic retinopany saves us billions annually. it is resulting in treatments that is slowing vision loss. starting next year the first wave of the 78 million baby boomers will be turning 65 years old. an age of elevated risk for eye disease. in the african-american and hispanic populations and the increased incidents of eye disease, the n.e.i. will be challenged more than ever to fund basic and clinical research that results in treatment and therapies. as demonstrated by its past history, i'm confident that n.e.i. will rise to this challenge. of course, we in congress must make sure that it is adequately funded so they can continue the research and the vision help for all americans. thank you, mr. speaker. i yield back the balance of my time. the speaker pro tempore: the gentleman yields back the balance of his time. the gentlewoman from wisconsin. ms. baldwin: thank you, mr. speaker. i want to close by recognizing just a few of the champions of eye health and the warriors against eye disease from the district that i have the priv

five of the costliest illnesses and conditions, cancer, cardiovascular disease, diabetes, lung disease, and strokes can be prevented. yet only a fraction of every health care dollar goes to prevention or public health. that's starting to change with an investment we're making in prevention and wellness programs that can help us avoid diseases that harm our health and the health of our economy. as important as they are, investments in electronic records and preventive care, all the things i just mentioned, they're just preliminary steps. they will only make a dent in the rising costs in this country. despite what some have suggested, the reason we have these spiraling costs is not simply because we've got an aging population. demographics do account for some rising costs because older, sicker societies pay more for health care than younger, healthier ones. there's nothing intrinsically wrong in us taking better care of ourselves. what accounts for the bulk of the costs is the nature of our health care delivery system itself. a system where we spend vast amounts of money on things that a

i have been a type 1 diabetics for the last 25 years in the last 17 years i have been without insurance. three weeks ago i was diagnosed with a cancerous condition in my lungs. i have had to make these decisions myself. as to how to get insurance -- how to get coverage, how to get my health situations covered. that is just so that i can live. this is real life. this is not some kind of a theoretical thing for you. to people who are uninsured are happy with their insurance -- hell, i am not happy with many things that go on in my life except that over one-third of my income has gone to pay for just maintenance of my diabetes. now i will need to cover the need to stay alive. i am 61 years old. i do not fall under medicare or medicaid. the gentleman that i work for, honest, good man, a republican, cannot afford insurance for those i work with because of a guy like me. get real. this is easy. host: will the spending policies of the obama policy to help a guy like this in kansas? guest: yes, the health care policies will. to make it possible for those who need health care coverage to get it.

otherwise, the rates of obesity, diabetes and other chronic diseases will likely rise. and we need to reinvest in the crucial part of our public health infrastructure so that we can take community-based action to fruendt long-term public health crisis. secretary sebelius, you're the head of what i think is the largest public health agency in the world. you probably know as well as anyone that public health workforce is rapidly aging. by 2012, half of the public heathrow work north some states will be ready to retire. in my opinion, our public health system did a good job of managing the recent h1n1 flu outbreak but this incident has shown us how critical it is to not let our public health workforce deteriorate any further and i'm pleased that the -- my piece of us was incorporated into the draft bill. madam secretary, i want my colleagues to understand how critical the public health work forcest is. will you please outline for the benefit of this committee how your job is dependent on having a robust public health workforce backing you up? >> congresswoman, first of all

idea and prevention is a powerful with the public and they get it intuitively that if someone has diabetes and can self monitor his or her condition and treat it it costs a lot less and has a far better outcomes and if you put out here until you have to have a leg amputated so i think the messages about the positive aspects of prevention and wellness is common sense we intend to reinforce and that. in terms of the coverage one of the more powerful messages to emerge through recent things is your insurance company should be able to deny treatment because you're sick five years ago or your child has asthma and so i think hitting does your friends when messaging to the public is something that resonates and people understand both from this makes sense without having taken into the number of dollars that goes to health care management and highlighting the potential both in terms of unwellness and out comes as well as prostrating. >> is an example of the approach to have which is it is not just about this condition that the swing to diabetes and expanding greatly and giving people does m.r. pub

influenced by prevention, including the quality of ambulatory care, which can check the progression of diabetes, hypertension, or chronic disease, and through this, incidences of stroke and heart attack. at the very end of the causal chain is the world of disparities. the quality of medical care matters much more than the disparity in the quality. in the 6.5 year life expectancy gap and the 4.5 racial gap for women, which are larger when one accounts for the conditions, they are unlikely to be affected on the focus -- with the focus. the preoccupation with trina disparities is an end game, and it simply misses the fact that many minority patients simply find themselves confronting the end game sooner than everyone else. thank you. >> thank you. doctor? >> thank you for the invitation to -- whoops -- to address you today. is this better? thank you, chairman reynolds and co-chairman. my name is sally satel, and i work at a methadone clinic in northeast washington, d.c., and i wanted to give you an overview today of the contours of the health despair to debate. now, what do i mean by debate? there

chronic disease management gets into diabetes maintenance. it gets into heart disease and things that one can do in part in lifestyle change, in part through regular treatment, scheduled treatment by a physician. i'm not sure that all three of them can be lumped into the same thing. and i think if you look at the savings side, whether it's pitney bowes, safeway, whether it's dell, whether it's sas, whoever it is. there's no question that i think every company is out trying to do prevention and wellness. not every company has figured out how to set the correct incentives in place to do chronic disease management. i just want to draw a distinction between the three boxes. >> the department said that after publication of the department's 2006 wellness program regulations, that's what gave the 20% variance. they said a number of, quote, wellness programs began to proliferate compromised of little more than biometric screenings to obtain reduced premeiums. these have the potential to discriminate based on health status. so, again, if we're going t

if you have diabetes to go this is somebody. i have a friend who recently tried to take his life basically because of the recession. i'm sure there was more involved but business -- we all love this, the stories are out there. and i said send flowers, i am calling -- most people don't know what to do but to do the same thing you would do no matter what the particular illness is and that is part of the way to educate people. so when i first approached the whole subject the really was astounded and how we could discuss this publicly and the kind of shame and stigma that was attached to its. i think that is something that we really have to address. cannot allow to be trivialized as a character witness when it is a medical disease. part of said answer in combating all that is in research being done and yet to be done, the role that genetics and the environment play in the genesis of the most serious mental illnesses. part of the answer lies in better access to the full range of eight health care and that is something on the table th

and that if you look at the cost of treating depression with someone who has either heart disease, diabetes, any chronic illness, heart disease, by treating that mental illness, the general costs go down and it's a pretty powerful argument. >> i think so. and i know from my mom who lived with diabetes and depression, when she wasn't taking care of the depression there was no way she was going to check her blood levels and her blood sugar levels. just no way. this thing goes to something else that maybe it's premature for the conversation right now but i'm increasingly thinking about, and that is that i think we understand now that in the general medical settings, and less there is a mental health specialist who is on the team and on the floor, it's not going to get done. somewhere around 44% of gps say they are comfortable with detecting and treating the debt under an depression. if we look at alcoholism, that drops below 20%. so one of the things that this is going to require is we are going to have to figure out how to have a specialist, not over on the other side of the street in the men

the incidence of diabetes in this country is unbelievable. it rach it's up, up and up -- it ratchets up, up and up every year. and you wonder about that, wonder about america's children and the number of children that are overweight and obese, and walk into a school and then find out that in a number of schools in our country, they've decided to -- to make money by allowing the -- the soda machines, the pop machines from the largest manufacturers in the country to sell coke and pepsi and the other soft drinks in the schoolroom hallways. and you can buy not only a soft drink full of sugar and then you can buy perhaps a bag of doritos to go with it in the middle of the afternoon at school. so what kind of message is that in a country in which a substantial number of the people, especially children, are vastly overweight and in which we, by the way, minimize physical fitness in our schools because we've become very obsessed, and necessarily so -- we care now more about math and sciences and getting out of our school system more engineers, more p