dr. burgess, for his leadership on this issue. and can only hope that as we move forward, we do, we are allowed to have an open and a vibrant discussion so that the congress of the united states can have the benefit of the wonderful experience of people on both sides of the aisle as we move forward to solve this remarkable challenge in the area -- mr. shadegg: would the gentleman yield for a question? mr. price: i'm pleased to yield. mr. shadegg: i couldn't agree more with the mandates. i thought it would be useful to us for the audience to illustrate kind of the kind of poster child for mandates that the other side often recites and talks about. and that's mandatory auto insurance. the gentleman pointed out that individual mandates tend not to work. and indeed the individual mandates in the health care plan in massachusetts are not working. people are refusing to go along with those. people are choosing to refine instead of complying with the government mandate to buy health care. as the gentleman knows, most of the states, matte

dr. burgess said.absolutely this idea of course of cobra, if somebody loses their job and they can continue to get the health insurance through that particular employer. only they pay 100% plus 2% so 102% for 18 months. it may mean that person has been working for that company for 15 or 20 years and developed coronary illness or type 2 diabetes. and what happens after the 18 months runs out and they try to get, as mike said, a health savings account or individual policy or small group policy? they either have to pay two or three times standard rate or denied coverage completely. well, this is an area where we say we can fix the system in regard to insurance reform by saying to the insurance company, that man or that woman deserves credible coverage. and because they've been paying all these years in the insurance company made a healthy profit off that individual who may be has gone fought doctor at most once a year for a checkup during all these years and then all of a sudden they find themselves in a

dr. burgess' amendment on medical malpractice reform.can't -- we can't pick and choose and that is my great concern. the other, just on feet subject itself with regard to the community assisted living services and support is that cbo has already spoken on this issue that the question whether its actuarial sound over the long term and whether premiums will be insufficient to support the goal for which you're seeking to achieve. so, really bothered here at the moment that the chairman of the health subcommittee at a markup whereby we were given a 1,018 page build in the first amendment out of the box is a 75 page amendment and it could be a bill in and of itself. i'm bothered both on two grounds, mr. chairman. one on substance and the other on procedure. so i will rest to the gentleman's point of order and ask that the chair be impartial in his ruling. >> i yield back, mr. chairman. >> the chair is ready to rule. the gentleman from georgia wish to speak on a point of order? the gentleman is recognized. >> i did have a question not pertaini

dr. burgess from texas the remainder of my time. >> i thank the gentleman. this reminds me of a christmas club back when i was a kid. put money away each month and there's no insurance on the account but you have the good faith by christmas time it will be there and it will have accumulated some value. despite what my ranking member says i'm going to reserve the right to oppose this amendment because -- one of the biggest funded liabilities in the medicaid system is long-term care obligation to people who are my age and who will be medicare eligible in ten or 15 years' time. the fact of the matter is we are not doing enough to prepare ourselves for that pagen coming down the python, and i worry this type of legislation will give people a false sense of security that they addressed the problem when in fact they have not. i'm also worried about as mr. walton already appropriately pointed out there is no number filed in the bill. we don't know if it did become a payroll deduction what amounts are there and whether or not it is age adjusted, with the amount woul

dr. burgess' amendment on medical malpractice reform. we can't -- we can't pick and choose and that is my great concern. the other, just on feet subject itself with regard to the community assisted living services and support is that cbo has already spoken on this issue that the question whether its actuarial sound over the long term and whether premiums will be insufficient to support the goal for which you're seeking to achieve. so, really bothered here at the moment that the chairman of the health subcommittee at a markup whereby we were given a 1,018 page build in the first amendment out of the box is a 75 page amendment and it could be a bill in and of itself. i'm bothered both on two grounds, mr. chairman. one on substance and the other on procedure. so i will rest to the gentleman's point of order and ask that the chair be impartial in his ruling. >> i yield back, mr. chairman. >> the chair is ready to rule. the gentleman from georgia wish to speak on a point of order? the gentleman is recognized. >> i did have a question not pert

dr. burgess' amendment on medical malpractice reform. we can't -- we can't pick and choose and that is my great concern. the other, just on feet subject itself with regard to the community assisted living services and support is that cbo has already spoken on this issue that the question whether its actuarial sound over the long term and whether premiums will be insufficient to support the goal for which you're seeking to achieve. so, really bothered here at the moment that the chairman of the health subcommittee at a markup whereby we were given a 1,018 page build in the first amendment out of the box is a 75 page amendment and it could be a bill in and of itself. i'm bothered both on two grounds, mr. chairman. one on substance and the other on procedure. so i will rest to the gentleman's point of order and ask that the chair be impartial in his ruling. >> i yield back, mr. chairman. >> the chair is ready to rule. the gentleman from georgia wish to speak on a point of order? the gentleman is recognized. >> i did have a question not pert

dr. burgess, with whom i worked very hard on this amendment. >> i thank the gentlelady for the recognition. this is -- the concept was to allow for end of life planning before you got to that point of the care of a patient. and really this was only to deal with the ability to establish grants between the recipient of the care, and wouldn't involve the states. >> with the gentleman yield? >> yes. >> isn't it true though the language that mr. stupak and mrs. baldwin agreed with appear to be pro-life language in other words, if you are a pro-life member the unanimous consent request improves the bill in that respect; is that not a true statement? >> of course i am pro-life member and the statement is correct. >> i would ask my friend from oregon to not object to this. this actually improves the bill -- >> if you will allow -- if you have the time, doesn't this promote with the people of oregon voted for? to provide information about in of life alternatives? it doesn't conflict, as i understand it -- with your policy. >> it is just to find out what in the devil it does or doesn't do. and what

dr. burgess' amendment was written to give the secretary that same discretion and it was ruled -- it wasuled nongermane. and i mean. and well, the gentleman, only briefly. it says specifically the program does not go into effect until -- until a statute is passed that does that. that -- that establishes the voluntary payroll deduction. we have to have -- legislation to accomplish that. that's how it avoids the problem that you're suggesting. >> i'm going to yield to mr. shadek. >> it was my intent to seek time on my own, because i have a deep concern about the germaneness of this particular amendment. if you go to page four, it talks about -- liability protections for volunteers or volunteer practitioners. as i understood mr. burgess' amendment, it dealt with the issue of liability. we're told that's within the jurisdiction of the committee. i have for years wanted to extend federal liability protections to -- to surgeons working in emergency rooms, performing -- performing procedures or doctors, performing procedures in emergency rooms compeled by impal has. but -- i assume that if we r

dr. burgess with us. doctor? >> don't get any ideas about the young stuff because trent was talking about testifies i remember when i went to practice indenton county i was on a party line. i would have to ask people if they would mind vacating lines. i really like this bill. i like the sensibility of this bill and the emphasis where it puts really the rubber meets the road in healthcare and that's where the patient and doctor interact in the treatment room or the operating room, the emergency room, what have you. you think about how our government has punished through the tax code someone who has the audacity to want their -- to own their own insurance policies. someone who wants to have a lodge attitudal relationship with their insurance outside of their place of employment and yes they can do it but it's going to cost them significantly more than someone who purchases insurance through their workplace. i like the way that this bill puts the responsibility, really gives the dollars to the patient and allows the

on our panel and is in alphabetical order where we have michael burgess, the 18th district. rep. and drical association where he is active in the georgia delegation surgeon for 20 years and a three term representative for, the sixth district of georgia. and it dr. phil's perot, ob/gyn for 30 years, first term from the first district of tennessee. in addition, we have our physician panel at the end, dr. stuart cardiologists, and the chairman of the board, we have a vascular surgeon and past president of the district of columbia, and we have a woman and internist and endocrinologist. we're going to start with dr. signees who oppose the first question. >> thank you, peter. i'm going to close -- pose the first question. during the healthcare debate there is much attention paid to the needs of the 47 million uninsured. as measures to ensure that all americans of quality health care should be a central piece of any health reform by congress i would ask who are the 47 million insured and how to provide them health care. >> thank you very much for the question before and specifically answered i

burgess. dr.e do testing and if you have to report the positive results, after a while if you see a continued positive results for e. coli from a plant, it indicates two of a problem and we have to get there were these increase inspections, like a peanut butter one and the salmonella where we had report after report of problems but no one received a report, no one ever knew what was going on. >> i agree with you. the fda has got to respond to problems very aggressively and has got to be able to follow up with manufacturers that aren't meeting standards and if necessary shut them down, and in recent weeks we have taken action against some firms. >> but you would know unless he received positive results, unless you receive the results. some one receive results then looked at them, right? >> could be that we get a complaint and investigate it. it could be the testing that fda doesn't i'm sure it does do some testing in the samples. we can find out the problem. we can get somebody call on us say there

dr. burgess to strike the public plan. many of us are deeply concerned about the creation of the public plan indeed many doctors across ira katz are concerned that public plan will reimburse doctors at medicare rates. many of us are aware doctors across america cannot practice at medicare rates and indeed many communities across the country it is impossible to find a doctor who will take medicare patients and doctors are more and more singing they will do that. they will no longer accept patients on medicare because they cannot accept the reimbursement. all of us as members of congress are each year by doctors who come and see us and ask for an update of their payment we struggle that issue each year. it would be inappropriate if costs were shifted on to the private plan so why amendment simply says that the secretary shall negotiate not payment rates for providers under the public insurance option with all health care suppliers and providers and that it shall do so without any reference. the secretary shall do so without

dr. burgess. arra amendment is based upon legislation that i first introduced with chris smith last year, the independents at home act. our amendment is quoted by a wide range of stakeholders including the aarp, consumers union, the american academy of comcare physicians, intel and 30 other organizations. our amendment creates the independents at home pilot program in the 13 states with the highest medicare patient costs plus 13 additional states to be identified by the secretary to ensure geographical representation. and the district of columbia for a total of 26 states and the district of columbia. >> would the gentleman yield? we are prepared to accept the amendment. you might want to let mr. burgess no briefly but we think it is a good amendment. >> i thank the gentleman and i will yield to the gentleman from texas. >> i thank the gentleman for yielding and i so appreciate him offering this amendment. this is one of the most important issues that our generation will face and hand off to the ne

dr. burgess?s is, i guess, the only active hearing on the house side that is going on even though we are right now being told we are under a tight timeline. i've heard your testimony before and it is always moving. i do not think i have ever heard quite that wrapup you gave about no one down here checking your bank account. and last night the president called us out as doctors and said we were not seeing sick people. that is just flat wrong. america's doctors and nurses have been doing the right thing in spite of medicaid, in spite of the abysmal reimbursement rates that are there in the public sector. thank you for saying that. i did not intend to do that, but you force me, and i'm glad you did. dr. secours, could i ask a question? the german as a tight gaveled here, i know of. -- the chairman has a tight cavell, i know. could you discuss the differences between your medical system and ours? >> it is regionally organize and still allows for very little choice. the go to a general practitioner who

dr. burgess. >> trend was talking about the telephones, i remembered if people would mind vacating the lines so i could call in for my patients. i really like this bill. i like the emphasis it puts on where the rubber meets the road on health care. that is patient dr. interaction. if you think about how our how -- if you think about how our government has the audacity to wants to own their own insurance policy, someone wants to have a longitudinal relationship with their insurance outside of their place of employment. yes, they can do it, but it will cost significantly more than someone who purchases insurance through their work place. i like the way that this bill puts the responsibility, really gives the dollars to the patient and allows them to direct where it is going nothing that we have looked at in the other proposals that are coming out this afternoon really do anything to limit the volume of health purchases except for perhaps putting some caps on physical therapy and radiology. otherwise, we don't address the volume cited all. we will have to address the volume side runt -- one day

dr. burgess, for yielding.he state of indiana in 1975, we became the first state of the union to enact comprehensive malpractice reforms it is called the indiana compensation act for patients it became a model for other states as it balanced the need for physicians for affordable liability insurance premiums with the need for patients for good access to all kinds of care. our law contains components very effective for three decades. our statute of limitations limits on recovery, patients compensation fund, a medical review panel and the limit on attorneys' fees. when you balance indiana's success, the state of indiana contiguous is very expense is city of practice medicine, meaning people who live in indiana have greater access to health care. now, when you think about the trends and jury awards and settlements, overall, 74% of the medical liability claims in 2004 were closed without payments to the plaintiff. the plaintiff lost a majority of the cases that went to the jury. of the 6% of the claims that went to

dr. burgess, for yielding.in 1975, we became the first state of the union to enact comprehensive malpractice reforms it is called the indiana compensation act for patients it became a model for other states as it balanced the need for physicians for affordable liability insurance premiums with the need for patients for good access to all kinds of care. our law contains components very effective for three decades. our statute of limitations limits on recovery, patients compensation fund, a medical review panel and the limit on attorneys' fees. when you balance indiana's success, the state of indiana contiguous is very expense is city of practice medicine, meaning people who live in indiana have greater access to health care. now, when you think about the trends and jury awards and settlements, overall, 74% of the medical liability claims in 2004 were closed without payments to the plaintiff. the plaintiff lost a majority of the cases that went to the jury. of the 6% of the claims that went to a jury in 2004 to a

dr. burgess and then mr. stern's. >> and thank the gentleman for yielding, between these two proposals offered by the ranking member, this proposal mr. chairman is a shame we did not serve from this .4 months ago. there is a broad consensus and would have delivered a product that would have solved a problem for a million which is the real problem they're asking us to solve, they don't want us to turn over 17 percent of the nation's economy to some program they don't trust the they do want us to fix this problem and as you can see from this discussion there are good ideas on both sides to have to get this down. i yield back mr. vartan met mr. stern's. >> quickly, council appears to me that the offensive did this start six months after enactment but there is a clause on page three special rule for collective bargaining agreements and the question i have reviewed is this of this, the more these collective bargaining agreements and special exemption. the bill starts by six months after enactment of a site into th