cleve is a very important leader of healthcare reform in massachusetts. he's also participating very much in the day-to-day way in that healthcare reform as well. he's been an outspoken advocate for quite a bit of time now on payment reform and he is doing some very interesting things with his own company. joining him will be andrew dreyfuss who is executive vice president of healthcare services for blue cross blue shield of massachusetts. >> good morning. it's good to be ñ avoidable medical errors and they could be by abuse or omission of services and a strong statement about medical errors generally in the system. it was the first time that the magnitude of the problem was characterized for the nation in such actionable terms. this report came from a prestigious organization, the institute of medicine, which has lots of physician credibility all around the world. and so about five years ago, kind of having righted our insurance company, we decided that the next place to add value for our members was to improve the quality of care that they received. an

the gentleman from massachusetts. mr. lynch: madam speaker, we have no further speakers at this time. however i continue to reserve. mr. bilbray: madam speaker, i yield back the at this time. the speaker pro tempore: the gentleman from california yields back his time. the gentleman from massachusetts. mr. lynch: madam speaker, i just urge our colleagues to join with congressman cuellar and naming this post office in memory and in honor of our united states and texas veterans. with that i yield back the balance of my time. the speaker pro tempore: the gentleman yields back the balance of his time. the question is, will the house suspend the rules and pass h.r. 2325. those in favor say aye. those opposed, no. in the opinion of the chair, 2/3 of those voting having responded in the affirmative, the rules are suspended, the bill is passed and without objection the motion to reconsider is laid on the table. mr. lynch: madam speaker. the speaker pro tempore: for what purpose does the gentleman rise? mr. lynch: i'd like to reque

within massachusetts and instead of focusing on coverage it focused on cost. and one of the centerpieces of that law was the creation of a commission, a payment reform commission, which is focused on how do we change payments in massachusetts in a way that advances these twin goals of improved quality and cost. and, remarkably, by the first meeting of the commission on which i serve, the consensus emerged that was we have to move away from the server system and towards a system of global payments if we are going to as a community slow the rate of growth in health care spending, and improve quality. much of the deliberations of the commission and i believe the ultimate recommendations due to be released within weeks, of the summer, were based on the alternative quality contract which we call our aqc in massachusetts and i want to plain that now to you, what we are -- explain that how to you, what we doing with that. what is our alternative quality contract? well, the assignment was fairly simple. but, challenging to accomplish. design a payment system that prom

the chair recognizes the gentleman from massachusetts. mr. lynch: madam speaker, we have no further speakers at this time. however, we continue to reserve the balance of our time. the speaker pro tempore: the gentleman reserves the balance of his time. the chair recognizes the gentleman from utah. mr. chaffetz: madam speaker, seeing no other speakers, i'd yield back the balance of my time. the speaker pro tempore: the gentleman yields back the balance of his time. the chair recognizes the gentleman from massachusetts. mr. lynch: thank you, madam speaker. we yield back the balance of my time. the speaker pro tempore: the question is will the house suspend the rules and agree to house resolution 435 as amended. those in favor say aye. those opposed, no. in the opinion of the chair, 2/3 having responded in the affirmative, the rules are suspended, the resolution is agreed to and without objection a motion to reconsider is laid on the table. without objection, the title is amended. for what purpose does the gentleman from massachusetts rise? mr.

the gentleman from massachusetts. does the gentleman from massachusetts continue to reserve? mr. markey: i continue to reserve. the speaker pro tempore: the gentleman from massachusetts continues to reserve. the gentleman from texas. mr. barton: madam speaker, i am going to ask unanimous consent for a brief recess to find the official copy that includes everything passed at the rules committee last night because i am told that what is at the desk is missing 300 pages. that cannot be the official copy. the speaker pro tempore: is there objection? is there objection? mr. markey: i would object but ask the gentleman to yield to me, if he would. mr. barton: why don't you reserve -- mr. markey: i reserve the right to object. mr. barton: i'll be happy to yield to my friend from massachusetts. mr. markey: i thank the gentleman for yielding. the manager's amendment, which is i think what is of concern to him, is on the rules committee website that can be accessed right now by and has been there and available for any member or any citizen of the united states to be able to read. it is on

cleve is a very important leader of healthcare reform in massachusetts. he's also participating very much in the day-to-day way in that healthcare reform as well. he's been an outspoken advocate for quite a bit of time now on payment reform and he is doing some very interesting things with his own company. joining him will be andrew dreyfuss who is executive vice president of healthcare services for blue cross blue shield of massachusetts. >> good morning. it's good to be here. we don't often get a chance to present to this particular collection of folks, so this is pretty exciting. we are grateful to have this opportunity. as nancy just said i'm copresenting with andrew dreyfuss, my partner in crime back in massachusetts. his team leads the development and implementation of our alternative quality contract. what i'd like to do is just take a couple of minutes to try to create a context in which the aqc emerged and then andrew is going to take you through some of the main elements. in the mid-'90s blue cross blue shield of massachusetts was in trouble. it

the chair: the gentleman from massachusetts. mr. lynch: i'd like to yield for the purpose of closing to the individual, along with congressman hoyer, mrs. maloney has championed the bill for the past 15 years. i yield her the remaining time in order to close. the chair: the gentlelady is recognized for 30 seconds. mrs. maloney: may i inquire how much time i have? the chair: 30 seconds. mrs. maloney: i appreciate my colleague's hard work and effort but i rise in opposition to the amendment. the amendment would do absolutely nothing but maintain the status quo. it asks federal employees to continue to cobble together sick and annual leave if they want to get a paycheck while they care for their new child. this policy does not help relatively new employees, younger workers, or those with health problems who have little accrued leave to draw on. it also puts the health and well being of our employees and their families at risk. a new baby typically -- the chair: the gentlelady's time has expired. mrs. maloney: i would request an opportu

mcgovern of massachusetts. the chair: pursuant to house resolution 572, the gentleman from massachusetts, mr. mcgovern, and a member opposed, will control five minutes each. the chair recognizes the gentleman from massachusetts. mr. mcgovern: thank you, mr. chairman. i yield myself 1 1/2 minutes. the chair: the gentleman is recognized for 1 1/2 minutes. mr. mcgovern: mr. chairman, this amendment is identical to the amendment approved by the house last year. its purpose is quite simple. for over 40 years the names of students and instructors at the former u.s. army school of the americas and now the western hemisphere institute for security cooperation were available to the public. all you had to do was make a phone call, write a letter, file a request and the names were provided. suddenly in august of 2006 the names became classified. the on reason cited by the defense department for denying the names was the list includes personal information. but nothing about the request had changed. no one had asked for new

is currently around 10%, so medical costs are growing at about 10% per year in massachusetts. premiums are growing a little bit lower, because shifting cost to workers, but medical costs are growing about 10%. so then the second thing, and just the second thing we do is then sit down and negotiate an inflation rate, which we're trying to get down to very close to cpi, in the 3% to 4% range, which is very different than what has happened in massachusetts. that's the first thing we do. the second thing we do is talk about performance incentives. and here, we're not talking about the 1% or have percent on even 2%. we're talking about perform an innocencincentives when it coulw hospitals to learn above 10% above their global payments and think for a 2nd, how different this conversation is. most conversations between health plans and physicians and hospitals are every other year, adversarial conversations about price. this is the conversation about a five-year partnership. a five-year partnership about quality and about affordability. it's an entirely different conversation. so pro

jones: i thank the gentleman from massachusetts. i respect everyone's position and everyone's right. but i would like to say that to die for a mystique is an article written by andrew who i quote add few minutes ago. subtitle, the lessons our leaders didn't learn from the vietnam war. . here we are extending an eight-year commitment of our troops in afghanistan. what's going to happen three or four years from now if we are in the same situation and then we're talking about a 12, 14, 16-year commitment? look at what the russians did. they spent 10 years and billions of dollars and thousands of russians killed. look at alexander the great. he tried to conquer afghanistan. he failed. look at what the british did, and they couldn't make it. so all we are saying is, we are not talking about a pullout. we are saying have an end point to your war strategy that the marn people will understand and more -- american people will understand and more important, our military. they're tired. they're worn out. they'll keep going. they'll go back fiv

mcgovern of massachusetts. the chair: pursuant to house resolution 572, and the order of the house of today, the gentleman from massachusetts, mr. mcgovern, and a member opposed each will control 10 minutes. the chair now recognize mr. mcgovern. mr. mcgovern: i yield myself two minutes. the chair: the gentleman is recognized. mr. mcgovern: this amendment requires the secretary of defense to provide congress by the end of the year with an outline of our exit strategy for u.s. military operations in afghanistan. this bipartisan amendment offered by representatives walter jones, shelly pingree, barbara lee, and me does not demand a timeline for withdrawal or halt to the deployment of the 21,000 additional troops called for by the president. it simply asks the administration to present its plan for the beginning, middle, and end of u.s. military operations in afghanistan. for over eight long years, our uniformed men and women have done all that we have asked them to do in afghanistan. we are now asking them to do m

lynch of massachusetts. the chair: pursuant to house resolution 522 the gentleman from massachusetts, mr. limple, and a member opposed will each control five minutes. the chair recognizes the gentleman from massachusetts. mr. lynch: thank you, madam speaker, i yield myself such time as i may consume. the chair: the gentleman is recognized. mr. lynch: before i begin, madam speaker, i'd like to thank foreign affairs committee chairman berman foring can my amendment and i congratulate the committee for drafting a bill that i think will truly strengthen our foreign affairs profile overseas. as well as strengthen our capabilities. i rise in support of my amendment which will direct the state department to assess and report to congress on the special immigration visa program for certain iraqi and afghan nationals employed by or on behalf of the united states in both afghanistan and iraq. as a member of the house oversight committee and a member of its national security and foreign affairs subcommittee, i've been t

lynch of massachusetts. the chair: pursuant to house resolution 474, the gentleman from massachusetts, mr. lynch, and a member opposed, each will control five minutes. the chair recognizes the gentleman from massachusetts. mr. lynch: thank you, mr. chairman. i want to thank mr. thompson, the chair of the homeland security committee, for his great work on this bill. specifically this amendment that i have offered would address a difficult situation that is faced by our transit security officers, especially those on the mexican border, but in every port of entry in the united states. we have about 50,000 of these officers that actually come in contact, physically wanding and screening travelers. as you may remember after the outbreak of h 1. n 1 virus -- h1n1 i virus the outbreak was in mexico city. the officers we put on the border, especially in laredo, texas, and other heavily affected states, were not allowed, they were not allowed to wear asks, to wear gloves, or to use hand sanitizer as they proceeded to

the chair recognizes the gentleman from massachusetts. mr. lynch: thank you, madam speaker. i ask unanimous consent that all members may have five legislative days to revise and extend their remarks. the speaker pro tempore: without objection. mr. lynch: i yield myself such time as i may consume. the speaker pro tempore: the gentleman is recognized. mr. lynch: thank you. madam speaker, on behalf of the house committee on oversight and government reform, i'm pleased to present house resolution 356 for consideration. this legislation expressing our support -- expresses our support for the designation of february 8, 2010, as boy scouts america day. in recognition of the youth organization'sup coming 100th anniversary. house resolution 356 was introduced by my colleague, representative ralph hall, of texas on april 23, 2009, and favorably reported out of the oversight committee on may 6, 2009. additionally house resolution 356 enjoys the support of over 70 members of the congress. madam speaker, the boy scouts of america was incorporated by chica

health care grow at a slower rate than it has been and i will tell you the health care trend in massachusetts currently around 10% of the medical costs are growing about 10% per year. premiums are growing a little bit lower because shifting costs of workers but medicare costs are growing about 10%. so the second thing we do is then sit down and negotiate an inflation rate we are trying to get down close to cpi and the three to 4% range which is different than what's happened in massachusetts. so that's the first thing we do. the second thing we do is talk about performance incentives and here we are not talking about the 1% or half percent or 2%. we are talking about performance incentives when fully executed could allow physicians and hospitals to earn up to 10% above their initial global payment. think for a second how different this conversation is. most conversations between health plans and physicians and hospitals are every other year adversarial conversations about price. this is a conversation about a five-year partnership. five-year partnership about quality and about affordability.

, massachusetts -- consumers will pay half. it's a vitally important part of cost component. there would be a willingness to share that cost across load. the distinction i want to make here is that the issue of cost allocation from building lines to interconnect generation resources departs from that. we want -- in order for our consumers to be protected, we want the cost of developing generation and the cost of compliance measures and the cost of delivering reliability to load so you don't impact the reliability of the system including the price that they are charging customers. >> just one comment i think this is a new approach that some of us are suggesting. because there is new national need just as important for reliability and that's to prevent the earth from turning into toast. so that's the reason for our thinking. thank you very much. >> the chair -- the gentleman's time has expired, again, there will be a second round of questions for all members who are interested. the chair recognizes the gentlelady from the state o

mcgovern of massachusetts. amendment number four by mr. mcgovern of massachusetts. amendment number nine by mr. franks of arizona. amendment number 15 bhi bimr. akin of missouri. amendment number 34 by mr. holt of new jersey. amendment number 20 by mr. connolly of virginia. the chair will reduce to two minutes the time for any electronic vote after the first vote in this series. plan for the beginning, middle, and end of u.s. military operations in afghanistan. for over eight long years, our uniformed men and women have done all that we have asked them to do in afghanistan. we are now asking them to do more. of and we are giving them more resources and more boots on the ground to accomplish their mission. what we have not told them is how to tell when their contribution to the political solution is done. and they can begin to transition outs of afghanistan. mr. chairman, i want president obama to succeed in afghanistan. i stand by our commitment to provide the necessary resources to help the afghan people take charge of their own future. as congress authorizes and a

we have seen at up to now with massachusetts. for three years, it has been working with its big comprehensive health care plan. the point that president obama made in his letter to the senate democratic leaders this week was that while he was not crazy about an individual mandate during the campaign -- he criticized his democratic opponents for having such an idea. now, he is saying that he could warm to the idea if there were protections for people that cannot afford to purchase their own health care. host: how much would that cost? guest: it is hard to say. what we know about the 46 million uninsured is that a certain number of them are the working poor. they just cannot find affordable health coverage. they would probably need some assistance in purchasing it. we also know that there is a group between the ages of 55 and 65 that are not yet eligible for medicare. they are having trouble purchasing insurance. they might need some assistance. they might just need a good pool that they could buy into. then we have a group called

i have an lng facility in my district of massachusetts. massachusetts working with federal government has the license to the lng facilities about 10 miles off the coast line to bring in lng into our market and into the new england market. it is a portnow of 30% of the natural gas we use in new england and we support lng and we have license to facilities that notwithstanding, massachusetts city into the ferc will, we don't need another one on land. we are doing it offshore and licensed them with, and the ferc, not yours but the ferc at this point says no, you are going to have another one in massachusetts and even that decision itself could affect the amount of renewables that we need. notwithstanding the fact natural gas may be half of the carbon use as coal it's not nearly as good as renewables will be but it's going to affect our marketplace by having them be forced upon us and the ferc is pressing that now the last four or five years. so that kind of calls into question, kind of this federal one-size-fits-all process where even the when

we took that on in massachusetts. i understand the president considers this plan following the model of massachusetts. let's learn from our state. we have 98% of our people covered by insurance. we did not put in place a government plan. we have competition in health care. we don't need to have the government get in and create a health insurance company in order to have competition. let's be clear. this is not about getting competition in health incur -- health insurance. this is a trojan horse. barack obama said he is in favor of a single payer system. he said it for years. it is the wrong way to go. every single republican who knows anything about the public sector says this is the wrong thing. host: and another of your rights, the money is spent now. employers paid now, call it anything. michigan on our independent line. caller: i would like to say what mitt romney said being the wrong way to go. congress enjoys full health coverage at taxpayer expense. and yet, congress, especially the republicans, will say that h

our project for which even though they're not within massachusetts, massachusetts will consumers will pay half of. it's a vitally important component of cost allocation. and we're looking at reliability to be a willingness within an integrated power grid to share the cross across loads. the distinction i want to make here is that the issue of cost allocation from building lines to interconnect generation resources departs from that. we wanted in order for our consumers to be protected, we want the cost of developing generation, including the cost of meeting compliance measures, and the cost of delivering power reliably to load and making sure you don't adversely impact the reliability of the system, to be borne by the generation developer and included in the price that they're charging customers. >> i really appreciate that. just one comment. i think this is a new approach that some of us are suggesting, because there is a new national need just as important for reliability, and that's to prevent the earth from turning into toast. so that's the reason for our thinking. thank you very

he has been locked up in the state of massachusetts because the supreme judicial court of massachusetts, one of the most venerable institutions in the united states -- it was formed immediately after the salem witch trials -- that -- it is that old. nonetheless, the supreme judicial court of massachusetts ruled that there have been so many appeals in gerald's case that time is more important than justice. we have to put an end to this process. this shocked many, many, many people in the legal establishment in massachusetts. so there we are. c-span: so how do you know -- i mean, what -- what sense do you have that -- as i was reading, i was thinking, why does dorothy rabinowitz write about this? and why are all these other people wrong? i mean, what... >> guest: they aren't all wrong. they -- i knew -- the first that told me what was wrong was -- the kelly michaels trial was my first encounter with this in the '80s. the atmosphere was very like the ayatollah's camp when i raised to the television news editor -- i said, you know, we should do a story on this. there's something wrong with

i have an lng facility in my district, in everett, massachusetts. massachusetts working with the federal government has licensed two lng facilities about ten miles off of the coastline to bring in lng into our market and into the new england market. it's upwards of 30% of the natural gas that we use in new england and we support lng and we have licensed two facilities and not withstanding massachusetts saying to the ferc, we don't need another one on land. we're doing it offshore and we licensed them. the ferc, not your ferc, but the ferc up until this point is saying, no, you're going to have another one in massachusetts and even that decision itself could affect the amount of renewables that we need. right? >> not withstanding the fact that natural gas could be half of the carbon and its use as coal, it's not nearly as good as renewables will be but it will affect our marketplace by having that forced upon us and the ferc has been pressing that now for the last four or five years. so that kind of calls into question kind of this federal one size f

the senator from massachusetts. mr. kerry: mr. president, i ask unanimous consent that the proceedings just -- the prior proceedings not interrupt the comments that we're engaged in. the presiding officer: without objection, so ordered. mr. kerry: thank the chair. and, mr. president, could i have a five-minute notice from the parliamentarian. the presiding officer: the senator will be notified. mr. kerry: mr. president, let me just briefly state before i talk about dean koh in the time we have before the vote -- and i know it is important to get to that vote -- so the science is clearly not divided with respect to global climate change. in fact, every major scientists in the united states whose life has been devoted to this effort -- like jim hanen at nasa or the president's science advisor formerly at harvard -- all of these people will tell you in private warnings that are even far more urgent than the warnings that they give in public. and the reason is that the science is coming back at a faster rate and to a greater degree in

from the university of massachusetts, boston. in james is a member of an organization that was withheld and retirement benefits for fortune 500 companies. he went to george washington university. he retired in 2001 from one particular organization. robert is from the heritage foundation. he is involved in a health insurance reform initiative in 2005. he received his degree from the university of arizona. our next guest was an operations manager. she is very experienced. our next guest directed the bureau of health professions. he has a ba from harvard university. welcome to all of you. thank you for your patience today. you will be given five minutes to summarize your written statement. if there is something you want to comment during your presentation from what you heard from the previous panel, feel free to do that within that timeframe if you think it would be helpful to us. >> thank you. the afternoon to all of you. congratulations on a very good try committee -- tri-committee. your hard work and wisdom and practicality is ev

john had become bored if not disenchanted with his life as a lawyer in massachusetts. he continued its pursuits as his duty to provide for his family. and now, unforeseen by him and everyone else, he was running in revolution. his spirits pour refi, his mind engaged, his studiale became transcendent to preserve the liberty and civil rights of his countrymen. this did he stimulated his brain. it appealed to his ego. it bolstered his self-confidence. he discovered that the talents that had earned him success as a provincial lawyer, his sagacity in his speech. suited him as well in the larger theater. he had it right somewhat timidly at the first continental congress wondering how he would measure up to the great delegates from other states. to his satisfaction if not his amazement, he measured up. now he had joined with them in an undertaking that consumed his attention and his energies in the best of missions. he was liberated from the law. gis and became liberated from most of his family responsibilities because abigail, his partner, was a willing consort in his new mi

even in massachusetts is a cohort two cannot get coverage because of the economics. i think a mandate is an important component of the overall health care reform package. but again come if we cannot address the underlying economics it does not really matter what other kinds of things we have. we will not get the deal done. >> writes. right. that leads the group who supports having a government auction saying that plan will be less expensive and therefore bring everyone in. it is a debate obviously. but the issue of having our country's ordering, whatever the word, every 21 year-old, a young man or young lady that drives a motorcycle says i don't want to have coverage then has an accident which cost one or $2 million and other question is, of who pays for that? >> i was just thinking what tom was saying and sitting here right now, if we could get 97%, i would take at. [laughter] that sounds pretty good. if i can come i have a question for these folks. myself which for any of you, other question about coverage, we think coverage is if something happens if given the cav

i agree with one thing the gentleman from massachusetts has to say. this bill has very important consequences. those consequences are devastating for the future of the economy of this country, and it is in pursuit of the fantasy of thinking that this legislation will cause us to be able to turn down the thermostat of the world by reducing co2 gas emissions when china, india, and other nations are pumping more and more co2 gas into the air all the time. we would be far better served by legislation that would be served -- dedicated to building new technologies before slam the door on our traditional sources of energy like coal, oil, natural gas, and a nuclear power. the most co2 free admission that we have, this bill has done nothing to promote it. it stifles the people of this country to have the kind of competitiveness we need in the world to be able to get an expensive sources of energy. i strongly oppose this legislation. republicans and democrats offer over 200 amendments to try to improve this bill. in shutting down this democratic process, the sp

the speaker pro tempore: the gentleman from massachusetts is recognized for three minutes. ms. markey: i thank -- mr. markey: i thank the gentleman from california, and i thank him and his staff for the outstanding leadership and vision which he has provided on this legislation. this is the culmination of a career of work for the gentleman from california, and it's my honor to have been allowed to partner with him in order to construct this legislation that we bring to the floor here today. i want to thank, as the gentleman from california as well has noted the other members who have worked on this legislation. mr. dingell, mr. boucher, mr. doyle, mr. inslee, mr. green, mr. butterfield, mr. stupak, mr. rush. i mean so many members, including members off the committee, like henry cuellar from the state of texas who worked with us on natural gas-related issues. we will not be here unless we had the cooperation of so many members across the full spectrum of the house. during this process we have received valuable input and expertise from other leaders in the house like chairman ra

the gentleman from massachusetts. mr. lynch: i would like to yield at this time three minutes to the chairman -- full chairman of our committee,ed towns of brooklyn, for three minutes. the chair: the gentleman is recognized. mr. towns: i would like to thank the federal work force subcommittee chairman, mr. lynch, for the outstanding job that he has done. i would like to thank congresswoman maloney for her leadership on this issue. i would like to thank the majority leader, steny hoyer, for his work on it. and i would like to thank congressman connellly for his work as well. the the gentlewoman from from new york has worked tirelessly to make the federal government an environment that is supportive of working mothers and fathers. i want to thank her for her efforts. and may i add, a job well done. we need to recognize that the federal government is the largest employer in the united states and that it is -- its policies should set the tone for the country. h.r. 626 provides federal employees with four weeks of paid parenta

[laughter] which as it so happens springfield massachusetts is full of anyway.we all the american car a lot more than entertaining spectacle of detroit's barry as billionaires. [laughter] in fact, many people my age, we owe our very existence to the car or to the car's back seat. [laughter] where if you check our parents' wedding anniversary with our birthday and find them a little too close to comfort that is probably where we were conceived. there was no premarital sex in america before the invention of the internal combustion engine. [laughter] it is true. you could dance naked girl into the record of your farmhouse because your mom and dad couldn't commit so they were stuck working on the farm. and you're from house to not have an iraq run because recreation have not been discovered to to all of our work. on a saturday night you could take a girl out in a buggy but it was hard to get her into the mood to let you bust into her course of it because the two of you were facing the hind end of a horse. [laughter] it spoils the atmosphere. so the car lead us out o

that that would then change the economics of developing the renewables that are indigenous to massachusetts and new england, whether it be in maine or off the coastline of new england. i think and i'll add this as well, one of the things that is not well understood about the east coast of the united states is that when you go out 10 miles, 20 miles, 30 miles, 40 miles, you're still only in 200 feet of water. when you go out that far on the west coast, you're out -- you're miles deep in the ocean. and so in terms of the siting issues along the east coast for wind especially you can go out miles and miles and still be just hundreds of feet from having to site these wind facilities and then with superconducting technologies and bring them in from the shore and hook them into the preexisting grid that already is there in new england with the states having to work out, of course, what the cost allocation is, but knowing that all of new england for example and acknowledge and maryland are committed to resolving and cooperating in the production of new renewable energy resources. so just opening u

aren't that many people in massachusetts affected by it. the rate of noninsurance in massachusetts before it was less than 10%. but if you look at california, the rate of noninsurance is 20% of the population in that state. in florida, it's 25%. in texas, it's 27%. these are the people that we're going to help? and once they find out how much washington is helping them, i don't think they're going to appreciate it very much. in fact, instead of dictating to these people, we should be listening to them. there's a reason that they're not buying coverage. and it's not just affordability. 1/3 of the uninsured are already ill eligible for free medicaid. they found out once they enroll in a program, they still can't see a doctor because medicaid pays doctors so little that very few doctors will take it. so they roll down to the e.r. just like they did before they were on medicaid. so what's the point? why bother having coverage? why bother enrolling when nothing in your life changes? and in fact, for schip program, a third of the uninsured charne

that's what happens in massachusetts and perhaps other western european countries or canada. i'm not here to either praise or condemn those systems. in western europe, the united kingdom, or anywhere else. they're different systems. people need to understand that. what happens in those systems when the costs continue to rise for health care and there aren't the tax dollars to meet the costs they deny care. i think we all know that -- we know that people are concerned about cures, not treatments. they want to be treated like human beings, not numbers. unfortunately, that can happen in those systems when off single payer system, take a number, wait for dialysis, wait for hip replacement if you can wait that long. if you're canadian, if you have the money, come across the border and get the care you need when you need it. i think we have to have this sober discussion. mr. kirk: the gentleman points out canada, a country with a two-tyre health care system, the canadian health care system, then when you're denied care, especially prevalent when you need imagery, we come to the --

distribution center in massachusetts. the warehouse, which employs 90 people, was slated for closing by the end of the year under g.m.'s restructuring plan. but there was a new lease on life for the facility. unquote. the congressman's woke spann said that the congressman was -- quote -- "doing what any other congressman would do. precisely the reason for these cars are awards. as the journal put it -- quote -- "that's the problem with industrial policy and governmental control of american

up until this time they have been saying you are going to have another one in massachusetts. even that decision itself could affect the amount of renewals that we need. notwithstanding the fact that natural gas maybe half in its use as cold it is not nearly as good as renewable. it is not going to affect the market place. the ferchas been pressing that for 5 years. that calls into question the federal, out 1-size-fits-all process, where even when the state is saying back off, this is what you are going to have 4 new england. how do we reconcile that? >> mr. chairman, i am not suggesting a 1-size-fits-all process. i am suggesting that f.e.r.c. has the primary and initial responsibility with access to of permitting, states the given the initial opportunity in this regard, and that opportunity should be given all the tools necessary to succeed. >> are there other members who wish to ask questions of this panel? >> one more big question. i appreciate the chairman asking our witnesses to make this understandable for the viewing audience. we had a discussion recently, follow the el

now, many of these, as i think in massachusetts also, works as fee for service payments, with bonuses or penalties for quality and efficiency. and the key challenges nationwide are can effective@Ã powerful, if patients were engaged. if not only were the efficient providers rewarded on a, say, per capita, per enrollee basis, but also, the enrollees had an incentive to use the efficient providers, so you can get movement to them, which is much more robust, and you know, the key thing is we're to the going to save a lot of money just by moving patients from one delivery system to another because the delivery systems are limited in how fast they can grow their compassist. but -- capacity. but if there was enough movement that these systems that lost enrollees noticed it, and decided to improve their efficiency, then we could get much more rapid gains from this approach. this brings me to private payers. where do private payers fit in with it? and i think there is a lot of potential for medicare to work with private payers, because their interests are the same. in fact, working with medica

we're joined from massachusetts lloyd hill rich's brother who was responsible for making him throw the ball left-handed. lloyd, why did you want your younger brother to pickup a baseball and become a left- hander? >> well, rich always loved being part of a team when we were in the park leagues and thought it would be a good idea. since everybody else who precede him was a ride -- right yusmeiro petit and thought he could could something from the left side -- was a right henrik sediner andthought he could do something from the left side. >> buck: it was a big focal point and was involved in the family. >> sure, rich came to our games as we went through the amateur leagues around boston. my dad, lloyd, sr., they were inseparable. he'd take them to the park every day, batboy, pitching whiffle balls with a big, red whiffle ball bat. i was in center field when we were playing. >> jim: lloyd, in listening to you, i hear the boston accent. when we talk to rich, we don't hear that. how is it that rich doesn't have that very distinctive, new england boston accent? >> i don't know. maybe as he w

many people in massachusetts affected the rate of nine insurance before was less than 10%. but if you look at california the rate of nine insurance is 20% of the population and in florida it is 25 and texas 27 these of the people we will help and once they find out how much washington is helping them i don't think they will appreciate it very much. instead of dictating to these people we should be listening to them. there is a reason they're not buying coverage and it is not just affordability. one-third of the uninsured are already eligible for free medicaid. we find out once they enroll in the program they still cannot see a doctor because medicaid pays doctors so little that very few doctors will take it. so low they are rolled down to the e.r. just like they were before so what is a point*? why bother having coverage when nothing in your life changes? and four the s-chip program one-third of the uninsured children that are currently eligible were enrolled in the program within the past 12 months. they know how to get enrolled and they founded of so little value they did

in federalist number 47, one of our founding fathers, james madison, cites the constitution of massachusetts which states -- quote -- "the judicial shall never exercise the legislative and executive powers or either of them to the end that it may be a government of laws and not of men." close quote. so madison in arguing for the constitution trying to convince the americans to vote for it, quoted the massachusetts constitution this provision in it with approval stating that's essentially what we have

let us not think we are in massachusetts. let's think the trendline is only 8% per year.nd based on $18,000 and then have a look what will happen to this family. so as i recall, the baseline -- the wage base of 70,000 will grow at 3% to 94,000 10 years from now. the health spending -- i think it goes to 38 something using next year's at 3% compound growth and then i get that 10 years from now, 41% of that family's wage base, that is before fringes, before anything will be set aside just for healthcare. and what is left over, the other 60%, has to pay all the fringes, taxes, schooling, housing. that's what we're looking at. this is a beautiful nchm slide on the great report from the uninsured that nancy and her staff produced. and i like it because it shows so very clearly how being uninsured is related to income levels. and so far the middle and upper middle class, there are some uninsured but it's not a big phenomenon yet. but what i'm thinking is, in this coming decade, the status of being uninsured absent health reform will creep up this income distribution very fast.

the one example i can give you in massachusetts we enacted legislation that requires our utilities to enter into long-term delivered price contracts with renewable power sources. so that the utilities themselves would issue solicitations and would select the lowest cost option for meeting that goal of the massachusetts state legislature. you could consider something along the same lines were at some point you could evaluate whether or not the country is heading towards meeting its carbon cap and its renewable power floor and if there is a deficiency identified have ferc stepped in and essentially a backstop planning mode and require that regence, rto's, utilities are interconnecting transmission owners issues solicitations from long-term contracts for renewables. >> i want to make sure i have, if you would wrap up, i want to make surrogate the other two. >> thank you congressman. i am optimistic that if congress sets the goals and sets the process and has a strong backstop authority, that we will be able to get this done. if we don't get it done, again i think that is when the role of

the chair recognizes the gentleman from massachusetts. mr. lynch: i ask unanimous consent that all members may have five legislative days within which to revise and extend their remarks. the chair: without objection, so ordered. mr. lynch: i now yield myself as much time as i may consume. the chair: the gentleman is recognized. mr. lynch: today i rise in strong support of h.r. 626, federal employees paid parental leave act of 2009, which was introduced by our colleague, congresswoman carolyn maloney on january 22, 2009. as chairman of the subcommittee on the federal work force, postal service and district of columbia, i'm proud to serve as an original co-sponsor of this bill, along with 55 other members of congress. h.r. 626 takes an important step toward improving the federal government's ability to recruit and retain highly qualified work force by providing paid parental leave to federal and congressional employees for birth, adoption or placement of a child from foster care which is a benefit extended to employees in the private sector as

alaska's one that doesn't, massachusetts for some reason -- i don't know why, you'd think massachusetts would, but massachusetts does not and oklahoma. so you've got three states. and roberts in this decision really kind of gets to as he did in his confirmation hearings and, again, not to go on another tangent, but when you think about the confirmation hearings, those kind of can be teaching moments, and we saw that with john roberts talking about the conservative approach to the law. i'm just going to quote you some of what he says because it's complete textbook. to suddenly constitutionalize this area would short circuit what looks to be a prompt and considered legislative response. establishing a free-standing right to access dna evidence for testing would force us to act as policymakers. it would take the issue out of the state legislatures and the state courts where they've been dealing with it very well and allow the federal courts to intervene. and as roberts wrote, we are reluctant to enlist the federal judiciary in creating new constitutional rules for dna. now, the liberals on

now, many of these, as i think in massachusetts also, works as fee for service payments, with bonuses or penalties for quality and efficiency. and the key challenges nationwide are can effective organizations be created where they do not cies? and, can enrollees be attributed accurately to, you know, who gets the capitation payments or who is basically logged in with a capitation payment for enrollee a, and a final issue, which is not on my slide, is i think that it's important at some points to be involving the consumer or the patients in these payment methods. you know, this is a different approach than consumer directed health care, but i think that the two of them really need to come together because these methods would be a lot more powerful, if patients were engaged. if not only were the efficient providers rewarded on a, say, per capita, per enrollee basis, but also, the enrollees had an incentive to use the efficient providers, so you can get movement to them, which is much more robust, and you know, the key thing is we're to the going to save a lot of money just by moving pat

massachusetts, for some reason, i don't know why, you wouldn't think massachusetts would, but massachusetts does not, and oklahoma. you've got three states, an roberts, in this decision, really kind of gets to, as he did in his confirmation hearings, and again, not to go on another that tangent but when you think about the confirmation cases they can be teaching moments many we saw that are with john roberts talking about the conservative approach to the law. i'm going to quote you some of what he says. it's complete textbook, to suddenly constitutionalize this area would short circuit what looks to be a prompt and considered legislative response, establishing a freestanding right to get d.n.a. with access