racial and ethnic minorities experience greater mortality and morbidity. african-americans have a laugh -- life expectancy of 66 years, when white men will live to an average of 74. compared to an american indian, they will live in their mid =fifties. -- they will live into their mid fifties. major health and technology could dances and the past 60 years, despite that, 1.6% higher than whites is the african- american race, and that is the same as it was in the 1950's. examining the prevalence of certain diseases and conditions and racial and ethnic minorities gives further evidence of health disparities. african-americans have the highest mortality from hiv/aids, stroke, cancer, and hypertension green in fact, if you look at hiv/aids rates, more than 80% of women who have diagnosed -- and hypertension. in fact, if you look at the hiv/aids raids, more than 80 percent of women who have been diagnosed with an -- hiv/aids rates. hypertension and african- american leads to a a% higher stroke mortality rate, 32% higher rates of renal disease than the general pop

we showed that this was not due to greater morbidity amongst blacks or differences in socioeconomic status, we showed that we believed the achievement gap was the explanation for their survival lot comes. the study is memorable for me, one of the first major analyses published in the medicare database which is a cornerstone of cancer care and one of the few studies that demonstrates that treatment gaps were important in terms of disease outcomes. prior to that, treatment gaps were illustrated without a link to outcomes. we were unable to determine why treatment rates were lower for blacks. our study was not designed with that question in mind. and data was insufficient to address the granular patient little question. we had used national data covering many areas and tens of thousands of patients, we had little individual level information. other disparities, notably the opposite. sometimes covering a few patients and doctors in a single practice setting from which a lot can be learned about that setting but less about the universe of care settings. the fallout from the publication was a ed

and, of course, as it's our responsibility to do as members to reduce the unnecessary and morbidity thatwe now had evidence was occurring. to deal with this, we designed a four-point strategy. the first point headed to a hospital governance. how do we teach hospital trustees to be better advocates for care in their institution? and we made a partnership with the massachusetts hospital association to get this done. public education was another component. how do we teach the public in massachusetts what's true about healthcare delivery. legislative and regulatory reform was the third, the third point, the third point of intervention and then payment reform. the idea was to do all these things together. do them all at one time. and then arrive at a tipping point where providers would feel that it's more beneficial for them to do it the new way than to do it the old way. and our participation in health reform process in massachusetts was an expression of achieving the legislative and regulatory reform we needed and importantly health reform massachusetts was accomplished without a public pla

defined as significant gaps or differences in the overall rate of disease incidents, prevalence, morbidity, mortality, or survival rates of the population as compared to the health status of the general population. the institute of medicine defines disparities as racial or ethnic differences in the quality of health care not caused by differences in clinical need, patient preferences or appropriateness of intervention. the landmark institute of medicine report in 2002 served as a significant data point in terms of tracking and analyzing issues related to health disparities. overall health status in the u.s. has improved significantly as demonstrated by increases in life expect expectancies for the majority of populations. however, in spite of the many improvements in health over several decades, gaps exist by race, ethnicity, gender and other related subpopulations. these gaps may be related in part to demographic changes in the united states, but according to census data, the population of the u.s. grew by 13 percent over the last decade but has increased dramatically and diversely at an

it's been mentioned mortality, morbidity incidents. the u.s. care system has been very good if you're healthy. unfortunately, that's not the case for many individuals. despite the overall improvement in the u.s. population, racial and ethnic minorities experience high rates of morbidity and mortalities than nonminorities. it's proven by looking at life expectancies. african-american have shorter life at 66 years than white men on average will live to 74 and compare that to the american indians where in some areas are expected be to live if their mid-50s. the life expectancy gap that between white and african-american males have not changed significantly in the past 40 years. even though our country can top major health and technological advances in the 60 years, african-american mortality rate is 1.6% higher than whites and this is identical to what it was in 1950. infant mortality is just as dismal. 2.5 and 1.5 times higher than whites. examining the prevalence of certain disease and condition and racial ethnic minorities we have further evide

different individuals can react very differently to the same medications based on body chemistry for morbidities. as was raised by one of the questions, different groups in our society, very different medical circumstances, many highly important ways, how does comparative research address these aspects of individuality with respect to both the studies and treatment. third, compared effectiveness research, comes through very clearly. one is putting together a body of knowledge and useful guidance, and the other is cost benefit judgments. the cost and additional benefit and treatments may have. the obvious question is, leave doctors and patients free to make their own decisions in each case as to what they think looks best. and great constraints. you go one step further. what role, if any, should this research play in addressing the seemingly inevitable imbalance between fully meeting all medical care needs and any reasonable projection of resources that would be available for medical care. and the one addressed to peter, is there any reasonable way to estimate the benefits comparative economic re

substantial reductions in morbidity and mortality rates among smokers, that's what we seek to achieve. so the great challenge that i have here that in the committee we are now looking at legislation with regard to food safety and drug safety. the f.d.a. is charged with approving medical products based on scientific evidence that based on the products outweigh the risks. tobacco products are inherently risk products that cause disease when used as directed. now, we're going to turn to the f.d.a. and say, we want you to regulate the tobacco product so we take the gold standard of the f.d.a. now and apply it to tobacco, and now there is this inference that somehow the f.d.a. has said -- now, tobacco is a safe product. that is something we should not be doing. it's why i sought to create a separate agency rather than the f.d.a., creating a mission that is counter to their present mission. you see, if you use a cigarette and follow the instructions and you do that every day it will kill you. now, think about that? it will kill you. we don't want the f.d.a. to create some time of inference

we adjust our payments based on every year on the health status and morbidity of those patients that physician practiced in that hospital is caring for. third, we are adjusting the payment every year in line with inflation. not the kind of mccaul inflation many providers have been learning the last decade, but still in capitation was often at the end of the year when we lowered the payment. we are not talking about that. finally, to the criticism there might be withholding of care under a system based on capitation that can't happen in the system because it only works financially for physicians and hospitals and only for patient safety is quality incentives get paid out and quality incentives as you will see in a minute or based on quite a comprehensive set of measures. so how do we think about this measurement work? we start with a set of principles and said the measurement work should build towards the institute of medicine's definition of the end state which is safe, affordable patient centered care that the measures said include process measures, and measures of patients experien

and, of course, as -- it is our responsibility to do what we could to reduce the unnecessary and morbidity that we now had evidence was occurring and we designed the four point strategy and first had to do with hospital governance, how to teach hospital trustees how to be better advocates for care in their institutions, and we made up a partnership with the massachusetts hospital association to get it done. public education was another component, how do we teach the public in massachusetts, which -- how health care delivery and legislative and regulatory reform was the third and the -- third point, third point of intervention, and, then, payment reform. the idea was, to do all these things together and do all of them at one time and arrive at a tipping points, where providers would feel it is more beneficial for them to do it the new way than the old way and our participation in health reform processes in massachusetts was an expression of achieving the legislative and regulatory reform we needed, and, importantly, health reform in massachusetts was accomplished without a public plan becau

well, we adjust our payments based on every year, based on the health status and morbidity of those statements, that that physician practiced and that hospital is caring for. third, we're adjusting the payment every year in line with inflation. now not the kind of medical inflation that many providers have been earning over the last decade, but still, capitalittation was often at the end of the year is how can we lower the payment? we're not talking about that. and finally to the criticism that there might be withhold willing of care, under a system based on capitation, that can't happen in our system, because this only works financially for fir significances and hospitals and only works for patients if these quality incentives get paid out. and the quality incentives, as you'll see in a minute, are based on quite a comprehensive set of measures. so how do we think about this measurement work is this we start with a set of principles? we said that the measurement work should build towards the institute of medicine's definition of the end state, which is safe, affordable, patient centered care,

a hospital known for its liver transplant center which has the lowest morbidity rate of any transplant center in the united states. memphis has been a medical certainty for years with st. jude children's research hospital, the finest research hospital for children illnesses, catastrophic illness, and cancer. for southern college of optometry. the from the bonner children's hospital. for cam be blesclinic and orthopedics and other -- for campbells clinic and orthopedics and others. we are sorry mr. jobs had a liver transplant but we are happy he came to memphis and chose the best. it shouldn't be only the wealthy can come to memphis with the best medical care. we need to let every american have the opportunity to get the best medical attention available and come to memphis to receive it. thank you, mr. speaker. the speaker pro tempore: for what purpose does the gentlewoman from north carolina rise? ms. foxx: thank permission to address the house for one minute. the speaker pro tempore: the gentlewoman is recognized. ms. foxx: thank you, mr. speaker. democrats are the ones with no new id