these public/private partnerships that mr. shea mentioned. what hasn't been mentioned as president obama has rightly said the medicare facility, payment advisor commission should play a in role in improving medicare paying for certain services more efficiently and i believe medicare and the new public plan should be doing a better job encouraging the right care and quality care rather than more care. >> i want to say that as we move toward a national standard is important that these standards acknowledge differences based on race, american indians, thank you. >> thank you, mr. chairman, in my opening statement i did something you never do and that is misspeak. my final comment in the opening statement is there are positive solution to the challenges we face and i am hopeful the house will allow for an open, vibrant, robust debate and a deliberative process that respect america's doctors that most of all, america's patients. we have heard less talk about the patients specifically than i had hoped. there is a lot of common ground in health i te

that has to be a regulatory ischetschemieschemscheme to eli external -- >> mr. shea, there's a play in massachusetts where you can -- your employees don't get any insurance. it is important that if you don't choose to pay option, the employees get coverage. >> absolutely. is also important that there is a meaningful payment option, not let massachusetts, $300 a year per employee and you are proposing something substantial. that is the right way to design it. >> mr. cassidy? >> mr. visco, when you speak, i think of my wife is a breast cancer survivor, that is music to my ears. dr. hacker, a couple things. as i think about it, your proposal, congratulations, this is your brainchild and it has become something. the public auction is innovative, the sense that nationalizing the insurance company creates a government run health insurance company, but as you're speaking of the need for innovative payment methods, medicare and medicaid have lagged far behind other companies in coming up with innovative payment schemes. and certain as i look at this, the patient is central.

pollack and mr. shea might be willing to speak to that. >> i appreciate the question, and i think you're right on track. one of the ideas that has been widely discussed is the notion that we need to be able to, as we link payments to quality, we need to be able to do rapid cycle testing of the way to do that so that we're not in the system where medicare once a year makes set rates and so forth. we need a more -- we need a more flexible and nimble approach that really matches the quality improvement efforts that are being done around the country and rewards those and incentivize those. i know that in the senate health bill i was admiring some of the things that they did that were beginning steps to do this but sensible kind of things like we're going to pay a physician's office extra money if they do follow-up on hospital discharges. this is a huge problem. it costs us an enormous amount of money. it's very simple to solve but the current system we have has nobody responsible for that. well, why not pay a

mr. shea, there's a pay and play where your insurance don't get any insurance. is it important if you choose the pay option that the employees actually get coverage? >> oh, absolutely. and it's also important that there's a meaningful payment option not like massachusetts. that they are $300 per employee and you're proposing something that's substantial. i think that's the right way to design it. >> mr. cassidy? >> my wife is a breast cancer surgeon and when you speak, i just think oh, my gosh, isn't that just nuke my ears and to my wife's ears. we share your concern. dr. hacker, a couple of things. you know,no carrierringconnect central to improving outcomes. what i do see there's a great emphasis on bargaining power to decrease cost even though in your paper you mention that probably for physicians, that bargaining power has been used to excess and you can demonstrably show in some cases that physicians that access the decrease because of it indeed the cbo scoring of this or maybe the document, the cbo score said there would be limited access to some specialis

occasions to and past four years twice at hearings chaired by the vice-chairman of the commission, mr. shea is, when he was in the house of representatives. we've submitted comments on legislation and participated in the comprehensive lessons learned projects conducted by special inspector general for iraq reconstruction and accountability office and in 2005 conducted a formal joint lessons learned review with commanding general of the army. we know the commissioners appointed to conduct this review and had the opportunity to work professionally with many of them during the past and we worked professionally with senior commission staff and each and every individual brings expertise and perspective to these important tasks. we also have the a fraternity to work with the key federal agencies involved in developing the requirements including the oversight activities and special inspector general for iraq reconstruction. we appreciate challenges they faced and commitments they've shown to fulfill the government's mission. we've also been privileged to work with dozens of companies and hundreds

mr. sheae to the committee. >> good afternoon and good afternoon to all the committee members. i want to start by congratulating by putting forward a bill which we think really addresses the issues that the american people are concerned about. and we look forward to working on this bill. our druthers might be talking based on the current system does provide a way to get the kind of reform we need. and what i want to talk to you about briefly today is what we think it takes to stabilize the employment-based system which is the backbone of both theÑ coverage and the financing of healthcare in the united states as you know. it has proved remarkably resilient despite enormous cost pressure. it has shown that employers want to continue to offer coverage and that employees highly value the coverage they get at work. but we've lost five percentage of points in coverage of people between the ages of 18 and 64 in an employment-based coverage from 2000 to 2007 and frankly this is a pretty fragile syst

shea-porter: thank you, mr. chair. i'd like to thank chairman thompson and his staff for their hard work on this very important bill. i'd also like to thank my colleague, mr. chaffetz. we share a deep concern and respect for the privacy of individuals. when this full body imaging was first introduced, t.s.a. said it would only be used as a secondary screening method for those people who set off a metal detector. now it has become very clear that the t.s.a. intends for this technology to replace metal detectors at airports all over the country. "the new york times" reported as much in an april 7, 2009 article. the chaffetz-shea-porter amendment would ensure that full body imaging would be a secondary device. and people that go through it is well informed. mr. chairman, we do not take this lightly. as a member of the armed services committee, i'm very aware of the security threats that are facing our country. we too want to ensure that the department of homeland security and the t.s.a. have the tools that they need to pr

shea-porter: i thank you, mr. chairman. this amendment would ban the use of open air burn pits overseas after 12 months. such a dangerous waste disposal method should only be used temporarily while permanent and safe alternatives is developed. the amendment specifically prohibits the burning of medical and hazardous waste or solid waste containing plastic in open air pits. the burning much such waste produces chemicals that have proven toxic to humans and es

mr. bishop: i thank the chairman for yielding. i rise to join my colleague, representative carol shea-porter, in urging our colleagues to ban burn areas in the war zone. we talked about the reckless disposal of hazardous waste in iraq and afghanistan and the devastating toll they are taking on the health of our service men and women. it's encouraging that the generals have taken seriously our concerns about the dangers of burn pits. but this legislation is necessary to make sure this takes place. this sendorsed by the american legion, by the d.a.v., by the iava, by the national guard association and by the v.f.w. i urge its passage. the chair: the gentleman yields back. the gentleman from california. mr. mckeon: reserve the balance of our time. the chair: the gentleman reserves. the gentleman from missouri. mr. skelton: mr. chairman, i yield one minute to my friend, a member of the armed services committee, the gentleman from virginia, mr. nye, one minute. the chair: the gentleman is recognized for one minute. mr. nye: i'd like to thank the chairman for yielding. mr. speaker, a lot of the legislation that comes through this house deal