with what pediatricians do with ad adhd, i am not an expert on this and are no the academy of pediatrics is coming out of the program for all the members about how to do mental health care right, which is an extraordinary opportunity. my impression is most pediatricians can't get reimbursed, for the time it takes to do a reliable work out of adhd, you needed detailed history from the parents, it takes a minimum of half an hour to go through that, the scales have to be filled out, it is going to be reliable and so on. the kids are getting any treatment at all, half the kids who are getting treatment don't have adhd, and half of them are getting nothing except medication. this is a cup that is half full and half-empty. the conversation of how to do that is a critical conversation for all of us, and may be the focus of next year's conversation when we are thinking about how do we have an impact on the reforms that have been enacted. >> i want to make a couple points about cost. it is the underlying issue that needs to be addressed. my first point was made by somebody in the audience. i sat

come back to the point* of necessity of a mental health person on the team with respect to what pediatricians do with a ph.d., i am not an expert in this, the american academy of pediatrics is coming out with a program for all of the members about how to do mental-health care right in pediatric practices which is an extraordinary opportunity my eighth impression is pediatricians cannot get reimbursed for the time that it takes to do a reliable work up of eight ph.d. -- adhd it takes a minimum half-hour to go through that and there are scales, reliable and what we see is advocates with adhd are getting any treatment and half the kids and get treatment don't have a and virtually none of the kids are getting anything except medication. so this is a cup half full and half empty so the conversation about how to do the right is a critical conversation for all of the us and probably are may be the focus of next year's conversation when we say how do we have been impacted now on reforms enacted? vermette dae want to make a couple of points about cost because i agree it is the underlying issue my first p

package and a somewhat weaker doing here -- and based on what we are doing here, that we have met that need. whether their pediatricians are cardiologists, if they think they have a better way, i would be open to hear it. right now, i do not want to change what we have in the law based on back and forth. there were also some other legal things that were suggested. >> mr. chairman? i'm going to ask unanimous consent on page 323 of the bill, line 5, where's his recommendations and not be construed as -- where it says recommendation should not be construed as mandates --that it be stricken. -- that it be stricken. i think that satisfy a lot of the concern. >> that exactly the suggestion by senator hawkinrkin. and what i said is that i will be sure that i knew the consequences because words have meaning. i would like to reserve the right to object. >> can we leave this open as possible suggestion? >> yes, that is exactly right. >> let me say that the active director of nih stated he cgr would be used to contain costs. that is what worries me. this also worries the senator from oklahoma. >> if we can leave this open. >> tha

doing here that we met that need. if, in fact, other of the national academies of clinicians, whether they are the pediatricians, whetherthey are the cardiologists, et cetera, say, oh, no. we think we've got a better way. i'd be open to hearing. but right now, i don't want to change what we have in the law just based on a back and forth hearing. >> mr. chairman? >> there's also some other legal wordings that are suggested, but i think we need to really look at that. >> mr. chairman? >> yes, sir. >> i am going to ask unanimous consent that -- on page 323 of the bill, line 5 where it says senator reports and recommendations shall not be construed as mandates for payment, coverage of payment that the word on line 6 construed be stricken and that the bill would read recommendations shall not be used as mandates for payment coverage or treatment and i think that would satisfy a lot of the concern raised here. >> that is exactly the suggestion that was given -- >> by senator harken. >> i call it the harken rule. >> and what i said to harken, which i will say to you, is i am going to be sure i know the consequences because wor

do you think he looks too skinny? i would measure the circumference of his thigh with my thumb and middle finger. when i couldn't get an appointment with the pediatrician, i asked the local public health nurse to come by and weigh him. unfortunately, she was far more interested in screening me for domestic violence than in evaluating the baby. he's fine, she said absently ticking off an item from her checklist. has your husband physically assaulted you in the past 30 days? [laughter] i was worried, but i accepted everyone's reassurances that abe was doing fine, that my concern was a reflection of my own neuroses. i went forward with abe's bris who also missed the fact the baby was still suffering from starvation. i was, however, sufficiently concerned not to be altogether surprised at our pediatrician's response when she finally put him on a scale. give this to him, she said, no. abe drank four ounces of formula in 5 minutes, astonishing for a baby his aim. i sat there weeping, sick at the thought that he'd been in pain. he'd cried a lot doing what he could to let us know he was hungry. after a while, however, he had stopped. he was a good baby, we tol