where i can really use some help the specialization areas of pediatrics. i don't want them to be excluded or is important to do so so it is that idea that it takes where we are picking the winners and losers. >> i just want to say the reason you don't have pediatrics of specialists is you don't pay them. it is a is an same reason. you know, we have to pay and the payment their rancho between the pieta ecologist is about to honor to present. it is a but what manicure sets up and medicaid sets up the reimbursement mechanisms, if you look at the medicaid reimbursements per pediatrics of specialty is you will seem that they are paid on average of our less than what we pay under medicare for the same procedure done on a child which is much more difficult by the way that it is on an adult's. in his payments and as long as we continue to ignore the economic source of our disproportionate to mix up positions we're never going to fix the problem. again, -- >> we have been over this before and as it will senator harkin about the cardiologists and why i don't get mor

esso anomaly in a way that has been obviously an the other is a plan from the area of pediatrics has been the opposite case paramount so the sweeping statements we made which have a lot of accuracy is about correct. we have all made the point on some occasions over the last nu

i think this is an important requirement but i'm worried about the implications for pediatric health care quality measures because even though discussion draft requires the measures to be designed to assess the delivery of health care services to individuals, regardless of age, the section is funded with medicare dollars. under the previous administration, hhs determined that medicare dollars could not be used for pediatric measures. i'm wondering if you can comment on this and what plans the administration has to address pediatric health care quality and what the view of the agency is going to be? >> well, congresswoman, i think that we're convinced that medicare can be a leader in improving quality of care for all americans. certainly, the development of quality standards i think is appropriately done under that umbrella. but all americans definitely includes children and that is a huge priority of the country's moving forward so there will be a coordinated effort to make sure that the pediatric standards are very much developed in terms of quality outcome. >> do you think that can

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 point* was made by somebody in the audience. i sat through the first session and somebody said it is not saving money but spending money smarter. it is not a matter of me saying to a p

benefits and access to pediatrics specialists for medical necessary care. how can i work with you to make this a reality madame secretary? >> congressman, i would love to have a chance to work with you on that critical. as you know, there are some mandated benefits for young children in the medicare packages which all states must follow, but beyond that you correctly identified that eligibility rates vary from state to state for particularly the chip program and very -- in terms of the very earliest prenatal care. so the likelihood of having reducing low birthweight babies and bringing people into the system very, so it is a huge challenge and i support and i know that the president supports the notion that the system starts with a focus on children. i think that is why he was so enthusiastic during the course of the campaign about a mandate applying to children and we felt we needed to start universal coverage with children. so working with you making sure all children have access to the benefits you've described is something i look forward to. >> [inaudib

i understand that comes from the national academy of pediatrics? >> theash. >> we also included senator hatch's clarify amendment to include chiropractors as part of the community health teams, which is more than agreeable to us. it adds the standard of i.o.m. to define what is

market exclusivity for beneficial changes to their products and even more exclusivity if they conduct pediatric tests on their products. this tiered approach, which i hope to include as part of the health care reform bill moving through the "help" committee, would provide needed competition, long-term savings, and an opportunity for consumers to have safe, effective, and affordable medical treatments. biologics -- and i credit the manufacturers and the scientists and thank them -- the medical researchers -- for this they provide great promise and they provide hope to those suffering from devastating diseases and chronic illness. but absent price competition, how can -- countless americans will be unable to benefit from these medicines because they're just too expensive. when you're talking about tens of thousands of dollars a year just for this drug treatment, this biologic treatment, let alone all the other doctors' bills and medicine that they they'd. i hope that when my colleagues are lobbied by the industry and they're spending millions of dollars on this because this means hundreds of mill

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

pediatrician, a child advocate, and just happens to be president-elect of the american academy of pediatrics. she provided compelling testimony and i won't go through all of her testimony, but here is something she said which i think has relevance for the debate we're having on health care. she says, -- and i quote -- "some times we as child advocates find it hard to understand why children's needs are such an after-thought and why? because children are little. because children are little, policy-makers and insurers think that it should take less effort and resources to provide them health care." "because children are little we think less effort is required," or less resources is required; less in the way of hard work. well, none of us really believe that, do we? we don't really believe that? children, the health care we provide them, the protection, the shelter we provide them, should be every bit as significant, every bit as fully resourced as the protection and help we give to adults. because i believe there's -- i disagree about a lot of details in the health care bill but i think we all

commissioner kessler called this a pediatric disease with onset of adolescence and most adult smokers began to smoke before 18 and it makes sense for congress to discourage young people from starting to smoke during these critical years. youth smoking in america has reached an epidemic proportion according to a report by the centers for disease control. smoking rates among high school students soared by nearly a third between 1991 and 1997. among african-americans the rates soared by 80%, more than 36% of high school students smoke by 1991 year high with youth smoking at crisis levels and still increasing we cannot rely on half-way measures. congress must use the strongest legislative tool available to reduce youth smoking as rapidly as we can." well, the senate told the american public that the passage of a massive f.d.a. tobacco regulation back in 1998 contained the strongest legislative tools available to address youth smoking issues. by the way, mr. president, they have decreased since 1998. overall smoking has decreased. i don't want anyone to think that there's no light at the e

you've ever seen, and this is an actual i ware to got thing, the brownie troop run by the former pediatric encolings so, you know, when they do their badge for first aid, they're basically giving people tracheotomies. [laughter] and god bless all those women, right? because that means you and i don't have to be on the nursery school committee, but at the same time it kind of ratchets up this anxiety for all of us. and now your prize. >> i actually have a follow up. lucky charms. >> my daughter will be happy about this. >> proves my point. >> but dope you think it is -- don't you think this is just the hate red that especially straight women -- >> isn't this the latest form hate red women have always felt for one another? oh, that's depressing. you don't see a lot of, like, with some exceptions on some issues, you don't see a lot of men out there screaming, you suck, you're doing this wrong. i don't get hate mail from men. i mean, i've gotten some hate -- not hate but respectful disagreement from men who are pro-life, but i've never gotten an, oh, my god, you're a bad mother. i get can you

evidence based information and as i understand senator dog that comes from the national academy of pediatricsand also included senator hatch's clarifying amendment to include chiropractors as part of the community health teams which is more than agreeable to us. in ens the standard of iom to define what is primary care and the rise authorization for such sums as may be necessary to carry out this title so that is a brief description of the amendments and ask unanimous consent that both mikulski and donna be accepted. >> is there objection? of those in favor say aye. by unanimous consent they are a great. >> the amendments are agreed to? >> yes, ma'am. >> i understand the first amendment senator reed, jack reed to mcnamee apologize, we need all members to adopt, in order to have a discussion so we will have to wait until a couple more show up and i apologize. >> we will lead the votes to sign it. we need a two? otherwise you could have unanimous consent. i've been two those kind of meetings. in perhaps we could proceed to the discussion on senator reid. >> thank you mr. chairman, thank you sen

there's the institute of medicine, there's the national academies of pediatrics or cardiology, et cetera. so and it is -- in the agency for health care research and quality which has been around for more than 20 or 30 years. >> let me just say this. nothing in the bill prohibits cms from using cer to contain costs and it's peter orszag who is the omb director, obviously, said cer's principal purpose to is to retain cost,s a direct quote. the acting nih dector said costs will be a key factor in cer it just seems to me that we need this amendment to ensure that cer is not used to ration health care. >> peter orszag is not a member of congress. no matter what they might think. >> i'm going to do a hatch thing but i'm much louder than hatch so people don't listen to him. he's been doing this for a lot of years. now, i used to be a bucket toter, i was a bucket toter here in the senate for two year, went to the house, i was a bucket toter over there as a staff member. my box kathleen sebelius says you're in charge of health care. well i was in charge of everything, window, rug, administrative

today because one of the most profound experiences i've had in my life is spending a month at a pediatricf iowa hospitals and clinics. when i was in the big brothers big sisters program and my little brother was diagnosed with acute large celled lymphoma and spent the day watching patients with no hair, ivies in their arm or chest going into a port, walking around taking care of each other much better than our health care takes water of patients in their time of need, and it's a slander on the names of the health care professionals who do everything they can to help keep patients like your brother, like my little brother alive when we don't give them the support they need after they have invested their hard-earned dollars paying premiums to health care insurance company returns their back on the patient on their hour of need. and that is why i strong supporter of the health insurance option and proud mike colleagues on this committee, chris murphy and peter welch joined me introducing to get health insurance patience a public health insurance option with no discrimination so we don't have

conte away at a hospital meetings and bryan off to work in the pediatric work. i was trying to use my research paper. what? i said. >> little cia be seizing he reported. >> now, i said? zuri not his head. i jumped to me feet and ran a few feet to see his bedside. amy was there. watching the 2-year-old boy shake from his head to toe. with only the whites of his eyes showing as if possessed. cia's mom stood next to him crying fearfully as amber and her mother looked on from the adjacent bed. dr. conte was away so i waited for amy and zuri to respond. although short seizures are not really emergencies if they last too long they can lead to permanent disability and death but the nurse's lack of reaction became increasingly worrying. were they waiting for me to do something? [laughter] >> i'd made it clear i was just a medical student doing research. although i'd helped out with leila's malaria episode my position was in the far back corner of the room during any hospital emergency. so, i said? trying to spur them into action. [laughter] >> what do you guys think? my

nurses to pediatric specialists, to dental care providers to primary care physicians. mr. president, we have a lot of work to do. i'm very optimistic that we can pass good health care reform in this country. we know that the first rule of thumb is to make sure that if people are happy with the coverage they have, if they're happy with the insurance plan they're in, they can keep that plan. second is we've got to do a better job of reining in the costs to so many people in this health care system: employers, individual businesses -- employers, individuals, and government. third, we need to make sure t

because one of the most profound experiences i've had in my life was spending about a month at a pediatric oncology unit at the university of iowa hospitals and clinics when i was in the big brothers big sisters program and my little brother was diagnosed with acute large cell nonhodgkins lymphoma, and spent time every day watching young patients with no hair, with i.v.s in their arms or in their chest going into a port, walking around and taking care of each other much better than our health care industry takes care of patients in their time of need. and it's a slander on the names of the health care professionals who do everything they can to keep patients like your brother, like my little brother, alive when we don't give them the support that they need after they have invested their hard-earned dollars by paying premiums to a health care insurance company who turns their back on the patient in their hour of need. and that's why i'm a strong supporter of the public health insurance option. and i'm proud that my colleagues on this committee, chris murphy and peter welsh, have joined me i

a pediatrician advocate and president-elect of the american academy pediatrics. she said in her testimony last week before us and i quote, sometimes we as town advocates find hard to understand why children's needs are such an afterthought ny because children are little bit, because children are little policy makers and ensures think it should take less effort and less resources to provide them health care. well, she is right. we all recognize that children are little but they are not just all adults, so many attica's have reminded us in this debate. children may be little but and gauze is there are 7 feet tall. and we must treat them accordingly. so again the rules should be at the end of this long debate no child worse off. dr. palfrey that i just quoted, denise lewis that a code of especially tricia urban are waiting to see when we do. our time to make a difference tricia urban paid a terrible price but again it comes down to basic choice in terms of what we do. in the status quo resist change. status quote forces reform. i know this is a tremendous challenge.

over 1,000 medical, public health, faith and community groups from aarp to the american academy of pediatrics. from the southern baptist convention to the islamic society of north america. it's supported by the american lung association, the american heart association, the american cancer society, the groups that are best situated to understand the damage caused by tobacco and to recognize that a renewed f.d.a. can and must take on this new authority. the diversity of support for this bill shows just how critical it is to all americans. tobacco does not discriminate when it robs people of their health, their productivity and their lives. and that's why we must come together to rob tobacco of its fluence -- influence over americans. finally, i want to note this bill has a number of changes to respond to specific concerns that we've heard. in committee consideration of this bill over the past two years we made changes to ensure fairness and flexibility for convenience stores, tobacco growers and small manufacturers. we worked with the -- our republican colleagues to incorporate their suggestion

this bill would address shortages across the spectrum from nurses to pediatric specialists to, of course, primary care physicians. of like to commend the chairman and staff and the other members on both side of the aisle, senator coburn and hatch and everyone for their good work. i'm optimistic and looking for to the markup. >> thank you senator. senator hatch, former chairman of this committee. and his thinking when of the proudest moment i had in the seventh about 25 years ago was coal offering with orrin hatch, the first child care legislation since world war ii in this country. if the cord blood issues together and senator kennedy doesn't have a better friend in the senate. the list is along the matters you have worked on together over the years to take the next half hour to get on that list of matters you have worked together on despite coming from different parties in different ideological point of view the have been able over the years to find common ground on matters of no possible and i have a quarter-century ago. you have this appearance of building this calcine of the difficul

companies take care of children, the lowest paid people that work with various schools or daycare or pediatrics tend to make the least in this society. her employer wasn't able to offer health benefits so when she discovered a lump in her left breast she had nowhere to turn. she tried to state medicaid program but despite having an income in 2006 of $4,500 she dignity quote qualify. per daughter was grown, she had no dependent. she started chemotherapy but doesn't know how to pay her bills. the bills were developing in the senate would expand medicaid, this bill and working on in the house would expand medicaid and offer premium subsidies to those in need of help. the bill will increase competition. the bill will increase competition in the health insurance market by establishing a federally backed health insurance option for those that won it. there's nothing like a good old-fashioned competition to reduce premiums to improve customer service to keep the health insurance industry on its toes. on surprisingly the health insurance lobby's launched a massive campaign to prevent inclusion of a pub