this provides a little more detail on how accountable care can be implemented and provides paris change the way they are fee-for-service approach. accountable care providers working together identify who that are and a pair can identify who is getting care from those providers and patients accountable for based on actual patterns. doesn't require active enrollment, not taking benefits away from medicare beneficiaries and those providers responsible for the overall cost of the patients both services they deliver and others they receive a so there is a real connection between and the other providers in delivering care. the benchmark can be calculated about future spending and enter into a contract that provides potential savings for opportunity of sharon savings and accountable care organization now has a mechanism to make ends meet of still taking steps like answering e-mail's in using help i.t. attractively, using nurse practitioners and well as programs whenever it takes for their beneficiaries to get better health outcomes of our cost. this is part of a most of the health care reform

to continue provide it.increase in cost is those firms that are not currently offering benefits. mostly small, low wage firms and your bill addresses their concerns in terms of -- in terms of subsidies and tax credits to provide benefits but also offers the option to pay into a fund that would allow employees to get coverage not based in the workplace. in terms of controlling costs there are two core issues here. one is -- or strategies -- one is the public insurance plan option. this is an important element in terms of assuring coverage and benefits but it allows competition in the insurance market. we don't have any bargaining health benefits for 50 million people a year. we do not have any effective competition in the insurance market. but we believe that a public insurance plan would spur that kind of competition. i know there's a lot of issues and some of those issues have been raised here about the design of a public plan and you know the list as well as i do. i think these are design issues that can b

he might have an organization that is very integrated between primary care providers, especially providers and hospitals. on the other hand, these kind of support or better results for population of patients with a lower cost could occur at a regional level, could occur with a loose or virtual relationship or informal relationship between providers that might be spread out more geographically. maybe including a hospital, maybe not. it's important to consider that there are other elements that get brought in when you think about changing payments that focus on better outcomes and lower costs. mental health services, home health services, other elements of the overall delivery of care. and even things that are traditional health care like community based services and wellness programs that may be the most cost-effective way for some people to get better health outcomes at a lower cost, things that are outside of traditional medical care here and only by having payments that focus on medical and support better health outcome at a lower cost. you would provide incentive. you really bring those

s ability to provide quality medical care. without accurate predictive data, advanced appropriations will not necessarily provide the right amount of funding that v.a. needs to operate its health care system. therefore the bill also contains provisions that require a combination reports and analysis to determine the quality of the data v.a. will be using in its financial model to determine funding needs. mr. speaker, this bill while not a perfect solution is a very reasonable way to allow the advanced funding concept to be tested in practice and i urge all of my colleagues to support h.r. 1016 as amended, and i reserve the balance of my time. the speaker pro tempore: the gentleman from california. mr. filner: thank you, mr. speaker. i would like to recognize the gentlelady from illinois, mrs. halvorson, for three minutes. she's a new member of our committee and of this congress, but she's add add dynamic element to our deliberations. we thank her for her commitment to veterans. the speaker pro tempore: the gentlewoman from ill

providers don't love medicare, but medicare is probably more credible than private payers with providers. and medicare has the ability to engage the provider leadership in its work. and also, medicare has sufficient clout with many employers and you know, very contrary to predictions by my fellow economists when the plead care physician fee schedule was introduced in 1992, really changing the pattern of relative payment fairly radically, there wasn't really any evidence of access problems caused by this change in the medicare payment structure, so medicare does have clout. and we find that private payers are increasingly following medicare payment structures, so that if medicare changes, in many areas, the private payers will automatically change as well. the medicare relative value scale for physicians is used extensively, although private payers often need to deviate from it, to accommodate the market power of a particular provider. such as a powerful single specialty group. now, what can medicare do? well, there's a -- what i call an easy part of the reform agenda, a bunch of steps ju

for n.i.s., the bill provides $781 billion and noaa and the committee continues to provide resources consistent with the path identified. it also considers the science and research conducted at noaa and at nasa as critical to the nation's science enterprise just as that performed by nist. for law enforcement and department of justice, the bill provides $27.7 billion, $2 billion for d.e.a. and $1.1 billion for a.t.f. bureau of prisons addresses long critical shortages in staffing and education and drug treatment and state and local law enforcement. the bill provides $3.4 billion restoring in large part reductions proposed by the administration. programs funded through the office of violence against women, the bill provides an increase of $11 million, including $10 million increase for stop formula grants and $1 million increase for sexual assault victim services. while the funding table and report on the violence against women may appear in the report, the decrease shows because a number of programs have been moved which actually administers those programs. let me repeat, the bill inc

to providers. >> great. thank you for your service. >> sure. >> thank you for being here. >> thank you, mr. markey. miss christiansen? >> thank you, mr. chairman. i guess there is some benefit, i guess, at least in this instance, to being a delegate. and not having to go to vote. welcome, madam secretary. good to see you. last week we had some very good conversations on health disparities. but i note that at least in reading your testimony, because i had to step out both in the senate and here, there was very little, if any, reference made to this very important issue that by itself, results in close to 100,000 premature preventible deaths every year. i hope you'll work to make sure your entire department is sensitive to this critical issue, and office of minority health, and in particular the office of the national senate for minority health disparity research will be elevated that's critical to goals of eliminating health disparities. the b the bill directs that there will have to be a bridging between the

it provides incentives for the different providers to choose efficient provider partners so that the orthopedist doing the hip replacement becomes concerned about the fact that if they do meet at the most expensive hospital in town they never get a reward in their per episode payment but if they do we get a more efficient hospital that's less expensive they might not even have to change anything they do and this way they could be a winner in the per episode bundles. now the attribution of episodes of patients to different episodes or different providers can be a challenge. it's easy with a major surgical things. this actually has been pursued by private insurers as a modification of fee-for-service basically bonuses or penalties in per episode efficiency. and cms to me is leaving the groundwork for this in the future as they are implementing as directed by congress resource use reports which basically are for informational only reports to physicians on the efficiency with which episodes of treatment they are involved with are provided. now there has been some criticism by some of the

and they need to have an ongoing relationship with health care providers. so that they can get the kind of care they need, get the kind of advice, get the right prescriptions and be able to work with their medical practitioners to be able to comply with that advice and be able to make sure that they are healthy. the number out there is 50% of americans who get health care comply with recommended health care they're told to comply with. so obviously we need some work here. this is not only the responsibility of those who pay for health services and those provided but for patients as well. let me say on chronic conditions, some of these numbers may surprise us. but the five most costly chronic conditions are cardiovascular disease, cancer, diabetes, asthma, and mental health disorders. over 133 million americans suffer from at least one of these chronic diseases. over 75% of all medicare expenditures can be attributed to patients with five or more chronic conditions. just 10 years ago, these beneficiaries counted for only 50% of the medicare costs. so somethi

we are in fact in the business of providing healthcare coverage. we regret the necessity of even a single recision. the decision is never easy and that is why we follow a fair and thorough process that includes a number of careful review is. here is our system works. when we become aware of the condition that exists that prior to the application date and that information was not disclosed, a senior underwriter reduce the admitted information to determine if it was material to the underwriting decision. then the underwriting management verifies the analysis. fig mission was not material to the review is complete. if the omission was material the underwriter makes a recommendation to a review panel which includes a least one physician. this review panel evaluates information and makes the decision. the amount of the potential claim is never disclosed to the underwriters or to the review panel. the decision to resendiz only made when the undisclosed information would have made a material difference to the underwriting decision based on our guidelines.

that also is a fact of federally provided health care of. the veterans administration provides health care to our retired military personnel through the mass of civil periderm run health care system. i have 153 medical centers in seven her 55 community-based outpatient clinics. 232 cancelling centers and yet they still can effectively provide a minute routine medical service to all of its clients and in many cases have to rely on the private sector to fill in many of the services. fattah situation and i appreciate that alaska is different because of our geography and lack of providers but we still have situations in my state where for routine care you get to be shipped outside to seattle or other parts for a level of care that ought to be available within our system would and yet it is simply not there and it is not just alaska. and thing from any of several states throughout the country we have a tendency to see this and that medicare would. perhaps most specifically for a state like alaska and other rural states and those areas where our e

the bill provides $1 hundred -- 100 million to protect steams. this is a key part of our effort to protect the national forest and grasslands. and final ily, we have provided an increase of $86 million for the cultral agencies supported by this bill. we recommend $170 million for the national endowment of the arts and national endowment for the humanities. the endowments are vital for preserving america's cultral heritage and supports the smithsonian institution, with an increase of $43 million above 2009. i'm proud of the way we produced this bill. mr. simpson has been an outstanding ranking member whose thoughtful contributions over the course of 20 hearings has helped us to make this a better bill. we heard from 37 government witnesses and 99 members of the public. we received written testimony from an additional 94 witnesses. i was most impressed with the minority's attendance at those hearings. this bill is the product of a bipartisan effort. and i truly believe it is a better bill because of that. i want to take a moment to thank our staff,

providers. the fact that multiple studies note minority patients get less care is often interpreted of pervasive bias in the clinical encounter it could just as well be interpreted as one of the shortcomings in all observational studies that focus on the clinical encounter. second, because of patterns of neighborhood segregation, the same provider is rarely observed treating both black and white patients. and so what we have been calling prejudice in the clinical encounter is often a difference in neighborhoods referral patterns and the resources of providers that serve in these neighborhoods. this is an unfortunate confusion because improving neighborhood schools or changing referral patterns is not the same thing as reforming provider behavior inside hospitals and offices. researchers have made some progress on this challenge by using patient actors and implicit association tests where physician and the researchers studying them observed the same information in a laboratory setting. this is an

while the federal matching program provides funding for capital projects, states will need to provide the annual funding for those portions of the operating cost that are not covered by revenues. the u.s. department of transportation coordinates state efforts and administrators the federal capital fund for corridor development. amtrak is the nation's rail operator. it designs and provides service on behalf of the states and the federal government in cooperation with the host companies which own much of the railroad right of way. this is an extraordinary vision and a lot of the ideas that are contained in it will probably be components of the transportation re-authorization bill that's going to come before crong in the coming years. the american recovery and reinvestment act or arara provides $1.3 billion dollars for capital improvements. it provides funds for rail congestion mitigation grant programs with $8 billion of capital fund. it will focus attention and funding on those projects that can be accomplished in the nearer term. essentially in the next five to seven years to address

i would just like to point out that this bill does provide for the troops and it provides very well for our troops because that is the most important thing that we as members of congress can do. it provides $1.9 billion more than requested for mraps and 2.5 billion above the president's request for u.s. troops. that's the rind of things that we need to do as a congress to make sure our troops are provided for. mr. speaker, with that i would like to yield two minutes to the gentleman from ohio, mr. kucinich. the speaker pro tempore: the gentleman from ohio is recognized for two minutes. mr. kucinich: i have a question to my friends and that is how do we support the troops by keeping them in a war that's based on lies? how do we support the troops by keeping them in another war which keeps expanding and they are getting shot at on all sides? how do we support the troops by festering a war on the afghan border with pakistan and put them in even more peril because they don't have the support? how do we support the troops? we support them by bringing them home. that's what we should be appro

last year, this congress provided $10.5 billion for missile defense. since that time, north korea and iran's nuclear capabilities have grown as credible threats to the security of the united states. north korea has threatened to quote, wipe out the united states and reportedly is preparing a ballistic missile to launch against united states. the president said iran's nuclear ballistic missiles provides a real threat. despite these increasing threats, the bill cuts missile defense from last year and this includes a 35% reduction to a missile defense in alaska and california designed to protect the united states' homeland. these cuts lack supporting analysis and challenge common sense. if north korea does what it says or if the president is right about iran, this may be one of the most crucial votes we take. the $2.6 billion to pay for equipment for our troops needs to be maintained at last year's missile defense funding level, will come from a department of energy account that has received $5 billion in stimulus funding on top of the baseline request. w

let's say it's paid for by cuts in provider pay. >> can you find a trillion dollars in provider pay? >> that is what we hope to find out. the process we are following is we hope to say let's put a bill out there, which is the first debt and see if it can provide benefits the president has suggested he wants that democrats in the house want. once that is in legislative language, we will have to get the process. it will cost more, if it is a bill i want, it will cost more than we will be able to do. then we will have to figure out, we don't know yet, how we do various pieces and many of them are interrelated. how much do you subsidize? how fast you bring the subsidies then? all these things relate to the cost and our thought was that first we would put the benefits down there and secondly we would get across and adjust as we must. >> regardless of how you pay for it, democratic leaders have said there would be -- that it would be budget neutral. is that still the way you are headed? >> yes. there is an issue of dr./physician reimbursement that we have to take off the table. then we go

people need their products and we are proud to provide them to thousands of americans. individual medical insurance is affordable and belongs to each consumer and these uncertain economic times individual medical provides benefits to a growing population who do not receive a employee sponsored health coverage. that is why individual medical is so important. we work hard to ensure our health questions are simple, easy and straightforward kurds medical history is necessary so we can fairly assess the health risks of each applicant. the vast majority people complete the enrollment form accurately. the underwriting process depends on misinformation and we rely upon the consumers disclosures. people applying for an individual insurance are given multiple opportunities to verify correct and complete the information they provide. they are given ten days to notify us of any inaccurate information or to reject the coverage. at assurant talf we are acutely aware of how our coverage affects people's lives. it is the responsibility we take very seriously. unfortunately there are ti

can provide the content to the discussions. these are relationships that are building over time. we are way better than we have been. we are not as good as we will be next year or the year after. so much has to do with understanding each other's organizations and cultures. and now seeing what i call second or third generation effectings, people working together in one place and have a relationship so they can move much more quickly together. general mcchrystal i think set the standard aggressively at the operational level. and that command is serving as a higher sorts of the headquarters. we wake up with 85 members of the special operations command going to work in agencies of government. some you may expect and some you wouldn't, and small teams two to four people, with an o 6 colonel. and we wake up in tampa with those in our headquarters. full members of the team sitting on the discussions and on the global collaborations kind of briefings and this has provided a transparency that is helpful. and it's hard now to imagine bac

this legislation would provide this critical tools.it my written testimony provide several examples but i would like to highlight one of the most important new authority is now -- section 106 provides fda with explicit authority to act as with records during routine inspections thereby addressing one of the most significant gaps in its beef existing authority. the authority provided in this provision is essential to enable fda to identify problems and require correction before people become ill. it also enables a agency to verify during a routine inspections that firms are maintaining proper distribution records. records access and record-keeping by all persons in the distribution chain and a key mechanisms of providing regulators with information on plant operations, product safety and product distribution. such information is necessary to verify compliance and to identify problems. lastly, does of the legislation provide or anticipate resources for the agency to match existing and new responsibilities? the draft legislation that make

my computer automatically send along the cookie that service provided earlier. this request for an ad carries more information about me. it says that i'm interested in baseball and jazz which the social network site knows, and that my name is edward felten. the ad service recognizes that the cookie is the same as before so it knows that i'm the same person who looked up d.c. weather earlier. and it adds the new information to its profile of me. the service sends back an ad. this time it's an ad for a washington nationals ticket because i looked up washington weather earlier and i'm interested in baseball. notice that the ad is connectin -- the ad service is decking the dots between things that i did on different sites between something i did on the weather site and something i did on the social network site. this allows it to better target ad and also to build up a more extensive profile about me. next go to a bookstore and look up books about travel in hawaii. the bookstore site sends this information to the ad service along with another ad request. again the c

and they will have to negotiate with the providers of care and see which providers want to give care of that insurance plan as providers have to decide whether they want to do it under a private insurance plan hearing in the beginning i think the public plan will probably use medicare as a basis for the reimbursement by publicly higher than in medicare because they want to be sure that they can attract the doctors and other providers to the public plan. but a public plan will be open and transparent and i think will be looking to be even more nimble than other insurance carriers because of ill try to figure out how to provide care in a comprehensive way and a preventive way and hold down some of those costs. >> as relates to the question of rationing, i imagine all of this as competition. the whole world, the whole country rather will be watching how these plans intend to work and you can bet your life with the competition of one of them getting a reputation not providing that health care, it won't be in the united states government that would be directing it, it would be the governm

we provide all women of all ages reproductive health services and you can count on my support to get that passed. i do have a question. as we take on the challenges of health reform, i firmly believe that every american has a right to health care and should be especially true for every single one of our children. we need to remember that no population stands to gain more from national health care reform than our children. re from health reform than our children pete children ensured by medicaid and schip are covered under 50 different state programs and the d.c.'s coverage. 51 different programs. a child's access to health care coverage and health care should not vary by location in this country. so, the question is how does the federal government ensure that its most important investment, the investment in the health of its children, standardized in terms of uniform eligibility, national pediatric 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

monopoly, a government provider. most of my frustration has been the result of dealing with medicaid and medicare in terms of the access and quality of service to consumers i serve for 3 decades. i find the flawed funding mechanisms in terms of competition being named, ultimately decrease competition because of this new government entity, this taxpayer funded savings, there are immediate gains obviously for health information record but in the long run, is it sustainable? that is the type of thing you have to be able to invest in after a new generation of technology comes along. i raised that question in a previous forum and there were no thoughts about what happens a number of years from now when the technology changes and our health care providers are without the resources to do that. marching ahead, my first question, you noted that an employer mandate will be to a loss of jobs. some studies found using economic analysis prepared by our previous witness, that an employer mandate cost $300 million over 10 years wou

you provide public education, why not you provide a public medical for the working class people? guest: well, the caller purports to know what the working class and middle class want. i think he's mistaken. again 80% of the american people say their health care is good or excellent. and second, you hear a fundamental divide between the caller and mine, everything desire is a right, it's an entitlement. health care is a right. well, a right is an enforceable claim. and it's not a right in this country. housing is important, it's not a right. and it seems to me we should probably avoid casting every policy choice in this country as a right. because this right talk makes it difficult to split differences. host: warren, ohio, good morning. caller: good morning, first of all abc and the white house there will be no opposite and nobody fair. money won't come out [inaudible] and c-span needs to talk about [inaudible] and martha stewart. and can i disagree on iran and korea. and i think that iran is more dangerous and they get their food from china. iran is funding hezbollah and iraq, i

it provides an entry to the middle class as a key to building wealth. it also helps strengthen communities. homeowners have a greater stake in the success of local schools, civic centers and churches. we have recently experienced an upheaval in the housing market which affected the entire economy. thousands of fam is -- families have lost their homes. despite all this, we need to remember that home ownership has been historically the single largest creator of wealth for most americans. as someone involved in the housing industry for more than 25 years, i've seen more than my share of housing down turns. it's important to ensure that liquidity flows to the housing market to keep it functioning. the home loans are finally providing afordable, safe loans for home buyers who had been reduced to risky loans. there was also an act introduced to encuverage responsible home ownership. congressman ken calvert would extend the home buyers' tax credit. during these economically challenging times, it's more important than ever to provide help to homeowners. it's be

we would like that choice but because of prepaid health we can't provide that. >> thank you for that perspective. obviously, i have to think about it a little bit more. for some of the other panelists, i think from what i know about the private healthcare insurance system there's really a lack of transparency. for example, i don't know of any state that requires the health insurers carriers to file their rates and justify their rates. we do that in workers' compensation and for those states that have no fault auto insurance of prior approval. there's really a lack of transparency. .. specific language requirements that addresses the waste that is in the system currently. >> the bill as drafted has a number of elements of what we need to have a national, effective strategy for addressing quality problems and improving the delivery system. it is not as well integrated or robust as it could be. we had discussions over the weekend with some of the staff about this. needs some work and one of the things that is really important is that currently we have a consensus -- is not mandated by h

but if you can't provide a doctor that really provides it or a home health care provider that will provide that or any provider that will provide that, well, where are you? second, i'd like to see provided the cost estimates from the congressional budget office and the joint tax committee. just let us know how much all of this is going to cost. that's extremely important. we're hearing anything, $1 trillion to $2 trillion. then lastly, how will it be paid for? i know we're into an era now where basically we have the printing presses rolling. we have an economic recovery act and we have many facets of that. we have the stimulus, we had the omnibus. we had the president's budget. and we had tarp. and we had four different other acronyms under tarp. and we didn't worry too much about the pay fors and who was going to pay for it. we let the printing presses roll because nobody wanted to see economic armageddon. could we have done it better? i think so. but that's yesterday's decision. so we should identify how this will be paid for or are we not going to pay for it? are we simply going to go a

the clerk: h.r. 403rks a bill to provide housing -- 403, a bill to provide housing assistance for very low income veterans. the speaker pro tempore: pursuant to the rule, the gentleman from texas, mr. green, and the gentlewoman from virginia, mrs. capito, will each control 20 minutes. the chair recognizes the gentleman from texas. mr. green: thank you, mr. speaker. mr. speaker, i ask unanimous consent that all members have five legislative days within which to revise and extend their remarks and include extraneous materials on h.r. 403. the speaker pro tempore: without objection. mr. green: mr. speaker, i yield myself such time as i may consume. the speaker pro tempore: the gentleman is recognized. mr. green: thank you, mr. speaker. mr. speaker, i'd like to thank representative capito. she is an active member of the financial services committee and i thank her for managing today. mr. speaker, i'd also like to thank representative michaud, for his outstanding work in helping wi this bill. he is a co-sponsor. i thank the ranking member, spencer bachus. of course i thank mr. barney frank.

no provider is obligated to provide medical services under the public auction. the public auction will provide competition so that we can make the market work and keep everybody honest. it contains provisions to contain ethnic disparities and treatment. the draft that is a broken medicare physician payment system and prevents cuts that are scheduled under current law from going into effect. the draft takes the steps necessary to fix the shortage of primary-care practitioners and addresses and other providers. finally, at the drafting chores that people have a choice. a choice of doctors, benefit packages, and a choice among insurance plans. this approach builds on what works and fixes what is broken and make sure that people have choices that are pragmatic. it will produce the results of the nation's health care system so desperately need. it will lower costs, broader coverage, and better quality. today we will continue on a journey that began over 100 years ago to provide health insurance for all americans. some of our greatest presidents of the 20th century, t

different providers to choose efficient provider partners, so that the o orthopet does the procedure at the most expensive hospital, they never get a reward, but if they do it at a more efficient hospital, less expensive, they might have not have to change anything they do and this way they could be a winner in per episode bundles. now, the attribution of episodes to -- of patients to different episodes or different providers, can be a challenge. it's easy with the major surgical things. initially, this actually has been pursued by private insurers, as a modification of fee for service. basically, bonuses or penalties in for per-episode efficiency and cms to me is laying the groundwork for this in the future for medicare, as they are implementing, as directed by congress, resource use reports, which basically are for information only, reports to physicians on the efficiency with which episodes of treatment that they're involved with are provided. now, there's been some criticism by some of the proponents of c capitta ted of per bundles uses. i would bundle them in two services. one i

so long as we provide -- so long as we provide a hardship waiver for those who still can't afford its we move toward this system. the same is true for employers. while i believe every business has a responsibility to provide health insurance for its workers, small businesses that can't afford it should receive an exception. and small-business workers and their families will not be able to see coverage in the exchange if their employer is not able to provide it. now here's some good news. insurance companies have expressed support for the idea of covering the uninsured. and they certainly are in favor of a mandate. i welcome their willingness to gauge constructively in the reform debate. i'm glad they are at the table. but what i refuse to do is simply create a system where insurance companies suddenly have a whole bunch of more customers on uncle sam's dime, but still fail to meet their responsibilities. [applause] >> we're not going to do that. let me give you an example of what i'm talking about. we need to end the practice of denying coverage on the basis of pre-existing condition

this legislation provides a common sense solution to provide useful scholarship information to our nation's veterans and their dependents, providing a list of all available scholarships on the v.a. website will allow veterans advocates to reach a larger population and simplify the search for veterans and their families. i'm confident the veterans will come to rely on this tool for information on how to supplement their education benefits offered by the v.a. i thank congressman boozman for introducing this bill and urge support of the bill. i reserve the balance of my time. the speaker pro tempore: the gentleman from arkansas. mr. boozman: i rise in support of h.r. 177 -- 1172, to direct the secretary of veterans affairs to include in the internet website of the department of veterans affairs a list of organizations that provide scholarships to veterans and their survivors. beginning with the world war ii g.i. bill, the department of veterans affairs has administered education programs designed to provide a wide range of education and training opportunities to veterans. over the year that mi

providers. so if we've got this right choices program designed to help those have these one-time health risk appraisals and provide for a level of screening. but i think we would all agree is beneficial. that's good. that's great. but what about these individuals that are medicare eligible, that ' are willing. and, so, i don't want us to be in a situation where we pass legislation that, again, you mentioned it yourself. we say well, okay, we did health care. we did health care back in 2009. we don't need to take that up for another 10, 12 years. and, again, we have made a promise to individuals. we've given you a card. but we haven't put anything behind that card. so, again, i throw it out for discussion. and i offer it as a challenge as to how we provide for a level of care that is equal in rural parts of america as it is in our centers where we have some of our finest medical research facilities and hospitals. >> let me thank our colleague from alaska. others may want to make a brief comment o

the budget request includes what is necessary to provide special operations forces that will put the united states with capabilities. and the major force program has been strong of to me the mission requirements, the success of special operations forces depends on the dedicated budget but also the service parents and partners. special operations forces rely on the services for support. some capabilities must be provided by the services, including remote logistics and telecommunications, with a combination of the special operations command budget and support from the services, special operations command is looking for the balance, for the speed of response, the the operation of crisis, and to have the capabilities assigned in support for the special operations forces. the special operations command headquarters will continue to develop the most precise and legal counter-terrorism force and we will provide the most effective trainers and advisers and partners, with the skills and leadership and mindset necessary for tomorrow's challenges. we will continue to find kill and capture the i

market is essential because re insurance provides that much needed capacity in the u.s. for property, casualty and life risks. including their u.s. subsidiaries, foreign-owned insurance companies accounted for nearly 84% of property casualty premiums seated on u.s. risks by u.s. insurers. because the re insurance transactions between sophisticated business parties, the regulation of re insurance focused almost exclusively on regulation insuring the financial solvence we no consumer component. because re insurance is a business to business transaction involving knowledgeable parties, there are no re insurance guarantee funds at the state level and there's no need to create one at the federal level. there is no federal entity with federal authority or designated responsibility for oversight of insurance. there is no source of information at the federal level to appropriately advise policymakers. at a minimum, there is a need for federal entity that can utilize information and data from state regulators, but is empowered to conduct its own analysis and provide a broader per

you know, there are two basic strategy is to address provider market power. i don't think antitrust policy has been very attentive and has a lot of potential at least in the short term, but basically you can have basic incentives to choose less expensive providers which means revamping your insurance benefits structure because the benefit structures that such incentives. and the other possibility and that is the market approach and the other possibility is a regulatory approach of literally regulating the payment rates might all payers for a provider. neither of these has been getting much of any discussion in conjunction with health care reform. so if i can conclude in i think payment reform may have the greatest potential to ben and the trend of a medical spending, and medicare is well positioned to lead in this area in conjunction with health care reform. but medicare's potential to lead needs shoring upper. there is probably a real need for reform of the governance of the medicare program which is getting more and more attention in congress with all these

please swear or affirm the information that you have provided and will provide is true and accurate to the best of your knowledge and belief. let's get started. everyone will be limited to 10 minutes more or less and we will say what the q&a for the and so let's start with time to louis. >> on behalf of the american heart association and the moist and 22 million volunteers and supporters i want to express my appreciation for the average today to address the commission on civil rights and share information to reduce health disparities involving health disease and stroke. improving health care quality and high praise for the american heart association peridot given the fragmentation and health care system on average americans receive the care, and about half the time. however, racial and ethnic minorities and women generally receive lower quality treatment. compared to their counterparts. all patience but especially patience of color and women need higher-quality care. and our short time together outlook is much discussion on the american heart association's innovative quality improvemen

means is they need to provide care and what we should do is provide medical liability relief to those emergency room physicians by treating them as federal employees. not that they're going to be on the federal payroll but for tort purposes and the federal tort claims act they would be relieved from those type of lawsuits because we've had situations across this country where trauma rooms have been forced to close down. it's traumatic. we've also had some places in our country, an obstetrician who was at one hospital and said the only reason that we provide, the only reason we deliver babies is to you train our students. we lose money. and there are many doctors who choose not to deliver babies these days because of liability and in philadelphia at the time he know one hospital stopped delivering -- i know one hospitals stopped delivering babies. they only deliver so they can train their residents, they lose money and it's very costly to them. but they do it as a service and as a way of training physicians. that's a very sad state of affairs when we can't deliver babies because of the

instead of rewarding providers by how much care is provided, it reimburses doctors and hospitals forthe quality, safety and effectiveness of the care. so with that, i'd like to ask my colleague, andrew, to come up and give you more of the detail around the elements of the agency. >> thank you, cleve. so the question that cleve proposed to us is develop a payment system that will respond to these twin goals of the affordability and the key question for us is how do you extract the estimated 20 to 30% of care that is unnecessary and even harmful? our response was you do it by putting physicians, caregivers, and patients back in the center of the healthcare system and give them financial incentives to improve care and eliminate waste. because we believe that the most promising way to slow the growth in healthcare spending is by making care better. improved quality in our construct equals affordability. it may be the clearest win-win in the debate over healthcare reform and as cleve said, it's getting insufficient attention, we believe, here in washington. .. instead of focusing 0 covera

helps us to level the playing field, and it does provide real choice. i also would remark on the issue of this committee and on a bipartisan basis i think what we have tried to do is not taken juice the various diseases or illnesses that are focused on at the nih and our other research institutes, so that while i too have a personal interest in cancer, as a survivor, but if you will earmarking with autism and of cancer, i think we are best if we are not picking and choosing. i am going to go to another question hopefully in the second round and i will come back to healthcare but i wanted to briefly talk about early childhood and head start if i might, and the recovery program to provide a funding to the forehead start, and is part of the safety net, but the dollars as you know don't increase the base funding for the program. the recovery act also provided resources for child care and development block grant, but again, it isn't a part of the really the 2010 budget, which only included a slight increase for the block grant program, and what i wanted to d

if you cannot provide a lawyer we will provide one for you. and anything you say will be used against you. this new policy is misguided. never in history have captured war combatants overseas have been treated by such an overflow of privileges. they have been dealt with by our military, especially regarding interrogations. but now i guess we are changing all that, but that ought not to be. i guess next we will have a whole battalion of lawyers going into the battlefield to tell our troops if and when they can shoot back. have we gone a bit too far? and that's just the way it is. the speaker pro tempore: the time of the gentleman has expired. the gentleman from florida, for what purpose do you rise? >> to address the house for one minute and to revise and extend. the speaker pro tempore: the gentleman from florida is recognized for one minute. mr. hastings: we urgently phoenix to fix health care. every -- we urgently need to fix health care. every day americans worry about not getting well but whether they can afford to get well. llions more wo

so this slide provides a bit more detail on how accountable care can be implemented, via providers andders payors of green to change the way that they are paying for care away from typically a fee for service approach. the accountable care providers that are working together, identify who they are. and then the payor can identify who is actually getting care from those providers. who they're accountable for, the patients that they're accountable for based on actual patterns of care. it doesn't require any active enrollment steps. you're not taking anything away from private plan beneficiaries and those providers are then responsible for -- held accountable for the overall cost of those patients, both services they deliver and other services they receive. so there's an incentive to create a virtual or a real connection between the other providers involved in delivering care. the benchmark can be calculated based on projections about future spending, enter into a contract that divides all those potential savings up. it creates the opportunity for shared savings and then the accountable c

the president has already introduced his proposals that provide about $950 billion over the next decade to finance health reform. many of the resources come from bringing waste of the current system and prosecuting abuse and fraud. we are paying for strategies currently that do not work. we are over paying for medicines and equipment. it is time to make a better use of these hours. we know that reform can reduce costs for families and governments. it can protect choice and ensure affordable health care. as to move forward, we will be guided by simple principles. that is protect what works and fix what is broken. we have reviewed the key features of the tri-committee draft proposal to you enter house colleagues. it is clear that you and your committee have embraced these principles. by creating a health exchange that will ensure numerous plan options, along with the public insurance options, the plan promotes choice and competition. by lowering health costs, it is providing premium credit and it makes health care affordable for all americans. by investing in prevention and wellness initi

the clerk: report to accompany house resolution 578, resolution providing for consideration of the bill, h.r. 2996, making appropriations for the department of the interior, environment and related agencies for the fiscal year ending september 30, 2010, and for other purposes. the speaker pro tempore: referred to the house calendar and ordered precipitationed. -- printed. please clear the well. the speaker pro tempore: for what purpose does the gentleman from missouri rise? mr. skelton: mr. speaker, i ask unanimous consent that members may have five legislative days within which to revise and extend their remarks on the previous bill and also to file extraneous material thereof. the speaker pro tempore: without objection, so ordered. the speaker pro tempore: pursuant to house resolution 527 and rule 18, the chair declares the house in the committee on the whole house on the state of the union for consideration of h.r. 2647. the chair appoints the gentleman from pennsylvania, mr. altmire, to preside over the committee of the whole. the chair: the house is in the committee of the whole ho

to provide government to cease private propertiy only for public use. our colleagues will recall the controversial decision of the united states supreme court in 2005 the kelo versus the city of new london decision where the supreme court greatly broadened the definition of public use and greatly limited the property rights protected by the bill of rights for more than two centuries. the court held that the government could take property from one person and give it to another person if government decided that by so doing it would promote economic development. the kelo decision represents a vast expansion of government power of eminent domain and that's why i introduced legislation to limit that power and to restore the basic protections of our homes, small businesses and other private property rights that our founders intended, but in the fifth amendment of the constitution. i believe the kelo decision went too far, yet, by her decision in the case didden versus village of port chester, it appears judge sotomayor did not feel like it went far enough. ju