and the result is that now mcallen spends twice as much as the u.s. average. you can see that difference showing up in all sorts of medical indicators. you can continue down the list. those additional expenditures would be worth it if the result was higher quality and better outcomes in mcallen. but as the data suggests, we are not getting higher quality for those additional expenditures in mcallen, quality is actually lower in mcallen than in el paso. a central fact surrounding our health-care system is that higher cost does not mean higher quality. one of the key thing that has to change is we need to reorient the system rather than more. as we read that article, the first was stunning. they're not aware that they were more intense users of the health-care system. against comparisons event comparison hospitals. bob raised a series of interesting questions. one is the idiosyncratic nature that he faced. it would be useful for the physicians and doctors to have more information about what was likely to work. we have dramatic variation that is not explainable b

and now courtesy of the tool mcallen texas is now a famous example to me of responses by providers particularly physicians to the payment incentives in our system. physicians are also shifting to more lucrative specialties that we see primary care shortages increasingly in evidence and we also have research that shows specialty makes influence spending basically the mix we have in the united states. different from most other countries with a much smaller proportion of primary care is a factor that leads to our cost being higher. now, capacity leads to further higher rates of service use. capacity is often justified on the basis of patient convenience. it's more convenient for the patient to have their test right here in the office. they don't have to go to this hospital outpatient department and of course when we have third-party payments this changes the calculus of patient convenience so why should the patient be concerned if they are going to a less efficient, more expensive facility? and self referral incentives now apply to more services as more technical capacity is brought into physician

it is clear in some parts of the country -- and he was speaking of mcallen, texas -- the cost for medicare patients are dramatically higher than other places. we can bring costs down to a reasonable level and try to take control of a system that's currently out of control. but we can't do it if every day we are reminded of problems that don't exist. and that's what we've heard from the other side of the aisle. they're arguing that we want to take away people's health insurance. absolutely false. we've said if you like your health insurance, you can keep it. they're arguing that we want the government to take over the health care system. i haven't run into anybody who suggested that. what we want to do is have private health insurance and have a public option, which the senator from new york is going to address in just a moment as i close here. this is an important debate for every single american. it is time for us to put together a reform that assures quality affordable health care for all americans. mr. president, i yield the floor. mr. schumer: mr. president? the presiding officer: the

respect to differences in care and just say two quick things, one of the most remarkable -- in texas with el paso, texas and he found mcallen texas the costs were about double what they are in el paso. i think there are a number of things that we can do. i think there's some things that this bill would do that would help change those disparities. i think the promotion of comparative effectiveness research is very important in getting that proliferated as substantially as possible not precluding a doctor from, you know, making a clinical decision but at least providing guidance to the physician and to the patient, i think that's very important. so i think there are some things that can be done which i think will reduce this wasteful spending that occurs in too many places. one last thing, and that is -- >> it's going to be your last thing. >> the chairman wanted to us gavel us down here. we'll have to cut you off there. >> i don't know if he wanted to jump in on your question. he looked like he wanted to jump in on your response. >> the microphone. >> just very briefly. with respect to the cost of care and i think we really

something that's not as popular with many health care proirks and that is reducing the cost of this system. what happened in mcallen, texas, is unacceptable, that you can have health care providers trying to run the bill in an effort to make more money for themselves at the expense of the government, at the expense of health insurance companies but frankly not to the benefit of those who are being treated. the senator from kentucky frequently comes here and talks about how much he dislikes -- i'll use that word -- government-related health care. let's make it clear. i don't know anyone, including the president or leaders in congress, calling for a government health care plan to cover for everyone. that's not what we're asking for. we want to try to make sure that there is private health insurance that is held accountable and is competitive so that we can help bring down the cost. imu to argue that there is something fundamentally wrong with government-sponsored health care even if it's just an option, a voluntary option, for cuss mess across america is to ignore the obvious. there are 40 million americans today pro

now, a recent article in the "new yorker" showed how mcallen, texas, is spending twice as much as el paso county. twice as much. not because people in mcallen are sicker than they are in el paso. not because they're getting better care or getting better outcomes. it's simply because they're using more treatments. treatments that in some cases they don't really need. treatments that in some cases can actually do people harm by raising the risk of infection or medical error. and the problem is this pattern is repeating itself across america. one dartmouth study shows that you're less likely -- you're no less likely to die from a heart attack and other ailments in a higher spending area than in a lower spending area.

now a recent article in the new yorker, for example, showed how mcallen, texas, is spending twice as much as el paso county. twice as much. not because people in mcallen, texas, are sicker than they are in el paso, not because they are getting better care or getting better outcomes. it's simply because they are using more treatments. treatments that in some cases they don't really need. treatments that in some cases can actually do people harmed by raising the risks of infection or medical error. and the problem is this pattern is repeating itself across america. one dartmouth study shows that you are less likely, -- you are no less likely to die from a heart attack and other ailments in a higher spending area than in a lower spending area. there are two main reasons for this. the first is a system of incentives where the more tests and services are provided, the more money we pay. and a lot of people in this room know what i'm talking about. it's a model that rewards the quantity of care rather than the quality of care. that pushes you, the doctor, to see more and more patients, eve

the u.s. border patrol. for half of that time, i was border patrol sector chief, first in mcallen, texas, then in el paso, texas. as the only member of congress with a background in border enforcement, i'm keenly aware of the invaluable work these brave men and women perform for our country each and every day. we have a lot to thank them for. in these times of heightened security, the u.s. border patrol and those agents are not only vital in helping to protect our country from terror threats and illegal entry of drug, but they also apehend and deter human smugglers and bring them to justice. oftentimes, these agents are the first people to respond in humanitarian situations in the desert by providing first aid, food, water, and shelter to people who have goten in trouble because of the heat and the distance that they're forced to travel in remote areas. border patrol agents perform countless rescues every year and provide critical training to law enforcement both at home and abroad. mr. speaker, the u.s. border patrol is vital to our homeland security -- 30 seconds? ms. sanchez: i yield the gentleman 30 seconds

the best quality and lowest costs. people are healthier coming out of there and do great. then there is a town in mcallen, texas, where costs are 1/3 higher but the outcomes are worse. the key for us is to figure out how do we take all the good ideas from this one clinic and spread them all across the country so that it becomes the dominant culture for providing health care. that is going to take some time. it involves changing how we reimburses doctors, doctors forming teams and working in more cooperative way, and that is a slow, laborious project. here is the bottom line. if we pass reform this year, my expectation would be then immediately families are going to see some relief on some issues, but we will not have the whole system perfectly set up probably until four-five years from now. i think it is a realistic time frame. if we wait and we say since we're not going to get it right away, let's put this off for another two, four, five years, it will never happen. that is what has been going on for the last 50 years. people have been saying they cannot do it right now and as a consequence it is never

the lowest cost. people are healthier coming out of there. they do great. then you have places -- there is a town in mcallen, texas, where costs are a third higher than they are at mayo, but the outcomes are worse. the key for us is to figure out how do we take all the good ideas in the mayo clinic and spread them all across the country, so that becomes the dominant culture for providing health care. that will take some time. it involves changing how we reimburse doctors. it involves doctors forming teams and working in a more cooperative way. that is a slow, laborious process. here is the bottom line. if we pass health care reform this year, my expectation would be that immediately, families will see some relief on some issues, but we will not have the whole system perfectly set up probably until four or five years from now. i think it is a realistic time frame. but if we wait, if we say we are not going to get it right away so why not put it off for four or five years, is never going to happen. that is what -- that is what has gone on for the last 50 years. people said we cannot do it right now, and as a

but it's medicare spending is in the lowest 15% of the country. $6,000 per enrollee in 2006 which is $8,000 less than for mcallen, texas. i bring that up to say that in u.s. it is part of what you're describing, access -- patients need access to these tests but we also need to make sure that physicians and nurses and all medical specialists are getting the information they need to make sure that quality is what we're driving here. and you're dealing with just issues of insurance or just issues of defensive medicine, you're not necessarily driving quality but you're driving more test. i yield back. mr. kirk: one of the other things we've been concerned about is the increasing price of medical mall practice insurance in the united states and especially if you look at between 2000 and 2002, for opt trigses and gynecologists, for physicians and internists in general, you have an explosion in the cost of buying insurance. we do not have 30% more malpractice in america in just two years. but what we may have is a 30% greater chance of being sued in america, the most la tishes society on earth. all of this drives healt

the motivation should be, a healthy patient, a good medical outcome. he contrasted mcallen, texas, with the mayo clinic, a fantastic medical research in rochester, minnesota. mayo hires the best docks they can find and pays them by salary. they aren't paid by patient. or how much they bill. so these salaried doctors are looking for good outcomes. they don't want to order anything more than a patient needs. they want a good outcome. think in the difference in motivation between the doctors in mcallen, texas, and the doctors in rochester, minnesota. the congressional budget office sends a report yesterday and says if you want to reduce the cost of health care in america you have to get to the question of reimbursement. now, when you talk about that you get everybody at the american medical so on their feet, shaking their fist, saying if you cut back on compensation and reimbursement for doctors, fewer people will go into the profession, you won't be able to get the best procedures, and you understand what they are going to say. many of us have heard it. but we've get to find

do we want to continue the example of mcallen, texas, which is abusing the system, charging too much and not getting good health care results, or do we want to move to a mayo clinic model, one that is basically much more efficient and effective, keeps people healthier at lower cost? i hope the answer's obvious. it is to me. i would like to see us move towards incentives like the mayo clinic system. the president spoke to the american medical association in chicago last week. it was a mixed review. they were very courteous to him. there were a few people dissatisfied with his remarks, but it's a free country. you can expect that. some of those doctors in that room understand it's time for change and some of them don't. some of them think that change is going to be bad for them and bad for our country. but most of us understand that if we work together in good faith and conscientiously, we can change this health care system for better, reduce its costs, preserve our choice of doctors and hospitals, make certain that quality is reward rewarded, also make certain that we cover those 46 m