mr. speaker , i am joined by my colleagues this evening to talk about children 's health month . 
it is very important for all families in our nation , and certainly an issue that concerns all of us on both sides of the aisle . 
while the rhetoric of the house often echoes through these walls about cuts and people being harmed , it seems to me that is the only part of the discussion that we are taking away . 
little offers are made in terms of what is needed . 
what we do often hear is discussions of who is paying . 
should individuals pay , insurance companies be taxed more , businesses be given tax cuts , perhaps health savings accounts , association health plans , or just have the federal government take over ? 
but this should not just be an issue of who is paying , for although that is important , and how much we are paying is important , really much of this comes down to what we need to have is an open discussion of what we are paying for . 
according to the national center of health statistics , 83 percent of children in this country under 18 years of age have excellent to very good health . 
that is good news . 
now 17 percent of america 's children are in less than favorable health , either to mild or severe levels . 
we have to make sure we do all we can to help these children have a better health future and help the rest remain healthy . 
according to the american academy of pediatrics , 6.3 million uninsured children , over two-thirds of all uninsured children in america , are currently eligible either for medicaid or for the state health insurance programs , but they are not enrolled . 
there are many opportunities . 
i know the state of pennsylvania , where i represent the 18th congressional district , really has very good services and insurance for children of a low income level but we need to make sure that we expand enrollment and get those kids beyond . 
for those who are uninsured or underinsured but beyond the level of medicaid , there are several things that we should be looking at to make sure that they get the health care they need to maintain their health to prevent higher expenses for emergency care . 
but what this means is not just more discussions on we are cutting money out of medicaid or other aspects . 
look at what has happened to the growth of medicaid . 
in 1995 , and this is for all ages , medicaid spent $ 150 billion . 
we are now up to $ 300 billion . 
about half of americans are covered by some level of federal insurance or health care . 
but the system is growing , and the concern is it is growing out of control . 
while we are looking at such things as how do we pay for hurricane katrina 's outcome in this devastated gulf region , how do we take care of so many needs , is it fair to just continue to say to the american people we are going to continue to spend more without finding ways of eliminating waste and fraud and abuse ? 
let me give an example . 
the new york times wrote recently about an amount of some $ 4.4 billion in medicaid fraud in that state . 
one dentist billed for over 980 procedures in one day . 
clearly these were patients that were actually being seen . 
another company used van rides for supposedly disabled people , billing those rides to the government . 
but these people when followed by a reporter clearly were not disabled . 
they walked around just fine . 
there is example after example after example . 
i believe the american taxpayer wants to make sure that this waste , this fraud , this abuse is removed from the health care system . 
but it is not just a matter of that . 
when it comes to our children , we also have to make sure the system works with these programs in ways that optimize the health and outcome . 
one of the things that i want to talk about today , along with the gentleman from georgia ( mr. gingrey ) xz4001510 , is transforming our health care system . 
we oftentimes use a tongue-in-cheek quote around here that says one of the definitions of insanity is doing the same thing over and over again and expecting different results . 
indeed , in the health care system where so much money is used inappropriately and wastefully , we ought to have some changes . 
from the center of health transformation , they say we have this current health care system and we are trying to come up with some reforms within the network . 
we try things like so much money is going to pay for diagnoses . 
we ask for some procedures to be done inpatient and outpatient , all within that system . 
what happens is if this system does not change , it will lead to some decay . 
the system can not continue to go the way it is . 
anyone who owns a small business or a household can not continue to operate the way our health care system operates . 
when we go into hospitals , inpatient/outpatient , you will see the latest equipment , the greatest skilled personnel , mris , pt scans , ct scans , but very often we also see that data is kept on patients on pieces of paper . 
we have 21st century health technology kept on 16th century monitors . 
what happens , people slip through the cracks . 
the wrong prescriptions are ordered . 
tests that are done have to be repeated because someone can not get them . 
i was talking to one of our colleagues today and he was telling me how a sonogram was done of his wife who is pregnant , but he can not get it from here back home to his wife because he has to carry it manually . 
it can not be e-mailed . 
we take e-mails for granted , but doctors have to wait for papers to transfer locations . 
what happens ? 
can we come up with some real changes to really help our children ? 
yes , if we switch to an intelligent health system that uses electronic prescribing , electronic medical records , real patient care management for our children rather than having a system that gets bogged down and collapses of its own expense and weight , we can come up with success for our children and no longer be mired in failure . 
let me describe a little bit about what we mean by managing the whole patient . 
a lot of what people think happens when they have an individual or chronic disease is something common , like diabetes or asthma in a child , the doctor will examine and make sure that the child has the right medications , watches their diet and the environment around them , and hope all goes well . 
as long as the parents are monitoring that carefully and there is communication between doctor , nurse , patient and child , you can have a pretty good system . 
what happens if the information does not get to the parents , the patient education is not quite there ? 
maybe they skip a prescription , maybe they did not pick it up on time , maybe they do not fully understand all the elements of diet and medications for complicated diseases . 
what does that mean ? 
you can end up with chronic about 10 percent of the cases that show up in an emergency room are someone who has no ability to pay , but it is estimated that 60 percent or more , 60 percent or more of patients who show up in emergency departments are nonemergencies . 
if in such cases the care was given ahead of time , whether it is through a community health center , a clinic , direct patient care with a physician , if we monitored and kept a careful eye on those children with chronic conditions , we could save massive amounts of money . 
this is not cutting care , it is improving care . 
emergency care can cost five to eight times more than outpatient care , and we can actually save billions of dollars in the system . 
this is where we can find savings , and in so doing we save lives as well as money . 
but this means we use a chronic care model and not the inefficient going to a doctor , another disease , go to another doctor . 
what this involves is not just the health system , it really involves the community , the resources . 
what takes place , the support systems , the families , the individuals helping to make sure they are watching their children , they are educated and they know what to do . 
it is making sure we have a delivery system involved with making sure doctors are notified if someone does not pick up their prescriptions . 
a lot of this can be done with electronic prescribing notification . 
it is making sure that clinical information systems are there so that if x-rays are done , procedures and tests are done , that information is communicated back to the doctor . 
one study i looked at said something like 14 percent of the charts reviewed the physician found that they were missing some important data . 
perhaps the physician referred the patient on to have some testing done , and it was never done . 
in the majority of these cases , the doctor said it would affect what diagnosis they had and future tests called for . 
this is not a matter of just saying we are going to cut care , this is improving care . 
but this also means that clinical information systems must be there . 
they are a critical component of health care , of having the physician and nurse and family work together . 
what does that do ? 
it is a matter of having productive interaction between everybody involved . 
you have an informed , active patient and you have a prepared , proactive practice team . 
no longer the passive system , the doctor says here is your diagnosis , here is your prescription , good luck , call me if there is a problem . 
if that prescription is not filled , there is a call from the doctor . 
it is a system of interaction between the patient and doctor to make sure they are going back and forth . 
mr. speaker , i am not talking about things that take place only in families that have access to computers and finances to do this . 
a lot of this is done in areas of low income levels , of high risk populations where we really find it is much more affordable . 
what we need to be looking at here as congress is when we are reviewing such things as the medicaid system , it is not just saying we are going to lop off $ 8 billion or $ 10 billion and see what happens . 
it is a matter of doing more effective work . 
much like a household that says our spending is going out of control , they do not just say let us not spend any more . 
every small business and family does this . 
they look at what they are spending , but you have to change some of your habits and make habits more effective . 
the system that seems to be adapting the slowest is our health care system , perhaps because we just keep doing the same thing over and over again and expecting different results . 
what the federal government is going to do and what we are doing here in the republican conference is asking those questions and demanding some answers of changing some of that system . 
what i would like to do is call upon the gentleman from georgia ( mr. gingrey ) xz4001510 , who as an obstetrician has worked with many families , particularly in the area of prenatal care . 
one of the critical areas in cutting costs and being more effective in health care is dealing with prenatal care in an effective and positive way . 
mr. speaker , i yield to the gentleman from georgia ( mr. gingrey ) xz4001510 to talk about these aspects of prenatal care , and he can tell us about some of the elements of saving money by doing more effective patient care management . 
