because people aren't honest and don't care about other people, that is the problem. i raised his on 1500a month, never went bankrupt, never had defaulted on a loan and never had health insurance. my ex-husband would pay for it and i couldn't afford it but i pay my bills and didn't buy brand-new cars and that's how i did it to read it so it is doable for the individual. my question is one about putting a cap on how much these big ceos can make and different things and also as far as i am looking for a politician who is, people fought and died for this country and we don't have a politician who is willing to sacrifice his job. >> guest: let me start of the first point that karen made it -- she is right. we're in a moment of history and we saw this on the people on wall street who are not content

with making 30 or 40% rates of return, how to make more in a hedge fund managers making a billion dollars in personal gains and it need to make more. i think agreed remains almost every aspect of life. but i was a two care and who is my understanding with no health insurance because she doesn't have a lot of money, that is a dangerous position to be in because you never know what's going to happen tomorrow. you don't know what kind of illness can develop an accident your kid could have. so i think as a nation we have got to move toward health care for all people. in terms of putting one's job on the line i think there are people in congress who are prepared to stand up to the big money interest and take on the drug companies and insurance companies but i think she is right in the sense it is not enough. >> host: we have an e-mail entry to from daniel who says my sister had cancer and went

bankrupt because of it in 10 years later to have problems getting a job because she had cancer. >> guest: this is another issue bankruptcy we touched on, it to go to other countries around the world and people are going to criticize both countries but to ask how many people go bankrupt because of illness in canada or other countries and the answer in most cases is zero. and second of all we have millions of people today who are staying on their jobs not because they want to, not because they're content are happy but because they have decent health insurance and are afraid to leave their jobs to go to another job or the health insurance is not as good. it doesn't make sense from a personal point of view or economic point of view and the answer is it doesn't so what we about to do is move away from employer based health-care to national health care which says if you are an american a matter which her job with a sweep the

streets or president of the ad states to have the same quality comprehensive health care. >> host: he says can you clarify that the federal health care policy they receive referring to members of congress is seriously subsidized by tax selling is on my the comments of congressman gingrey. >> guest: number one, the program i have is the best of my knowledge of the same as postal workers in the same as my secretary in the same as anybody who works for the federal government so it is not like members of congress. the caller is right, like many other employer based health-care systems our health-care system, the federal health-care system is subsidized by the government. >> host: our last call from wyoming, independent line for a senator bernie sanders. >> caller: good morning. i just wanted to talk about, i am not sure that national health

care is to the answer. i know we need something. i am a retired social worker and retiree this than a year ago. 20 years in social work and nursing home, hospital assisted living, worked with medicare and medicaid and the veterans' association. it is terrible. people have a terrible time with it in the nursing homes, the doctors' offices have to employ two or four people to try and get reimbursement from medicare to argue with medicare and medicaid on their bill. i worry that a national health-care system run by the government like medicare and medicaid is going to be another problem like that. i think, i saw my doctor recently by heart doctor for 10 minutes and it cost me $92. that is part of the problem with health care. that is outrageous. >> guest: can i move ahead to one final question, but also

ultimately what to think congress is going to vote on. >> guest: what i would say to sandy is i think if you talk to most physicians they will tell you they are dealing with the private insurance companies is a lot worse than dealing with the veterans' association or medicare is mine understanding. and in terms of a sandy ping $92 she is doing pretty well, i have heard horror stories are people go into an emergency room and come up with a thousand dollar bill and that deals with reimbursement rates among other things. i think we in many ways are not putting enough money into primary health care. it's too many doctors are going into specialty care and that concludes of doctors and specialty care is driving up costs and is an issue we are looking at. what is going to happen? i don't see a crystal ball, i am not -- at the situation is a mcginley in flocks. i thank you have two committees in the senate working on its an

in-house working on it and the president to intervene so i think we don't know at this point what is going to happen but i would conclude by saying i hope the american people can actively involved in this process and i hope that they will demand that health care in america becoming human rights and all of us have it regardless of income and we have a simple comprehensive high quality system and guarantees here of care to all people. this max senator sanders, thank you for coming back to c-span. >> guest: three nice to be with you.

now in discussion on this health care and ever is to compare the effectiveness of various treatments and medical procedures. the speakers include senate finance committee chairman max baucus and white house budget director peter orszag. from the brookings institution this is about an hour. >> [inaudible conversations] >> good morning everyone, i would like to welcome new to this brookings institute this morning, im mark mcclellan, director of the engelberg center for health care reform at brookings and on behalf of bob and the hamilton project we would like to welcome you to today's events on one of the key issues of health care reform. implementing comparative

effectiveness research here and we're delighted to have such distinguished participants to discuss this issue and that, of course, includes all of you here, in the overflow room and i know we have a lot of participants, as well. comparative effectiveness research has vaulted to the front lines of the health care reform debate and as you'll hear from some of our upcoming speakers it could even be a game changer come a key part of bending the health care cost curve and comparative americaness research is moving toward. the american recovery and reinvestment act and a stimulus legislation of us at $1.1 billion in federal initiatives to conduct, comparative effectiveness research and expand current activity. this includes an average two cornyn a new and existing at risk in it comparative effectiveness research. the legislation created a new federal coordinating council which has begun its work and institute of medicine will produce its recommendations for national priorities for national comparative effectiveness research efforts by the end of

this month. but fulfilling the promise of comparative effectiveness research for better quality and better outcomes and value in health care will require answering important questions that have not yet been tackled. there are some differences in views about whether comparative effectiveness research can have substantial impact on health care costs gross purse and for the concern about whether that happening is a good thing. whether such restrictions on cost growth would be a good thing. as we will talk about today what kind of impact in come from comparative effectiveness research may come down not just to whether we spend the money but how it is done, such questions include whether research issues should be prioritized, what methods are a profit for comparative effectiveness research and where will the data come from and how can comparative effectiveness research findings be used to maximize the impact on clinical and health policy decisions. we will talk about potential answers this morning with the help of an oppressive and never said a participant -- we're delighted to be joined by

senator baucus and omb director orszag to give their perspectives on how comparative effectiveness research and the availability of better evidence on health care can help shape the health care system in years to come here and then we have a three commission the papers and discussions for those papers, peer review papers all participants distinguish records, their biographies are in your conference material, i will not try to summarize them but most apparently we look forward to hearing from you about the best ideas and concerns for moving this health care to pay for it. we have a full agenda and a limited amount of time. we will not have any schedule breaks here and if you need one please feel free to take it during the brief transitions between the panel. this is a large group and will set this meeting up in a way that has time for questions and open discussion. we will have rooming microphones, please raise your hand if you have a comment but it is imperative to keep them break and also please identify yourself and ask a question.

the event is being webcast live and we also have a number of attendants so please be aware that the remarks on the record and finally i want to alert our speakers not use senator baucus but others there is a timekeeper in the front row making sure that to stay right on time. [laughter] so with that i am very pleased to introduce senator max baucus sewell been giving the day's opening keynote. senator baucus says all of you know has a distinguished record of service from montana and the country in the senate since 1978. chairman of the frame for the senate finance committee where he is leading an effort in conjunction with ranking member senator chuck grassley to get consensus on a comprehensive bipartisan health care reform bill in the coming weeks a. as part of that effort he has been a passionate advocate for comparative effectiveness research downright, sponsoring his own legislation with senator conrad in the last congressional session and including provisions to address the inappropriate use

of cost information in the comparative effectiveness research. in addition to this he finds time per ultramarathons which is pretty good preparation for what he's trying to accomplish now. senator baucus, we're pleased to have you back at brookings institute for this opening keynote. [applause] >> thank you, mark, very much and thank you very much for inviting me to your session today to talk about an issue i think a great chance a primitive and that is compared -- that is comparative effectiveness research. santi in dallas $0.1, and men alike shopping they would call it research. [laughter] think about it. from cars to television when americans go shopping there rarely able to evaluate information about the quality and effectiveness of anything

but also for health care. and why should americans have information on what works and what doesn't? when it comes to their health that question is especially important when one considers that health care is where americans spend one in every $6 that we spend in the year. since the finance committee began preparing for a comprehensive health reform last year comparative effectiveness research has been mentioned in the very often. it is almost constantly mentioned and it has raised almost as much controversy. it is a hot topic summer so the senators on my committee on both sides of the i'll suggest that we stop using the name. stop calling it comparative effectiveness research. suggest that a switch to something else that this will less controversial and as branding. so when we talk about this off the top of my head i said let's call it fred.

[laughter] that might be more palatable but honest, another in a wicked use is based in centered at come research, at least it would reflect the intent of the research or just call it shopping. whenever we call one thing is certain -- we need to address the concern that this research might help -- might be used to it ration health care. people talk about cost effectiveness hearses clinical like the mess. people talk about whether the research can be used to make coverage decisions and these concerns boil down to an underlying issue -- rationing. is it serious and is to be addressed with integrity. there are several ways and the first is to make sure that that read the surgeon is patient focus and it must consider a patient's preferences for how they want to humans to work. patients must be actively involved in a setting the priorities and the signing of

the research studies and research is financed relative for patients. we should assist patients so they can participate in the process of developing priorities and designing studies. patients representatives should be given training on technical matters so they can interact with researchers and other stakeholders on these matters in short, patients must be at the center of the questions about medical care that we want answered. next practicing physicians need to be at the table. not just research physicians but those who use of prescribed medical care. they know questions to ask and they are key to making the research for the decisions that will be made with patience. and turn we need safeguards. same occurs when it comes to the use of research and federal health-care programs and medicare and medicaid should not be allowed to create automatic links to any single study and these need to be open to chance

parents and early how they use patience and research. nothing should be done behind closed doors without public input. we should not build walls about research. we should not bar any federal program from using its responsible and transparent way but we should build in very clear lines of the road so the agencies only use research and opened it and deliver to way. many patient groups to the value and the need for more of this type of research and must take prostate cancer. men with prostate cancer have a choice among three common treatments. surgery, radiation and chemotherapy. each approach yields different outcomes in terms of survival and quality of life. some areas of the country tend to use one approach and some use other approaches and some of these are more costly and less effective than the others. comparative effectiveness

research when compared to clinical outcomes of each approach and systematic way. that way they would have more information on how options work and for whom. patients want to know the best options are and this time the research would help. so what is the future of patients entered outcomes research? we have two choices. we can continue to hope that congress appropriates dollars to federal agencies and the studies they produce are ones of national import beer in oregon but this type of research on more solid ground removing from political influence in funding cliffs by setting the ground rules without how it is conducted. and i prefer the second approach. and that is why i introduce comparative effectiveness research activities as an aide two along with my colleagues. we share a passim for this. we believe it is fundamental to chance woman our health system.

from one that is volume driven to one evidence based here and there are many other components of moving that direction but comparative effectiveness research is clearly a part of it. this year we plan to reintroduce the bill and have been discussing and constantly with our staff and the committee and elsewhere and close to coming to an agreement and i tend to include my bill that is the comparative effectiveness research bill in a comprehensive health reform bill in the finance committee later this month. that brings me to my last point in it the need for comprehensive health reform. the finance committee has spent many hours many days and weeks and months blame the groundwork, we had 12 hearings last year, the library of congress' summer, three public roundtable discussions with three options for reform, both inclusive and bipartisan and i have never

participated in a more inclusive and never in my life and you come to one -- one fundamental agreement that something must be done. in 2008 america spent 2.4 trillion in health care and that is 16 of our economy yet we rank last among major industrialized nations in the commonwealth fund scoreboard on health system reforms which ranks of the number of deaths prevented before age 75 to health care. last we ranked. some analysts estimate 30 percent of our study is far ineffective retentive or inappropriate care. that is care that does nothing to improve the health care of americans and our system, please nearly 50 million americans without health insurance more without inadequate coverage and most bankruptcies are related to medical costs. our system is reformed. if we fail to add to health-care will account for 20% of our economy in 10 years.

put another way for you represent a family's budget will be spent for health care premiums. but rising health-care costs will swap better on state budgets and businesses and american families alike. if we continue to spend at this rate is only part of the we ask what are we getting for our money and what are we not getting for it. it is time for america and the doctors use the most of nance science of the most personal health-care decisions are made with access to the best available information. i will let minute, i've experienced going to a doctor, it might not be as much fun as going shopping for a car but was made sure that because we spend one of every $6 in america was made sure is at least as efficient as buying a car or that tv. in that way not only will we get a better experience with a go to the doctor but also get

healthier americans. thank you very much merit [applause] >> thank you very much, senator, he has graciously agreed to stay for a few questions so if you can raise your hands we will have microphones are on the run. so hands up of any questions. yes up in front, ellen. the mike is coming. >> thank-you. friends of cancer research. i want to thank you for your work on comparative effectiveness research, it has been appreciated. the senate bell, the funding have clinical effectiveness, and was taken out of the house and perhaps you can address that or address the importance of clinical effectiveness and some of the nuances. >> the real issue and it was a

big battle frankly in the stimulus bill is that rationing or not rationing in political terms and that came down to a cost analysis will not be included in the clinical effectiveness research. some members of the congress especially in the senate and also in the house where ferrell the dow be used to ration the cost and analysis and i made it clear that no this is a clinical attractiveness. clinically this procedure and is this a job and is in this medical device, is a better than the other or not? i am fond of this planning how fda reviews a drug application, it looks only to see whether it is safe and doesn't work and compares it with a placebo, not

against any other drug and i think we need to do a comparison here, not just drug and medical devices but also procedures to see which is more attractive and so have much more evidence based evidence in america based more on value and reimbursement, based more on quality and value than volume. and i think that we will be able to get this included in the health care reform as comparative effectiveness research or fred as we want to call it as long as you make it clear there is no cost benefit analysis here. this is pure clinical comparison. >> senator, to follow-up on that, there are some people who have argued if you don't have to focus on cost as well it will make it more difficult. the use comparative effectiveness research to get savings and sounds from your presentation earlier with all the evidence on effective care and the wrong here that you don't agree. >> i think that it will come in

and decisions made by patients and providers will take cost consideration and they will know what one procedure and cost compared with another one drug and patience will no chair and insurance companies will not abandon so that is a decision and that they will all have to make and have clinical comparison of to them to look across and not up to the agent to prescribe what should i should not be used on the basis of cost. >> a question in the back. >> bloomberg news. in can you hear me? we know that senate republicans sent a letter to president obama yesterday. voicing their concern about a government run health care plan. i want to know how you plan too.

that divided. how specifically in which you feel about this opposition here and i know you are close to senator grassley. >> i knew it wouldn't take long before they got to that question [laughter] you know, it is interesting to me, i am very pleased. like an example this morning, front-page in the york times and washington post, articles about the need to transform our health-care system. and that reflects the view of senators feared a both sides of the aisle. we know and not to be presumptuous about this but republicans also know that deeply know that we need to transform our health-care system as a quote buy senator gramm there is an example of that trying widely to find a resolution and it requires a lot of education. one of my biggest problems in getting the health care reform

legislation passed is it is so complex and so difficult. we all have a very steep learning curve and some of us in his article. so it has been a lot of time spent and that is why we have always meetings getting people up-to-date and up to speed and how does this work, was good and you know ignorance breeds fear so the more we dig into it we have a lot of meetings on so-called public auction. in many daily with other senators particularly key senators and especially senators and republican side who i think, i know are trying to find a solution to see how we spread the needle. but it is that letter i think to be honest about it is an indication, i don't want to overstate it but so what positioning. getting ready for resolution to

come up with but we will find a resolution. >> time for one more question in the back in mack national minority equality forum. in 202040% of u.s. populations are going to be african-american. >> i can hear you? >> in 2020, 40 percent of the u.s. population will be african-american or hispanic and manila in clinical trials of the last count 60% of the clinical trials and 3 percent hispanic, how to do comparative effectiveness in that environment anymore and poorly and we compare the healthcare system for there's population of patients variability? >> well, clearly the comparison analysis does take that consideration and make it in a primitive ever to make sure that of the trials represent a whole population as a whole. i am very excited. we are on the eve of do

something terrific in america in health care reform. it is going to be sold in changing and a lot of it is in the delivery system reform. i see peter orszag and he has us thinking about this and it is true, i am so happy that somebody gave an article to me there is a good article. it turned up the president's attitude about the same time an independently came to the same conclusion. is the rage among senators on health care reform, that is a commodity peace and then yorker june 1 issue. is he here? no, i want to tell him what a good job he dead. nothing is perfect but we are moving in the right direction. i am very confident that because of the basic understanding in the good will of members that we will get health reform passed. it is going to take work and it is really complicated.