that we did not rebuild. i want them to benefit from a health care system that works for all of us. where families can open a doctor's bill without dreading what's inside. where parents are talking to their kids and getting them, get regular checkups and testing themselves for preventable ailments. where parents are feeding them healthier food and kids are exercising more. where patients are spending more time with their doctors. and doctors can pull up on the computer all of the medical information and latest research they will ever want to know to meet patient's needs. for orthopedists amah oncologists are all working together to treat a single human being. where what's best about america's health care system has become the hallmark of america's health care system. that's the health care system we

can build. that's the future i'm convinced is within our reach. and if we're willing to to come together and bring about that future, and we will not only make americans healthier, we will not only unleash america's economic, but we will reaffirm the ideals that lead you into this noble profession. and we will build a health care system that lets all americans feel. thank you very much, ama. appreciated. thank you. [applause]

♪ ♪ >> reaction to the president's speech on healthcare before the american medical association. we will hear from ama president nancy nielsen and president-elect james rohack. this is about ten minutes. >> i am with channel 2 in chicago. essie mae for there were scattered boos when the president said he did not favor the med mal caps. no big surprise. he did not favor him-- the state capitol either. unhappy were you with that? >> he didn't say anything and so we really weren't surprised of course. what we were thrilled about is that this is the first democratic president that has talked with us about any kind of liability reform so that was the good news. i think the other was no

surprise. >> dave michaels with the dallas news. the president said today the public auction is your friend. speaking to positions-- physicians and the house of delegates is going to consider a resolution that would tell the ama to oppose the adoption. do you think the president's assertion that of the option is your friend will convince any of your positions seem to be very skeptical about a public auction that they should it least consider it? >> i think what you heard today was, was a call for a thoughtful analysis of all the options. and what is going to happen here over the next two or three days is the american medical association will figure out the way that we can best help the president reach the goals that we share, which are affordable health insurance for all americans, so i think that, i

think it was something that we share. >> if the ama, if it approves the resolution how much would it be in terms of being able to negotiate the bill the president and congress? >> i think our house of delegates tends to be very thoughtful and we usually come out pretty well at the end. we are not at the end yet. the debate has occurred in reference committee and we will begin to have voting over the next several days, so i think stay tuned, the resolution may or may not be the same. it may be change. that is the glory and the annoyance of democracy, so you have got to wait until we finish, okay? we are exploring the options and people had very thoughtful comments at the microphone yesterday, and we will wait and see how they respond. jim, do you want to add anything to that? >> i think as nancy has highlighted the goal that both

the president and the american medical association has is to make sure that all americans have affordable health insurance coverage to prevent the diseases that we know we can prevent and to not use the emergency room has the access point for healthcare. the emergency room should be used for emergencies and not for routine preventive care. we are also excited with the president signaling the important investment in prevention because as we have discussed with the president, the importance that even if we do health system reform the disease burden coming down the road both with the demographics of our baby boomers reaching age 65 has well as the obesity epidemic and its challenge on the health of individuals that we have to put the proper investment to prevent diseases, so we are excited about working with the president on this.

>> doctor? dr. nelson, bruce jensen with the tribune. what did you hear that you like relative to the liability reform aspect, and also, what kind of public option the you see the amsa favoring? in the next couple of days. >> first of all let's deal with liability reform. we knew he was opposed to a cap, as you heard him say, that was not a surprise but what we bored very pleased about what is that he is open to considering options that would lower the cost of defensive medicine. he had knowledge that it as an issue and he put it in the context of the overall rising and unsustainable and crippling healthcare costs, so he has not taken that off the table and in fact, as i said, he is the first one to put it on the table and that is what we were really pleased about. in terms of the other options,

he describes several things. he described in exchange and it will be very interesting to see as bills come forward, what the particular options will be. so, what we want to do and i think what the president appealed to people to do is to not get hung up on labels but rather look at what is being described, so we want to make sure that a label does not engender a reaction that may not be a rational reaction, so that is the best i can do for about one. >> your group has closed many overhaul efforts in the past four years including medicare in the clinton healthcare reform efforts. why is this and are you afraid of being seen as obstructionists? >> we are delighted this year because like every organization, organizations change because of society and the environment we are in. where we are right now is a

reality that 16% of gross domestic product is anticipated to be 20% within a short timeframe. because of the advances of medical science, the average life expectancy now is ten years long that was in 1965 when the medicare program was first created in people enter the medicare program at age 65, so what we have is a wonderful advent of improved technology, improved ways to treat, to take care of patients but we find 50 million americans and not having affordable health insurance. and, for that reason we are committed with the president to reform our system, to try and incent doing things right and get rid of the stuff that adds no value. the administrative burdens that we have lawyered upon a common the practice of medicine has really driven many physicians to level of frustration that they can't take care of their patients.

the patients are frustrated because the physician seems to not spend enough time because they are on phones trying to justify with an insurance company why they want to do the things that follow evidence-based guidelines and should be done, so i think the important signal is we are at a watershed moment in our country as the president indicated. our economy is driven by the health of our population, and unless we get our arms around the prevention aspect handed making sure that people have a strong primary care medical home, and we have incentives for specialties that we are in short supply of like trialed nets-- child and adolescent psychiatry, we need to start moving our system more toward a system so we can make sure where the patient enters the system their electronic records allows the physician to know what is going on with the patient. we have incentives to keep people well and with that, we

are excited and have committed with the president to move forward over the next year. >> the lights there kind of blinded me so i can't tell who is next in line. i know her. i am apologizing to the rest of you. >> cece conley with "the washington post." you say that you are happy that the president has put malpractice reform on the table. what exactly is it that he has put on the table? we know what he has taken off the table, but can you elaborate for us what it is that is now on the table? >> i can't elaborate any more than what you've heard today but we appreciate the fact that he has the acknowledged that indeed it is a problem and that it needs to be addressed and that there will be ways of looking at it, and then he is going to work with us to look at it. >> emily walker with med page. you said in your opening spade--

speech-- the president today said he mentioned as gee are saying that they needed to move to a system that was more centered on patient outcomes. were you disappointed he did not focus on amora and what did you interpret his comments to be? >> let's give him credit where credit is due and in my introductory remarks i commented on that. lenny crafted his budget and release the budget, he was the first president to lead knowledge that we need to pour cement into that hole forever and he put out a reality based budget, not one that presents and that 21% cut to position services was going to occur, so he did that and we are very grateful and that was the point of the introductory remarks. we all know that in he knows it. >> catherine, wgn is. you said the ama is committed to

covering all americans, working to cover the ensured and make insurance more affordable. can you talk about your proposal just as the president did today? >> actually, we have been developing a plan over the last decade. i am not sure that you knew that, but we have. we have been working on this issue of the uninsured for a long time. we are absolutely committed to those who are lawmakers and two are helping to develop the plans to make sure that we get to a solution this year. now, the details of our plan are available on our web site and i am happy to go over that with you but it is not our plan that is really on the table right now. we are committed to americans having choice, and you heard the president talked about that today as well. we want them to have a choice of coverage, the choice of doctors and you know, i am happy to discuss other areas that are part of our plan that probably

you want to hear more about what is really in place right now. >> in response to president obama's call for healthcare reform, gop senators john-- and mitch mcconnell of kentucky announce legislation that would bar the federal government from using medical effectiveness research to deny care. this is 35 minutes. >> mr. president on another subject, as the national discussion over healthcare intensifies, one thing is already clear. both republicans and democrats agree that healthcare is in serious need of reform. the only thing that remains to be seen is what kind of reform will it delivered. americans are increasingly worried about what they are hearing from washington. americans want lower cost than they want the freedom to choose their own doctors and their own care. what they don't want is a washington takeover of

healthcare along the lines of what we are going to be seen with the banks, insurance companies and the auto industry. americans don't want a government run system that puts bureaucrats between patients and doctors. and basically don't want the kind of government boards that exist in places like new zealand and great britain that tonight, the delay treatments that are currently available to americans. americans want change but they don't want changes that will make existing programs worse and that is exactly what a government run system would do. unfortunately, the notion of a government-run plan has been gaining steam. for the past couple of weeks, one democratic leader after another has insisted that it be included as a part of any reform. the reaction to this should tell us something. among those who have begun to mobilize an opposition to a government plan are america's doctors warn that it would limit access to care and could lead to nearly 70% of americans being

kicked off health plans they currently have. the u.s. chamber of commerce, which represents about 3 million businesses in this country, has warned the creation of a government plan would lead to a government run healthcare system. this ceo of the renowned mayo clinic warned that some of the best providers could go out of business. the national federation of independent business, one of the fleeting associations of small businesses has also expressed its concerns about a government run plan. americans don't want the kind of government run system that some in washington are proposing. they don't want politicians to use the real problems we have in our healthcare system as an excuse to tear down the whole thing, take away everything that is good about it and replace it with something worse. they want practical solutions to specific problems and that is

what the rest of us are proposing. here are some common-sense proposals. we'll the great healthcare in this country is too expensive. americans don't think basic procedure should break the bank and american family shouldn't have to worry about going bankrupt if a family member becomes ill. but government run healthcare will only make matters worse. if our experience with medicare shows us anything it is that the government health plans are not, i repeat not cost-effective. over the weekend the administration propose making cuts to medicare is a way of defraying the cost of a new government plan. that is exactly the wrong approach. america's seniors expect congress to stabilize medicare so that it continues to serve their needs, not drained its resources to pay for another even bigger government plan. changes to medicare should be used to make medicare solvent for seniors to day and for those who are paying into it and who will rely on the system

tomorrow, not to build a brand new government plan on top of one that is already on an unsustainable course. if we want to cut costs and grayned debt and extending medicare like system to everyone in america is exactly the wrong prescription. we need to make medicare itself solvents and find ways to improve the current healthcare system. one way to do that is to implement reforms that we know will save money. we could start with ann on this prevention programs that encourage people to quit smoking and control their weight. it is no mystery that smoking and obesity are leading causes of the chronic diseases that are driving up healthcare costs. and finding ways to reduce these illnesses would also reduce costs. we should allow employers to create incentives for workers to adopt healthier lifestyles. we should also encourage the same kind of robust competition

in health insurance and health insurance market that has worked so well in medicare prescription drug benefit part d. we can enact a long-overdue reforms to our nation's medical liability laws. for too long the threat of frivolous lawsuits has caused insurance premiums for doctors to skyrocket. doctors then passed these higher costs on to patients, driving up the cost of care. most people think the healthcare dollars out to be spent on healthcare, not insurance premiums yet doctors all across america are not only passing along the cost of higher and higher premiums, their ordering expensive and unnecessary tests and procedures to protect themselves against lawsuits. one steady suggest the roughly nine out of ten u.s. doctors in high-risk specialties practice some for the-- form of the expense of medicine and the cost to patience is massive. some doctors simply shut their practices or discontinue services as a result of these

pressures and patients like rochelle barryman of kentucky are the ones who lose out. ruechel's first babies were born in the hospital ten minutes from her home. but her third child had to be delivered 40 miles away because of rising malpractice rates that caused doctors to stop delivering babies all together. this isn't an isolated problem. and it is not just obstetricians. according to a report by the kentuckians into the medicine, kentucky is nearly 2300 dr. short of the national average. a shortage that could be reduced in part by reforming medical malpractice laws. comprehensive healthcare reform are long overdue. reforms to lower costs and increase access to care but a government run plan is not the way to do it. there are other solutions that address our problems without undermining our strengths. over the past few weeks i have warned about the dangers of government run healthcare by

pointing to the problems this kind of government run system has created in places like britain and canada and new zealand. these countries are living proof that when the government is in charge healthcare is denied, delayed and rationed. as i have noted the main culprits in every case are the government boards that decide what procedures and medicine patients can and cannot have. i have discussed of britain's government board had denied care to cancer patients because the treatments were too expensive. in one case bureaucrats in britain refused to prescribe cancer drugs that were proven to extend the lives of patients. because the cost to much. the government board explained it this way. although these treatments are clinically effective, regrettably the cost is such that they are not a cost-effective use of resources. i have also discussed of the government run healthcare system in canada routinely delays care.

today the average wait for a hip replacement at one hospital in kingston ontario is about 196 days. the replacement surgery at the same hospital takes an average of 340 days. now the american people don't want to be told they have to wait six months for a hip replacement or a year for a knee replacement and that is what could very well happen in a government run healthcare system. finally i discussed how new zealand government-- new zealand's board has ration care by deciding which new hospital medicines are cost-effective. in one case government bureaucrats in the country denied patients access to a drug that was proven to be effective, in fighting breast cancer because they thought it was too expensive. is one cancer doctor in the country put it new zealand is a good tourist destination but options for cancer treatment are not so attractive there right now. americans want healthcare reform

but they don't want the kind of reform that denies, delays in rations care like the government run systems in new zealand, britain and canada. they don't want to be forced into a government plan the replaces the freedoms and choices they now enjoy with bureaucratic hassles, hours spent on hold and politicians in washington telling them how much care and what kind of care they can have. they want healthcare decisions left to doctors and patients, not remote bureaucrats but some in washington get their way in a government takeover of healthcare, that is exactly what america can expect. mr. president i suggest the absence of a quorum. >> the clerk will call the roll. >> today would like to talk about a bill which today senator mcconnell and i introduced and i think a companion bill will also be introduced by some of the leadership in the house of representatives for a good number of the bill is 1259 and this bill is called the

patient's act, patient as and doctor/patient and the idea is to focus on healthcare as it relates to patients. the healthcare reform should be patient-centered, that nothing should come between the physician and patient. we are concerned that there is something that is being done that we need to stop because it could in fact insert government bureaucrats in between the patient and physician. what has happened is that in the stimulus bill, the congress appropriated $1.1 billion for something called comparative effectiveness research. now, compared to the effectiveness research has been used for years by physicians and hospitals, medical schools to do research and they determine what kind of treatments are best. for example if you have two different drugs for the same condition they will do testing

to see which one seems to work the best and it is called clinical research and physicians and hospitals frequently use the result of that research has recommended for the best way to treat a particular condition. it is not mandatory obviously. what is good for most patients and not be good for all patients so it is not something that is obvious that forced upon people but provides good information. the problem is that too many people now who are proposing healthcare reform want to use comparative effectiveness research to end up rationing care, to have a federal entity or even a state entity or i should say private entities that research in ways that would end up rationing care, to say that some care is just too expensive for you to have an since the government is paying for it the government isn't going to give it to you. what our bill would do is to make it clear that comparative effectiveness research cannot be

used to deny coverage of the there a healthcare service or treatment by the secretary of hhs and we say the secretary of health and human services because all of the various entities that might do that in the federal government are part of hhs, so we simply prohibit the secretary of hhs from using this comparative effectiveness research to deny healthcare service or treatment. now, you would think that that would be uncontroversial and i'm hoping at the end of the day that it is not controversial. nobody wants their healthcare rationed by somebody here in washington dc. it would also require that comparative effectiveness research account for differences in the preference of patients and their treatment response to personalize medicine and something called genomics. genomics is the breakdown of the genes in the body into all of the difference elements, which make as unique as individuals

and what genomics research focuses on is what exactly is it in your gene composition, the human genome that might be different from someone else's. that means a person lies treatment would work for you where is it might not work for someone else and they are actually finding that they can tailor specific drugs to treat specific genes in such a way that, if they know your human composition they can find a way to treat your condition, say a cancer, potentially slightly differently than they would treat somebody else is cancer, whether the dosage of the medicine or in a specific kind of medicine or however it might be, the point being that not everyone is the same. effect we are all unique, and one of the things madison must recognize is our unique as individual and not give into the habit of saying there is a sort of size that fits all here and we are going to say that if

doctors will treat everybody with this particular medical devices, drug entreatment then we will pay for but we will not pay for it they do anything else. that would not be good medicine. that inserts the government between the patient and physician, so we say that can be done using this comparative effectiveness research. by the way the bill makes clear that nothing prohibits the fda commissioner from responding to drug nc to concerns. obviously if the drug is not say, fda needs to say the drug is not sapan the government is not going to pay for it. the point here is that this compared the effectiveness research should not be used by the government to deny it or delay or ration care. the reason for it is obviously we all want to be in charge of our own healthcare with their doctor. we want a choice. at the doctor says we think you need this kind of treatment and we can get coverage for that from our insurance we want to get that care. if we can we want to find insurance that will provide that

kind of coverage for us. at a minimum we want to be able to pay for the treatment if nothing else. what we don't want is for the federal government to say it doesn't matter if you want to pay for it, it does not matter whether you are covered, you can't get it because the federal government says. this is especially important if we have a government run insurance company which is what many on the other side of that aisle is talking about. the president has said he wants the so-called public auction so that there will be a government insurance company that will be a place where everybody can go for coverage if they don't have a. i happen to think there are better ways of getting everybody covered. to the extent we have some people need help in getting coverage, the government can provide help with the change in the kind of coverage the rest of a separate everybody in america, surveys show by to the one that everybody believes we should help people get insurance you don't have it but by the same rough numbers, everybody says however, you don't need to affect my coverage in order to