in other words i have insurance, i want to keep it, i don't want to change and i don't want to have to pay their my insurance arthur having care rationed in order to make sure somebody else gets care. bottom line is we all want that patient's doctor-- sacred doctor/patient relationship maintain. you might say why would we be worried that this comparative effectiveness research might be used to ration care? is there anything in the legislation that suggests that this is going to happen? and as it turns out, in both the bill that came from the health committee and the legislation pending, or that will be drafted in the finance committee, their organizations that are going to do this research that could in fact ration care. in the health committee bill there's a specific provision that a government entity is going to be treated to conduct this research and nothing whatsoever for have is that entity from denying care based

upon the application, by rationing. and the same thing is true under the plan that is being talked about in the finance committee. there, a private entity is organized but again there is nothing that would prevent the private entity from, prevent the federal government from rationing care research by the private entity. the help committee creates what would-- what it calls the agency for health care research and quality in the department of health and human services. in the finance committee as i said it is a private entity but in neither case is the federal government prohibited from using this compared to the effectiveness research from rationing care and in addition to that the health committee bill establishes what is called a medical advisory council. the medical advisory council is specifically given the authority, a very broad authority to make recommendations on health benefits coverage. in other words what is covered by the federal government, and

obviously when the federal government sets rules insurance companies frequently applied the same kinds of rules. you don't want the government rather than patients and doctors making decisions about how much healthcare or what healthcare you would have. another point that i have tried to make to folks is that, if they think that the federal government isn't considering this, think about what some people at said in the federal government about allocating treatment based upon cost. no less than the acting director of the national institutes for health, maynard kington is his name, announce that the nih can use, could use this stimulus money, the money in the so-called stimulus bill that pays for the comparative effectiveness research, to ration care just as is done in other countries. i will quote what he said. dni e.h. released a list of

research topics and called for it. i am quoting now, the inclusion of cost effectiveness analysis because cost effectiveness research will provide accurate and objective information to guide future policies that support the allocation of health resources for the treatment of acute and chronic diseases. allocation of resources is a euphemism for rationing of healthcare. similar statements have been made by larry summers. frankly the president himself has talked about this, not in the specific terms but in a recent interview with "the new york times" for example. what the government can do effectively is to be an honest broker in evaluating treatment options. the government is going to be a broker in treatment options, i think that also is a euphemism for deciding what is going to pay for. in other words what you can get in what you can't. when former u.s. senator and at

one point candidates for hhs secretary talked about, he had knowledge in a book that erupted doctors and patients might resent any encroachment on their ability to use certain treatments but he called for the same kind of body in his book that would in effect allocate treatments based upon this kind of cost research. there are many others who have spoken about it as well. we know from experience that this hasn't worked out so well in countries that have tried it like great britain and canada. but, and in fact i will just quote one other individual who has talked about this, a professor at the harvard business school. he said that the stimulus, the comparative effectiveness research in the stimulus bill could easily morph into what, and i'm quoting, which called an instrument of healthcare rationing by the federal government and as they said there are comparisons to what is being done in great britain, and

other european countries and canada. ironically at a time when those countries are turning away from the federal monopoly or the national monopoly because of the fact that it has provided, it has resulted in rationing of care that the citizens of those countries had don't like at all. the former head of the american medical association, which incidentally has endorsed the legislation that senator mcconnell and i are introducing here, said this in an op-ed in the "chicago tribune" today. he said, he's talking about the british agency which ironically is the acronym is nice, the national institute for comparative-- i will get it in just a moment but he says quote for example the agency that makes these decisions in the united kingdom determined that we are all worth $22,750 for six months of life or $125 a day. i am sorry but $125 of the cost

of the nice date with my wife, not the value of my life. what he is talking about are something called quality adjusted life years, which is the british definition of the value that they are going to place on a life for the purpose of comparing the cost done by this cost effectiveness research to see whether it because the of the treatment outweighs the value of the life. just think about that. let me quote from the nice web site. i told you i would tell you what it stands four, national institute for health and clinical excellence. here is what it says on its web site in britain for the with the rapid advances in modern medicine most people accept that no publicly funded healthcare system including the nhs, impossibly pay for every medical treatment which becomes available. that is right, if the federal government has a monopoly, it probably doesn't have enough money to pay for every tree and

that becomes available. it goes on to say the enormous cost involved means that choices have to be made. that is why the ration care in great britain. it goes on, the quality, quantitative adjusted life year, the method helps as measured these factors so we can compare different treatments for the same in different conditions. this is the idea of how many extra months of years of life of reasonable quality person might be-- gain andy goes on to conclude, each drug is considered on a case-by-case basis. generally however if the treatment costs more than 20 to 30,000 pounds for quality adjusted life year then it would not be cut considered cost-effective and they don't give it to you. we have many, many examples of people in great britain that are denied care because the government has decided that the cost of the treatment is more than your quality adjusted life

year. this is adjusted for aids so the older you get, the more the treatment, or even though the treatment may cost less you are less likely to get it because of your age. think about that for a moment. something cost $20,000 in the united states and you were 65 years of age and they decide they can afford to pay for it, is that with the united states of america is all about? is that what our government should be telling us? to the government have the right to say based on this research we have done, you can't have the treatment? if you want to say, that can't happen in the united states. id will tell you i think it can. by legislation says it can't. so what is the harm in adopting our legislation? that is the question i'm going to be asking of anyone who says it is not necessary and i want to put the question, what harm does it do to say that this research can't be used by the federal government to deny or delay treatment?

i hope that my colleagues will appreciate that healthcare is the most important thing to all of us, for families and whatever else we may think needs to be done to reform healthcare in this country think the one thing we can all agree on is it should result in rationing of healthcare for americans. our legislation is one step in that process. it doesn't preclude rationing of healthcare in other ways. but the least it says you can't use comparative effectiveness research in order to ration care. so, i think, i hope our colleagues would be of this legislation as an important step that we can take. let me just give you a couple of examples that i said i could provide. there's a fellow by the name of rocky fernandez it was the kidney cancer patients in britain. he was given two months to live when the cancer spread to his lungs. is doctor wanted to prescribe a drug, a new drug for advanced kidney cancer that the british

government said no. he and thousands of other cancer patients protested the british government's decision. this is why do you would have to do i gather. the government ultimately reversed its decision and fortunately he was able to begin taking the drug. but, the british health authorities this was not the end. more costly life extending drugs would become available. patients would demand access to the drugs and the government would be faced with increasingly difficult decisions. so, faced with a finite pot of resources the health authorities decided that expensive drugs like this would only be approved under very specific conditions. they must for example extend life i have least three months and they must be used for illnesses that affect fewer than 7,000 patients a year. staub ben just ask yourself, is that what we want to hear and the united states before you can get a drug that would be better quality of life or extend your life, the government is going to run through test like this and

of the does not meet the test you don't get the drug? this is the danger of a government run system and bureaucrats and the government become healthcare costs. we don't want that in america, and so in the reform legislation that we end up acting on here i hope we can agree one of the things we can do to prevent this rationing is to at least say we are going to do no home pekka were not going to allow this research that is going to be done be used by the federal government to deny our care. mr. president i will ask unanimous consent to put the record, in the record a lankier statement and also the op-ed by, in the "chicago tribune" by dr. massimino, which i quoted from earlier. >> without objection. >> thank you. mr. president i wanted to conclude by mentioning a couple of things.

first of all, we have actually seen the danger in using this kind of research for rationing of care in another context. when we created the medicare part d, which provides drugs to seniors, we saw the danger of rationing of drugs and so we specifically provided in the medicare modernization act which provided for the part d drug benefit, an explicit provision that says you can't use cost-effective analysis to allocate the drugs. eight is prohibited there. what we should do is take that same policy and apply it to the rest of our healthcare. to seniors who are on medicare and to the rest of the population to the extent the federal government will be able to dictate its care. we have not related that same protection for any other carrier in the country and that is what

our legislation, the patient's act would do. mr. president the final thing that i would like to discuss here is the notion that we can have a government-run insurance plan and that somehow that will be healthy for the americans. stop and think for a moment, a government run option or a government auction as it is called, would be the federal government making decisions about care, so well you may decide that it is a lot cheaper because the federal government can subsidize the insurance plan, the government will actually be deciding what kind of coverage you get. this is one of the areas we are concerned about in using this comparative effected this research because clearly the so-called public auction, in order to keep costs down, could end up rationing care. that is okay if it is merely an option and people think it out, even though it is cheaper i don't want this.

but what lewin and associates, a consulting group says, unfortunately because private employers are likely to dump their employees into the government run system, about two-thirds of the people that have insurance today, 119 million people, would end up with the government run plan rather than the private insurance they have today. when the president says, if you like your insurance coverage you get to keep it, i hope what he means is that we won't do anything in our legislation to make that more difficult for you. but, if in fact the predictions of consulting groups like lewin come true, what will happen is that employers faced with this situation where it is much cheaper for them to insure their employees through this government ran plan, will take 119 million people, transfer them from private insurance to

government insurance. wet that point you don't have any option, said the government run plan is not like it is an option for you unless you want to change jobs to an employer who is willing to maintain the coverage. those are going to be few and far between. and the same thing is true with the individual healthcare market, so the bottom line is that when people say to you if you like your coverage you are going to be able to keep it, that is not really true and incidently and the bill written by the finance committee that is explicitly not true either. that is why we are concerned about this, because even though you may like the insurance you have today and say the federal government can't tell me what care i can get, it won't be too much longer before that may not be true. you will have government insurance and it will tell you what. can give you. when we talk about the fact that we are eager for health reform what we are talking about is allowing people to keep their current coverage, allowing them

to take their coverage with them, that is to save his portable when you leave one job and go to another job, to make sure you can be denied care because you have a preexisting condition and if you need financial help in getting insurance to find a way to provide that financial help. we believe those are better solutions to making sure that everyone is insured and providing a public auction. is a little like the government taking over general motors. the only difference is it is one thing if the people who are now running general motors make a mistake, it is used and not going to be a life-and-death situation but it is a whole new ball game of the government is deciding you can't get a particular drug or particular kind of surgery that your doctor says you need. the bottom line here is that washington run healthcare has significant dangers in it, more than if we are going to run the insurance companies or the car companies or the banks. when you have the medical the

advisory council, as the health committee legislation provides, or a national institutes for health and clinical excellence, a nice, as in great britain it is anything but nice when your healthcare is denied to you. so, what we are trying to prevent by this legislation for the final time here is a situation where the government is in a position to tell you that you cannot or cannot have a certain drug for treatment or a device that your doctor has said you need because to use this comparative effectiveness research to say, well in your case you are not going to live much longer anyway and it is not cost-effective for us to buy that for you. that is not the american way and as i said it is ironic that countries like canada and great britain are beginning to provide now private alternatives because they know they can't take care of all of their citizens and they know there's a ripple going on in their countries about people who aren't getting the

care they need, so the safety valve for that is to provide an option for the private sector to actually provide for this coverage. why would we want to replicate their basic mistake in so-called healthcare reform? they are easy, easier, less costly and less harmful ways to do that then the legislation that is being proposed that would allow comparative effectiveness research to ration your care. i hope my colleagues will take a look at our legislation, senate bill 1259, and if they would like to co-sponsor it we would love to have the support because when this issue arises when making get this to the floor we want our callings to way and then send a strong message that compared the effectiveness research is great but it is not good if it is used to deny care or to ration care to the american people. that we have to put an absolute stop to right now and our legislation would do that. mr. president, i note the absence of the corn.

>> more imprisoned obama's call for healthcare reform with the. [roll call] reporter. this is a couple of minutes. >> david drucker of roll call, was the status of the healthcare debate in congress? >> i think it all comes down to the government run public plan option which for its democrat is going to emphasize the public plan part because you believe that is going to allow people that find it difficult to get insurance in the private market have access to good quality health insurance. if you are a republican you are quick to emphasize the government run part of it because you believe in the implication of the public planas clinton crowd enjoy that private insurers and leave the government in charge of the healthcare industry and as the sole provider. that is honestly what is going to boil down to in terms of anything that will or will not get bipartisan support. that in how to pay for it of course will be a major issue. >> you wrote about one element of the emerging plan, that is

senator kent conrad. >> host: of alternative to a system run by the government. how would that work? >> it remains to be seen exactly. the senate budget chairman has tried to bridge the divide of a public plan and he is offering an idea that, instead of a public plan like an insurance company, which is essentially what the public plan would be, he is offering to create or helped create cooperatives that are similar to credit unions because they have some rules that make them a lot easier for customers to deal with and make them more price conscious, so they don't have the same pressures, business pressures as private companies in terms of profit making but by the same token there not government entities and therefore, would be much more fair in how the competed with private insurance companies so that is what these medical cooperatives would be theoretically, although some

democrats were willing to take a look at that idea are trying to design it in such a way that the government would essentially run the cooperative themselves, which are causing the public to say, well, that is just like having a government run private plan. even if you call it a cooperative, and therefore we are not interested. by the same token democrats are saying if the government does not play role we are not interested because the president obama alder's the public insurance in a speech to the american medical association. what was his message there? >> is message was he had no interest in socializing the united states healthcare industry. he has no interest in preventing people like their doctors and like their insurance companies and their insurance coverage from continuing to receive the same coverage and going to the same doctors for treatment, that all the bonds to do is find a way to ensure the 46 million or so people who currently do not have health insurance and to ensure people with preexisting conditions that live in

geographically out of the way parts of the country have access to the same quality of care as other people do, and that was the message he was trying to send to them. he is trying to preempt the ama to start looking at healthcare concepts coming out of the u.s. senate, in particular he is trying to prevent them from launching a full-scale offensive against the kind of healthcare reform that he wants. >> the helped committee is scheduled to work on its healthcare proposal later this week. what will you be watching for as lawmakers began in markup that could take weeks? >> well, the help committee in my opinion is not too much to watch in terms of the action. the help committee process, although it has included the republicans all the way through, now is pretty much democratic territory, with a bill that reflects the priorities of most of the senate liberal democrats, although it does that go as far

to the left as people like senator sanders would it-- what i'm interested is going to occur next week when the finance committee is set to begin marking up its bill. finance chairman max baucus, democrat of montana has been adamant in wanting to produce a bill that can garner a significant support. he believes that doing so will ensure that whatever path it has staying power for the coming decades, let alone next year, and so i am curious to see if these sort of sketch of the bill that they are going to mark up is going to leave republicans grinning or from. >> david drucker of roll call, thank you for talking with us. >> pleasure to be here.

>> british prime minister gordon brown announced today his efforts to start an inquiry into the iraq war. the investigation would begin in july and take a round 12 months. all secret documents would be made available but he said the hearings would be conducted in private, with the committee reporting back to the house of commons and the house of lords. this is an hour. >> mr. speaker with your permission the whole house will want to join me in expressing our condolences to the family and friends of the two soldiers who have recently lost their life serving in afghanistan, lieutenant paul marvis of the second battalion the rifles and private robert mclaren of third battalion, the row regiment of scotland, the black watch. their lives, jefferson contribution will not be forgotten their sacrifice for

mises of the dangers of serving our forces confront every day and why they must continue to give them all of our support. mr. speaker troops first went into iraq in march 2003 and now they are coming home. in total 120,000 men and women served in iraq during the last six years so it's fitting the should now come to the house to talk with their achievements the difficult times, to try the new relationship we are building with iraq and to set out plans for an inquiry into the conflict. as always mr. speaker, we can be supremist proud of the way our armed forces carried out their mission other beller in the heat of combat recognize in the many citations for awards and decorations and their vigilance and resolution amid the most typical the mentionable conditions and the ever-present risk of attack by an unseen enemy. today we continue to mourn and remember the 179 men and women who gave their lives in iraq in the service of our country. in my statement to the house

last december i set out the remaining task in southern iraq for our mission. first of the want to entrench improvements in security by putting the iraqis in charge of the defense. second to support iraq's emerging in democracy particularly through the provincial elections and to promote the reconstruction of the country, to promote economic growth and basic services like power and water come to give the iraqi people what matters most for their livelihoods in the years to come and that is a full stake in their economic future. i can report mr. speaker that these three jackets are being achieved and thanked for efforts and those of our allies over six difficult years the young democracy is replaced the vicious 30-year-old dictatorship. in recent months we have completed the training of the 9,000 troops in and 14 division of the iraqi army or now fully in charge of the security of basra. does 14 division who with their help in the help of the americans took on the militia in the operation in spring last

year. since the violence and crime in the basra region have continued to fall well levels of violence across the rakis so whole are at their lowest since 2003. provincial elections are also held peacefully on 31st january was 7 million iraqis turning the to boat, for 440 different political groupings. the iraqis ran the elections themselves with only three violent incidents across the country and preparations are underway for aashto elections on the 31st of january, 2010. since 2003 the united kingdom has spent over 500 billion pounds in iraq for humanitarian assistance, infrastructure and promoting economic growth. support to the health sector has included 189 projects including the refurbishment of basra general hospital in the building of basra children's hospital. the international community has rehabilitated or 5,000 school as well as constructing entirely new schools and new questions in existing schools and despite high unemployment and the scale

of the global recession economic growth in iraq this year is predicted to be nearly 7% for the significant challenges remain including that of finding a fair and sustainable solution to the sharing of iraq's oil reserves but i recs features now in its own hands and the hands of its people and its politicians emmy must pay tribute to the entrance of the iraqi people and we will pledge to them our continuing support. but it will be support very different from the kind provided for the last six years. as the house knows our military mission ended with the last combat patrol in basra on 30 april. as of today there are fewer than 500 troops in iraq with more returning home each week. mr. speaker on the day of that let's combat patrol in april, i welcome the prime minister maliki and most of his cabinet to london for kubli sign together a declaration of partnership, friendship and cooperation defining a new relationship between our countries for the future. at the request of the iraqi government is small number of british navy personnel, will