programs. very quickly, my first amendment clarifies senior adviser for health care fraud established under this bill will focus also on fraud in medicare, medicaid and schip. my second amendment requires the senior adviser for health care fraud created under title five of this bill to report to congress on federal efforts regarding the detection and prevention of health care waste, fraud, and abuse. my third amendment requires school based health centers and those employed under or under contract to follow state law requiring the reporting of child abuse, child molestation, sexual abuse, rape and incest. funding authorized in title iii is discontinued and the provider of services fails to report this information in accordance with state law. n deferment

program, also known as the 220 rule. this rule was eliminated in the college cost reduction and access act and has had a negative effect on the ability of medical residents to repay their student loans. we're going to increase the pot, we better increase the providers. my fifth amendment requires school based health center program to provide age appropriate care to children. my sixth amendment requires the u.s. preventative services task force to develop a clinical, preventative guidelines in the from the agency for health care research and quality, national institutes of health, centers verdes control, institute of medicine, specialty medical associations, patient groups and scientific societies and my seventh amendment creates the commission proposed of insurers, employers, providers and consumer groups to barrier

programs including medicare, medicaid, schip, ryan white, a grandson of the public health service act and other federal laws regarding policies and procedures to eliminate fraud, waste and abuse under such programs. such commission shall review such programs for two years following the date of enactment and provide a report with recommendations to congress within three years. not heavy lifting, mr. chairman, going after waste, fraud and abuse and making sure that providers of school based programs live up to state law. we've got a lot of work to do and i hope mr. chairman that we take our time doing its. i'm not sure that that will be the process that we follow, but i think it is a prescription that we should. i think the chairman and thank the members for their indulgence as i had the opportunity to fully that the frustrations but

the truth is we have only one shot at this. there are many things that we do up here with a change in administration and a change in the makeup of congress reverses a mistake and it all goes away. drastically change health care and you are talking about a generational change for america. you're talking about a mistake that is not fixed quickly, talking about a mistake that americans feel the pain from from some time. i'm not sure that is what we intend to do, but there are many things that we do in this town that are unintended consequences and i think we at least ought to make sure that the changes we make here don't have unintended consequences as well. i think the chair. >> before turning to senator murray by a welcome your eminence and as you explain them several that i suspect will find

some common interest in just as you describe them so i appreciate your offer. and this is exactly how this happens, in a way if you don't have a product and eminence don't get past you don't move the process so i appreciate the frustration is being expressed. i am inviting, i want to make sure that our staffs will start with a quality area, this does not preclude the data every then is to be ongoing in these other areas where ideas are brought up in staff instructed to meet and work on this so we can address many of these questions in a way that will provide a common result. that is my determination. i am committed to get as much support for this idea as we can, but i'm even more committed that we get right. of love to have a unanimous vote at the end of the day in committee, but if the result is to get a unanimous vote at the expense of doing fundamentally

alters the present system that is unsustainable and i'm used to the same words in listening to the principles i don't think there's an ounce of this agreement to what we're trying to achieve -- that is unique. and a lot of times we debates at opposite sides of the spectrum, and agree all want to achieve the same result and are different methodologies and how you do it that will provoke some debate. but my goal is i presume all of us here to do a good job at this. as you point out we're going to get one shot at doing it. 60 years have gone by with republicans and democrats that have sat at tables like this or sad at meetings with a goal in mind of achieving the results we have been asked to achieve and they all fail that. with aspects that have improved but not a comprehensive approach we're taking and i'm still a believer that we can do this. i believe in it because i know mike enzi and he is determined to be part of a solution and

virtually every one of you, i have worked with every one of the on the issues and when it comes down to it we have a common determination to get this right. i know my colleagues on the democratic side very well are deeply committed to these issues and we are going to stick with this and the only way to do it is not walk away. i mentioned to the other day about having my office saying from edward r. murrow because it is true of everything else, he once said the ones is that history will never forgive you for is a problem was too hard and. this is hard, but history will not forgive us because we thought it was too hard. it is hard, it wouldn't be if it weren't, but our job is to move for the. >> mr. chairman, i take him at his word and in this bill we drastically change erisa to note where many of the successes and safer is that my talked about aren't going to be able to do what they did.

and now like to work with you personally to make sure that is the successes of people out there providing health care and doing it for less money but more and poorly are doing for prevention and disease prevention right. let's not analyze them. >> are not -- our intention is not to do that at all. senator murray. >> mr. chairman, thank you very much and i have to say i'm one of those people who are very delighted and that we are finally at the table working to get a health care bill out. i want to commend senator kennedy as we all have, we feel his arm on our shoulder today pushing as foreign because he knows and has worked on this for so long to get this right and knows that until we sit down and start working our way through a bill and to the legislative process we are not going to get where we need to be and we are going to keep pushing under your leadership going to get there and i want to thank you, senator

harkin and senator mikulski and senator bingaman who spent time on this and especially our staff who really have worked hard to get us to the point that we can now begin this markup process. there's a lot of work ahead of us, absolutely. and by delaying it, that's not an option mr. chairman. the line is not an option. i am frankly a little disappointed with the town from the other side this morning of doom and gloom. mr. chairman, i go home every weekend to washington state and i hear from my constituents, i will tell your the doom and gloom is coming in is in people who don't have access to adequate health care today who are so afraid not going to sit down at this markup and start working our way to a process that makes their lives better. i just met a woman a few weeks ago in my home states, owns a small business, her name is molly moon and she opened up an ice-cream shop. shoes and her late 20s and hired

20 young people to work for her. and she is successful and opening up a second shot. she said to me, i am a young person today that wants to be responsible and do the right thing for my employees in my country and provide them health care and she is struggling to do that because she doesn't have access to at. the marks we have laid down, the bill we are working on will help mali and other people like her get access to affordable health care so they can do the right thing for their employees and be a proud american as she told me. i met another young woman who is starting out or has a business selling clothes, in her late 20s, she told me that she can't buy health care today for her business, for herself and her employees and she and her husband decided they couldn't have kids because they couldn't afford to have health insurance. what a tragedy in our country today that that's what people are making imports of live decisions over that they can purchase health care. that's what we're here trying to

solve, these of the people i keep in mind. i met a young boy who i think is all of us work our way to health care we all have something we think about -- i think he will be who i keep in mind throughout this entire process of working our amendments to this committee and the finance committee, the house and sometime hopefully late this fall to a consensus bill but i remember a young boy who i met was about seven years old and who told me that his mother got very sick, she was working. she was working at a fast food restaurant but didn't have health insurance. she got sick, tried to get a dodgers apartment and because she did not have insurance was delayed getting to a doctor, was not able to get the kind of care she needed. why? she was working, a single mom, mother of this little boy who didn't get her health care and get into a doctor late because she did have health insurance and she died.

this young boy told me, i don't have a mom because my country did it work for me and my mom didn't have health care coverage -- what a tragedy. i will remember that little boy. he was passionate to maim. as far as it was for him to understand the system vienna said his country failed him. that should not be happening today, that is what we're trying to do with this bill here and other hard decisions ahead of us? yes are there a pile of amendments, yes. to fight is is two these solutions absolutely. but the argument that we should delay doesn't have to hold water with me. we have been talking about health care reform for decades. we have listened to the stores like i've just talked about and reval heard and we can delay this any further, we need to get to the hard work sitting to this committee, working to the amendments, coming of with a product we can move to the end of the day the other argument i hear on the other side this is going to cost too much. i will tell you what cost too

much -- would cost too much is status quo. a $2 trillion a year that we spend in this country every year on health care with an adequate coverage for too many americans with not a focus on preventive care and that's senator harkin has worked so hard on that will save us cost in the end. will take us awhile to get there but if we don't start now we will never be able to lower the cost of health care for families. in so we have a very tough job ahead of us absolutely, working our way to this to get to a product at the end of the day but i come today committed to working to that process. i come committed to finding solutions to these and working with our colleagues as best we can define solutions that the end of the day of understanding this is a democracy and we've got to find the votes in this bill through. but i will tell you the little boy that i meant doesn't want to hear that, well, we need to sit through a whole lot of more

hearings before we get there. he needs to hear that this country, us as senators are sitting down and working together and moving it toward every single day. i'm proud of the work we have done on this bill. i think it's an incredibly good piece of work and there's a lot of work left to be done but i will tell you, if we can get through it into the preventive care and quality care pusan provide coverage for people and over a chorus areas that we have worked so hard on so that people have access to health care professionals and lower the cost for everyone we can all be proud at the end of the day and i can go home and face that little boy again. thank you mr. chairman, i yield the floor can i thank you very much, senator murray. the chairman had to leave to go to the white house and we're going to reconvene in again and to 30:00 p.m. in the senate caucus room. we are supposed to be here at 1230 and we are about four

minutes away. it is next up? kim i senator harkin, maybe we should just adjourn and startup again, i would be glad to be here at 230. >> you will be first up. >> so we move to the senate caucus room? >> we are moving from here to the senate caucus room at 2:30 p.m. this afternoon. >> mr. acting chairman. i know my quality comes up and i just wonder if the staff's could work during the break in this area. i have four amendments on an administration supplication come into are duplicative, there are two amendments to strike an outrage had to senator and see. 24 of comparative effectiveness. i would debate all 24 but i wonder if we could come down to just kind of a scrub and make sure that are not duplicative and. to jesse not to stifle in any way debate or accretive

solutions and i will also be ready to take some, senator rakowski and the indian tribes commenting, our stuff that we're doing with senator gregg. >> i am sure our staffs would be happy to work on this and when we're talking about more time that is what we're talking about, we have and have the time to scrub to those to see what could be done and was duplicative and is to be done. >> i like to lead off on the quality that we get after the statements as go through those things we've agreed upon. >> yes. >> and we can take, would that be enough a way to go? >> i think so yes, where would they be working on this? >> first of all, we have got some that we're working with senator greg and. >> quizzically working on it? you're staff. >> help, i don't know.

[laughter] >> we will have them work out but anytime we want to do that through the weekend in. >> very good. >> it will be very helpful. thanks. >> the committee will stand adjourned until 2:30 p.m. at the senate caucus room. [inaudible conversations] [inaudible conversations] [inaudible conversations]

[inaudible conversations] >> will go back to the senate committee for the second part of the markup session in just a moment but first we want to let tonight to watch live coverage of thursday's health care markup on c-span 3. now the rest of wednesday's markup session. this portion is three and a half hours. [inaudible conversations]

>> [inaudible] it sounded pretty good to me by myself. i thought i was looking at the microphones in the room. i will repeat, we are gathering in the senate caucus room and this will be our home for the markup with the exception of a couple of days when there are some other events that they ask if we would give up the room for events that will be held and we agree to do that but one other

event next week my intention would be to gather in this room. there is a plaque on one of the walls over here and i see some young people in the room that if you want to read about the history of the room is a remarkable room with a great history of some of the most import hearings are held in the united states senate held in this room and i won't bother reciting all the various hearings. i was going to mention the titanic but i thought it would be a bad analogy. [laughter] there are other ones that are more positive along the way. so we are gathered again everyone to continue with the opening comments by our colleagues and i appreciate the importance that members want to be heard on the subject matter so i'm not putting a clock on anyone at all and i'm grateful to the people are mindful that everyone would like to be heard on the matter but realizing this is an important -- as of for a debate as we have had in a long time and may have for a long time to counsel people need to be heard on this matter. as i have said before and will

repeated, my goal here is to develop a piece of legislation that would enjoy as much a broadbased support as we can bring together but we want to make sure it is a meaningful piece of legislation that addresses the principles that are articulated by a judge granted this morning along with tom mark -- tom harkin and barbara mikulski -- i didn't hear any differences on the principles of what we're trying to achieve and obviously there are means to achieve those but that's a pretty good place to begin and mike enzi said we're 80 percent of their beer and i will start a marked up with a present any day of the week. ultimately we were able to achieve that understanding with each other and so i am a great believer that the way you get there is to start doing it. if you don't start doing it than just sitting around talking with each other doesn't necessarily produce results and my intention is not to jam and a thing or $0.4 a thing but to go through a process whereby we can talk to

each other and come to conclusions. i know the sats have had a chance to do with all of this yet, but senator enzi has indicated they will evenings and over the weekend, we have made some of 21 or 22 amendments to accept republican eminence and offers some propose already and are going to look at those and see if we can adopt agreement on 20 eminence before we have an amendment offered in the formal process and that's the way this can happen so we're going to move for the. we will next year for my good friend who i have enjoyed working with, lamar aga -- lamar alexander, we have worked on all sorts of issues and i admire him immensely. he gave me a wonderful book on the -- the little plaid a book and i will share with my colleagues another time. worthwhile period senator alexander.

>> thank you mr. chairman. in this room and this is a rumor to predecessors and i see it as two important questions -- howard baker as what to the president know and when did he know in the watergate hearing and then fred thompson was his minority counsel and he said mr. butterfield, or there any recordings of the office of those became the nixon tapes. and as a matter of interest at that time the watergate hearings were on every day for five or six hours a day on all -- and there are only three television networks and it was on all three networks. a senator in no way told us after about a month george gallup came and told him it was only one person in the u.s. but in on the senator and it was president nixon because the whole country was riveted to that set of hearings in this room. in case senator kennedy is listening which i hope he is, i would like to say to him how much we wish you were here

because we know how i'm for this bill is two him and he is important to us and we hope he is doing well. out like to express my appreciation to senator dodd for his courtesy is since he suddenly took over this proceeding in the midst of his other responsibilities, he does that as carefully and well as any member of the senate. i appreciate that very much as i appreciate the opportunity to let us see what we have to say in these opening comments. and i appreciate the work of the kennedy's staff and the republican staffs as well but just because i admire senator kennedy and senator dodd and the staffs doesn't mean i have to admire the bill and so i am going to be direct and what i have to say about. i believe that the bill we have been presented with is so expensive it can't be fixed and we ought to start over and i say that respectfully because of my to get to a result.

i think there are better proposals available from senator. and senator coburn and senator hatch is coming with one as senator wyden and senator bennett which has republican as well as democratic support which would be a better place from which to begin this discussion. as we have been sitting today what we hope our goals and i think the chairman is right, our goal sometimes sound pretty similar. if i ever listing them i would say as we go to work on health care these were the things i like to be able to say to the american people, we're interested in all 300 million of new, not just the 47 million who don't have health insurance. we want to make sure each has a health-care plan you can afford. we want to make sure is a plan in which you and your doctor made the decisions, not washington d.c.. we want to make sure is a plan that emphasizes prevention and wellness. we hear a lot of that here.

we want to make sure it's a plan that gives low-income americans the same kind of health plan that most americans already have usually to their employer. we would like to make sure that it doesn't make it harder for american businesses to compete in the world marketplace by adding a tax to their operating costs in the and we want to make sure that the plan we have is something that your government can afford it so that your children and grandchildren are saddled with such a massive debt that it devalue the dollar is that they earn in their jobs and it limits the quality of their lives. as the president has said repeatedly, we genuinely believe the best way to do this is in a bipartisan way. with the bill that we're asked to markup today is not ready to be considered, we don't have the details in some of the most important provisions of the bell. the medicaid expansion, the

employer mandate, the government-run insurance option, and we don't know the cost even though the president within the last two days has urged us to remember to pay as we go in his words. you got to make sure that if you spend a dollar you save a dollar. i might say or attacks a dollar -- one or the other. so obviously we can complete our work on this bill in committee unless we know exactly what the bill is and exactly what it costs or else we will be violating our common sense and let the president has said about pay-as-you-go but we do know these things. we know as the bill as presented to us in complete form leaves 30 of a 47 million americans who are uninsured still uninsured. it expands one unfeeling government program, medicaid, and creates another putting washington in between you and your doctor for many americans.

despite all the talk about incentives for wellness and prevention as written it actually reduces incentives for wellness and prevention. i hear that may be fixed but that is what it does has been an increase is 58 million americans who are low income americans into a medicaid program operated by the state's that offers sporadic substandard health care. and the proposals for expanding that medicaid program are so expensive that it will literally bankrupting some states and our government accountability office has told us that we raised one at of every $10 we spent on medicaid which is an astonishing $32 billion a year. about three-quarters of what we spend it to provide prescription drugs for every senior who is on our medicare program. it puts a new tax on people like auto suppliers in tennessee are watching every single cost to try to leave their jobs from

moving to mexico or japan. in addition, many of those who have talked and talked about how the cost of all of this is truly astronomical, the congressional budget office letter senator gregg put into the record, senator gregg also pointed out if we get it to the fifth year of the operation of the program as written of the cost of the program over 10 years is closer to $2 trillion rather than $1 trillion and that doesn't include the cost of expanding medicaid the government insurance option and the tax on employers. the baucus bill in the report says that as the one being considered is a trillion and a half dollars. one independent study said that it would be $4 trillion. over the next 10 years. the national governors' association and we've got i think all 13 of us in the senate to use a big governors and chief executives of stays with medicaid programs, it says that

the medicaid expansion alone will cost the state's $500 million over 10 years if you count of this expansion of medicaid in the increase in reimbursement costs that are provided in the kennedy bill. in tennessee alone the amount of money that we would be -- have to come up with whoever the governor is in 2015 would be additional $1.2 billion. doesn't sound like a lot of money up here but in our state that would be about the new 10% state income tax, that is how much of that money is. this is on top of the washington post reported in this year. last week it said that we have in that proposed by this administration that would add nearly three times as much to the national debt as we spend in world war ii in today's dollars so the question how it has to be asked, how this legislation which w p