over 10 years to cover 16 million more people, how does that reform our health-care system -- is that the best we can do? and regretfully this is absolutely not a bipartisan bill. now this is a bipartisan discussion, this is a family discussion. we like each other and your soul but we don't want -- a bipartisan event in the senate is when 10 or 15 or 20 of us a down from different parties at the beginning whether in his energy or intelligence or supreme court and say let's put our best ideas on the table and work together to produce a bill that we can support and usually we have to bend people off on the right and people from the left but we have a truly bipartisan bill. this is a bill written by senator kennedy's staff provided last thursday and we've had a lot of time to see a since then but it's not a bill that until that time had any aspect of

bipartisanship. so wish to start over if we want to results which is what we want and if we did start over mr. chairman based upon what we have discussed since last thursday and indicated this yourself we ought to be able to agree the one everybody covered, we won an added cost individual americans can afford, we want to make sure that pre-existing conditions don't disqualify you. i think we agree that prevention and wellness ought to be encouraged, and i disagree on how but we agree on that. i think we want low income individuals to have opportunities that are a lot like with the rest of us have and we want people to have choices. those companies close to what we can agree on so we agree on all these things and we reform the insurance market that much so why do we need to create a so-called government run insurance plan? that is the big difference of opinion here. i think. people say, well, what's the problem with government-run option? it sounds pretty sensible to me. many of us think that inevitably

leads to a washington takeover of health care. why is that? is like putting an elephant in the room with some -- and saying all right feliz competes and after a few days what is left. the elephant is all that's left, the miser crashed and you have an elephant. that is your only option or to take another example, some taken along and said i don't like what is left of the u.s. auto industry is doing. to give them on us let's have a government run a car company. less by the press at general motors, all 100% and let's have a government car and will make it the right size and the red color and have flex feel and put a solar panel on it and windmill on top of it and go 60 miles per hour and a people want to buy it will keep lorain the price. it will have a government car to make sure it works with a bunch of senators and congressman and get their ideas about how to make the car. that is not likely to create the

best possible car or to give the american people the best way to transport or even to have the lowest prices available. is likely to end up with one car -- in not very good government car. we have a good example of that already in our health-care system and is called medicaid. all out like to ask each of the senators here to call their governor and ask them how much the expansion of medicaid in their states would cost of the kennedy proposal and what they think about expanding health-care coverage using this government run medicaid program. my own experience with it is not good and really out like to find a way to require every senator who goes for 100 and 2% increase in the medicaid expansion to be required to go home and serve as governor for eight years and try to manage the program and pay for the program the way we pass said. i've talked to a few people in our state, not my gunner in this

case, but their word for the proposal for what we're about to do to medicaid, there one word was terrified. about the only way that you would want to expand medicaid program is if you didn't have to manage it, if you didn't have to pay for it and if you don't have to get your health care threat. let me be specific because that is quite a charge for me to make. first, the medicaid system that i know across this country, not just in tennessee but in other states is filled with lawsuits, filled with federal degrees limiting what the legislature can do to reduce costs and increase benefits, until then efficiency, filled with delays as the others might say, it might take a year to get the gunner permission to do what the state is doing filled with federal mandates written appear limiting when managers and national are different places can do and with an intolerable

waste of taxpayer dollars. gao has said the government accountability office that 10 percent of all we spend is wasted. if his $32 billion a year. that is -- think what we can do to help people have better health care without. second, the imposition of this proposed expansion would raise state taxes inevitably in a time when states are making massive cuts, if you are nearly literally bankrupting. it is daylight tennessee i mentioned earlier that by my computation it might cause us to enact a new state income tax by 2015 a 10%. why would that? here are the details on that because the state director says that increasing the expansion of medicaid to 150 percent of federal poverty level acosta's teefive under $72 million.

the federal government according to the finance committee of my pay for all that i remember a pays about there is one plan 6 million to increase so then pay for all that for the first three or four of five years. sounds good. let's said that. if we pay medicaid providers 110% and pay doctors at the rate of it as another $600 million in tennessee. remember that medicated doctors get paid about 70% of what medicare pays doctors, that is nationally and medicare nationally pays about 80 percent of what private people pay so you can imagine doctors aren't overly enthusiastic about those programs so i'm now that tennessee costs up to one plan to billion dollars and that is

3.3 but then the finance committee says we will gradually quote shift back those cost of the states so here comes the fun governor of tennessee in 2015 a great big $1.2 billion cost that i didn't have before. and where i get the money? it for% increase would have raised $400 billion. that is why i say the $1.2 million cost just for the expansion of medicaid isn't in this trillion dollar estimate that we got in the congressional budget office my coster's its equivalent of a 10 percent income tax. the national governors' association says it is not alone in this. they say if you take all the states up to 150 percent of medicaid that is 360 billion more dollars over 10 years, that is added to the trillion dollars we know about. they say if you added the increase medicare reimbursement

-- medicaid reimbursement to doctors from 72 to 83% to spin doctors more that would take three and 60 to $500 billion a year. one of the side alexis is is ruining our public higher education system and all the states. governor sir sitting there looking for ways to put money into research universities, community colleges and estate interests of the and have no money left because of their paying for medicaid yet we're coming along saying here's another huge bill for medicaid so that's the aventine a consequence of expanding the medicaid program and then finally on the medicaid program just because you have a card doesn't mean you get the care. there's got to be a primary care dr., there's got to be somebody there to take care of you and 40 percent of doctors nationally don't provide an will serve us

to medicaid patients because of the low reimbursement rates so it is hard for me to imagine why would you even consider expanding health care that we all want to do through such a failed government program whether so many other better alternatives. on on just one other aspect the employer mandate. of this is not a time to be putting a tax on employers in america. in the middle of a recession when we have 9 percent unemployment and automobile businesses are having a difficult time and are spotlighting defective worldwide competition we give you an example. tennessee is in idle state and a third of our jobs are on jobs. every one of those suppliers is sitting there watching costs. and just a little bit to the cost of making it part to a car in tennessee and it increases

the want the chance that that will be in mexico or in germany or japan where summer else. we have already seen with the legacy costs for health care did to detroit. they say it was a major things of this is no time to be adding a health-care cost to employers in america who want to try to compete in the world marketplace. so that is why reluctantly say that any version of this bill the matter how much i admire and appreciate the hard work of the staff will explode in the complexity and astronomical spending and never succeeded. there is a better way to deal with this. instead of stuffing low income americans into one failing government program medicaid, and creating another government program, we can give low income americans grants or subsidies so they could purchase private insurance in the same line the rest of us do.

biden bennett bill of which i'm a co-sponsor does this as a cost of zero. the coburn bill does this, the greg bill does this, the bill the senator hatch and cornyn are working on does this -- a dozen all without a government plan and without employer mandates, without expanding medicated and to make sure that everybody gets health care and not just discriminated against based on ratings. so mr. chairman, i thank you for being patient and giving me this much time, but i believe this latter way considering these other conservatives that are ready to be considered is a better way to meet our objectives. all 300 million americans receive a better health-care opportunity not just 47 million. a health-care plan that each american could afford would be available. it would be a plan in which each of us and our daughter to make decisions, not washington plan. in would be a plan for the first

time we emphasize prevention and wellness which we all want to do. would give low income americans opportunities for the same kind of health care that most of us have a year ago and would not make it harder for american businesses to compete in the world marketplace and ship jobs overseas as a result and as a born as anything else it would not add to our debt to an astronomical way by jealous of dollars so our children and grandchildren are saddled with a cost that delius the dollars they earn and reduces the quality of their life. so the president has repeatedly said the best way to do this is in a truly bipartisan way and i am afraid in on a to do that that we have to put this bill aside and start over. thank you mr. chairman. >> thank you very much, senator. senator reid. >> thank you mr. chairman and first let me echo the comments i think all of our colleagues to

say that senator kennedy is not only of the ship but inspiration is with us tonight. of particular in the want to thank you mr. chairman because you have been conducting of the last several weeks significant efforts to discuss and reach out and do the things necessary to start in this off the list of the bipartisan discussion in this is a bipartisan process. this is a time we have to began. we know the status quo cannot be sustained a huge amount of money and house of budget devoted to health care is estimated that within a few years almost half of of the average middle income family will develop their money to health care of thinking get it. huge public issues, senator

alexander refer to the impact in states, medicare and and medicaid on us, the status quo is not sustainable and we've got to begin in this frankly is the beginning. and we have had discussions over the last several days. i think they have been productive and certainly principled and i think principally senator enzi for his contribution to this discussion but unless we start buying a build up for it imperative that maybe and start the process of amendment and start the process of committee markup to a conclusion and the next up we're going to miss another opportunity and the italian the one thing we consistently have done a with respect to health care reform is missed opportunities. in 1994i was in an opportunity there and we frankly failed but let me go back to an earlier

time and quote some words i can describe a situation today. the costs have skyrocketed and the values have not kept pace. we aren't investing of our resources and not getting a full return on our investment. although the federal diriment should be viewed as one of several partners in this reform effort it does bear a special responsibility to help all citizens achieve equal access to health care system those of the rest of president richard nixon in 1971 when he introduced health care proposal which i think is not similar or identical to ours but how many elements of this shared participation but special responsibility to the federal government. we missed that opportunity back in 71. we can't miss this opportunity. i think we have to seize the moment and i would just say that

we have begun this bipartisan process. we understand the end of the day in the senate's there'll be a huge bipartisan efforts on both sides to get a building can support with strong majority. i personally think one final point that we do need a strong public auction. we need a strong public option because at the heart of the proposal is to provide a competitive check on private insurance, competitive incentives for increased emphasis on preventive care and in the '80s exchanges we want to give people a choice. they don't have that choice today. they really don't animus i think we have a strong public auction that choice is not point to be a real one. so i think that is something i want to emphasize and my colleagues are equally committed

to this public auction, but i want to thank you mr. chairman and senator and safer getting as a list to the point where the discussions, the questioning, the almost seminar time aspect of what do we do has finally yielded something at least we can agree to disagree on and begin to change and i know we all know there is going to be changed to the legislation going for it, but i sense that we are released reaching a point where we all understand we can miss this opportunity again. thirty-eight years ago we were here. roughly 13 or 14 years ago we were here. if we miss it again there is no more room demographically or financially to go another 10

years, another 30 years before do something. so i hope that at least until late today after opening statements become back with the notion we're going to dig in for everyone leaves and move a bill to the floor. thank you. >> thank you. senator isakson. >> thank you very much chairman don and i now want to be repetitive it except to say that i join with other members who have complemented senator kennedy and express our regret he is not here and in my 11 years the congress, the two most significant pieces of legislation worked on was the pension protection act and the riding of no gile love behind and senator kennedy was the senate leader of the committee in both cases and led the conference committee in both cases and in the end result came out which benefit of the people of the and states and used to be commended and we all wish him the very best and i thank you at mr. chairman for opening this up

and allowing us all to have a say at the beginning which hopefully we will in the middle and at the end will have something to talk about. most all the things opinions that i finally reached the age of 65 are based on my life experiences either as a father or a businessman, the operator of a business and legislator in the state or as a senator and so i want to point out three areas have given a lot of thought to of things being said about this legislation and caution us to recognize the consequences of not taking too easy an approach to a difficult problem here, the chairman said in the beginning that history will not look well upon in if you don't do something because it was hard. equally i think if you try to sell an easy answer to her solution it will be looked upon very well either in this is a very tough problem. a trillion dollars is a lot of money. pactel is embarrassed to use a bill in my state with a

constituent stood up and ask me a question and the question following a speech at a rotary club and senate mr. isaacson i only graduate from high school and i really can't deal with a trillion -- can you tell me how much that is? thing for a second, what would your answer have been two that question? it's kind of hard to explain which million dollars this so i went home and i worked on it. if you converted dollars to seconds and you said, how many seconds will it take -- how many years will it take for a trillion seconds to pass and it is three his 17,097 years, 11 months and today this. and that is a lot. so the point is when we talk about the cost cbo has scored a talk about pay for some talk about savings, we need to make sure we're getting it right because that type of astronomical growth and that would cost is huge. case in point, the president of the united states on tuesday or monday when he spoke to the

american medical association talked about the savings we are going to take place because of this proposal and he used the dish analysis. he told the doctors we spend, this will serve as a hundred billion dollars in debt payments over 10 years and years right. this year's appropriation is about $11 billion and now be 110 million over 10 years but just because you assume it you've got everybody covered does it mean that expense goes away, it just goes from a disproportionate share contribution to a hospital to expansion in the private plan and 50% increase in medicaid so the money is still being spent, is not a savings but it is an expenditure you don't make to a charity hospital and the unintended consequence on the example if you look into big cities coming years is to let i guess mr. ranking member, mine is a land of.

we have grady memorial hospital the decision in this dish payment because they get a disproportionate share of the advantage care. they depend on that this money to help balance their books. everybody is covered in linking ghent many of the most convenient place all of a sudden that money goes away for the charity hospital and the mechanism they finance their debt and the bon get in jeopardy so have to look at the consequences when we're saying in terms of what may be a savings we're really only moving money around the possibly choosing navigation as well. secondly i was a state legislative runtime and mr. alexander did a good job of addressing medicaid and am not going to be everything he said but he is a good point. i would like to put in perspective. the first year medicaid was law and the first to the state of georgia appropriated in his budget appropriations act for

mccain inappropriate $7,791,691. which was at that particular time 1 percent of the state of georgia's budget. in 2008 the state's share of medicaid as 2,468,000,003 had a $76,258 which is 12 percent of the entire state budget. and if you raise medicaid from 100 percent eligibility to 150 and tell the states they're not going to have to pay for the first four years we're going to have to pay for the first four years and is going to be an equivalent for my state alone of a billion dollars a year. we should remember that when we pass an economic stimulus bill is significant portion of it went to mccain to offset the difficult states are already having in meeting their obligations and when that stimulus expires in two years and the money is gone we don't

have the money to do it again in the hole is already deeper so we need to be cautious and careful about that. the as far as the private plan and i have so much admiration for the senator from maryland and she made an interesting statement regarding her support for the public a plan and i appreciate that. and she talked about she was a public plan because they would hold private plans accountable. well, it is our responsibility in government to hold people accountable. we do to regulation and oversight, i don't know if we ever did it to competition because when you think about it the entity that regulates you is not good to be a fair competitor if they don't have to make a profit to stay in business which brings me to my second point to remember was quoted last week that in this committee but from another committee was quoted last week when asked the question where are we going to get the savings from and he said what is going to come from the public competition because as a public competitor we don't have

to make a profit. if your theory is you are going to save money by removing profit you are also removing the incentives we were talking about for quality of health care. so that is i think if on philosophy and i think the suggestion by senator conrad which doesn't yet have any meat on the bones of a cooperative may make an awful lot of sense. we tried a lot of us in this is my final point in my remarks in both the house and the senate to move association health plans which is a form of a co-op and we never could quite get there and couldn't quite get there because we never could get enough votes because of the philosophical difference between a private solution and public solution which is ultimately really the dividing line in this piece of legislation, but on that point as a businessman i employ 250 people and a thousand salespeople. by salespeople were independent contractors which by federal law you cannot provide health benefits to them under the irs

for in an apparent contractor but you can for an employee. i have seen nothing yet your have i heard under pay or play an independent contractors and those who they work for are going to be affected by this legislation but i will tell you this. probably 16 to 17 million of the uninsured in america are people who sell things, people would deliver things where people who build things. their sole proprietors, independent contractors in so i can't wait to see what finance says in terms of how it is my duty that and pay for play alone, but that is some of the unintended consequences i think we need to take a long look at before we leap off on the financial and onto simple a solution for what is a very difficult problem. now i end my remarks by this -- we don't have -- i can see everybody because the bill is not in front of me. i don't know where you put them but i read the preamble and i

agree with every word of the preamble. we do want to reduce costs, we do want to improve quality, we do want to improve accessibility, we want to improve things with the lives of the american people and as committed to that as anybody in this room but i am not going to stand myself for a simple solution to a very difficult problem. when this country cannot afford to get this wrong because if we do we won't have another big issue to debate because we won't have a country. thank you mr. chairman. >> thank you senator and i mentioned with the exception of the newest members of the senate committee, virtually every member i enjoyed working with john isaacs and on tax provisions and housing starts and the like from a good man to work with an accord to working with you on this as well senator sanders. >> thank you mr. chairman and like everybody else on this committee we all wish senator kennedy at the very best, we

miss him and we appreciate the ricky is done for so many years and no evidence senator dodd, we hope that he is back. >> i hope he is back. >> i know you would, and we all want him back. i think we all agree on mr. chairman, i think most of the americans understand that our current health care system is disintegrating and that is the word adduce but today we have about 46 million americans who have no health insurance and very importantly we don't talk about this and we have even more who are underinsured and the importance this is not good enough to say everybody has insurance, you have to ask what is the quality of insurance, how meaningful is it? is a $10,000 or $5,000 deduction? for the war in the midst of this disintegrating system we have some 60 million americans who do not have access to a doctor on a regular basis because we have a disaster in primary health care. why is than ever airborne? it's important because we have close to 20,000 americans who

die every single year because they don't have access to a doctor in by the time they get medical care their achievements, their problems are so far of long, their illnesses are so severe that they die when they should have lived. i know that in the coming weeks and months we're going to see a lot of tv ads about all the terrible things happening around the world, i hope some of those people will focus on families that have lost a loved one simply because that person cannot add to a doctor because of lack of health care. we lose close to 20,000 people every single year because of a lack of a doctor that is three times what we lost the message times lost on 9/11 every single year. the 20,000 people now, in the midst of all of this some people will say you got all these people uninsured and all these people under injured and dying because they don't have a doctor but at least when i'm spending a lot of money.