but at least we're not spending a lot of money. when i was a kid, i bought a car for $200 that broke down all the time. well, i only spent $200. we spend 18% of our gdp, and we for a variety of reasons are growing who close to 1 million americans will suffer a personal bankruptcy because of medical

related problems. so when you're looking at -- i know we throw a around a lot of numbers and concept -- elma assistant to deal with, if somebody comes up with an elvis they're focusing on how to get well. the focusing this -- the family is focusing on how to get well. not only how to get well the financial consequences of paying off huge bills and an emily and families that leads to bankruptcy and the destruction of families. but it's not only a personal crisis. our health care situation is obviously an makarov economic crisis. general motors -- and we all know what is happening to general motors -- spends more on health care per automobile than on steel. more on health care than on steel. one of the reasons, one of the reasons they are where they are today with other manufacturers. small-business owners in vermont and across the country are forced to divert hard-earned

profits into health coverage for their employes he's rather than a new business investment. and because rising costs it is no secret many businesses small, medium are unable to provide any health insurance for their workers. the fact of the matter is we as a nation today are spending almost twice as much per person on health care than any other country. according to the oecd and 2006, the united states spends $6,700 on health care. canada spent 3600, france spent 3400, about half of what we spent. and italy spent $2,600. mr. chairman, i will tell you something. i think it is very easy to criticize other countries' problems. every country has a problem, no question about it. there is no perfect health care system on earth but i think it

would be interesting to bring the leaders of other countries here to tell how in fact in virtually every instance they are providing universal comprehensive health care for a fraction of what we are spending. what are they doing that we are not doing. that is a lesson. so despite all the problems we have and despite all of the expense of poor value for what we are spending according to the who. the united states ranks 37 in terms of health systems performance and we are far behind many countries in terms of infant mortality, life expectancy and keeping people from buying when they should not be dying. as the health care debate heats up in washington and on this committee we as a nation seems to me have got to answer to fundamental questions, and there is i think this agreement on the

first issue. and that is the very simple one. should every american have health care has a right? the texas in every other industrialized country obviously it doesn't exist in our country. 100 years ago people at the federal and state level said every kid in america should be able to go to school, every american can go to public schools regardless of the family is rich or poor. no one debates that. education is a right. when you dial negative 11 the police department comes through the door whether you are rich or poor. no one suggests you're not paying enough in taxes police shouldn't come. the fire department shouldn't come in your house is burning but somehow health care if a low-income worker gets very sick well, you're on your own. uniquely in the industrialized world that person is not guaranteed health care. so that's an issue we have got to deal with and i think i am on this side of the vast majority of the american people who say

something is wrong. health care should be the right of all people. not everybody agrees but i think the majority do. if we agreed in the second question is pretty simple. and that is how do you provide health care, comprehensive health care to every man, woman and child in a cost-effective way? you could provide health care to everybody and as others said he could destroy the treasury, bankrupt the country. a lot of ways you could do it but the challenge is how do we do it in a cost-effective way? now, let me raise a question that hasn't been raised or make a plant that has not yet been made and i find it amazing that somehow we have forgotten to talk about this issue. and that is it seems to me if we are serious about providing health care to all people in a cost-effective way somebody has got to say what makes our country different from every

other country on earth and there is no difference. the difference is our system is dominated by private health insurance companies and i hope i will not shock anybody on this committee or anybody in this country by suggesting what everybody knows to be true. the function of private health insurance company is not to provide health care. the function of a private health insurance company is to make as much money as possible and quite often the way you make money as a private health insurance company is to do not healthcare. every dollar id malae, every pre-existing condition, every time i terminate somebody's health insurance because they were really sick last year and need it is a dollar more i make. it is no secret private health insurance companies hire people to find out who was sick. go over the records to make sure we don't continue that policy. i'd think that is basically in saying. that is obviously endemic within

our system. and the we don't ask apparently we are not about to talk about in terms of the role of the private health insurance industry is they are responsible for giving the most costly wasteful comprehensive your credit system in the world. i just talked yesterday, the guy in my office is an attorney, smart guy. his wife has a phd. they sat down to go over federal employee benefits we have and they couldn't figure it out. ph.d. and a lawyer. there are people bombarded with hundreds of different types of programs. 1300 private companies that provide thousands of different programs and they are different if you're young, different if your old, sick, if you run the marathon, all these things and here's the point. some people say look at all the choices you have, well, people are not choosing health insurance companies they are choosing doctors and hospitals,

not health insurance companies. when you have thousands of different programs you have a complicated bureaucratic wasteful system and here's the fact that we should all appreciate. at a time in america today and there should not be any difference of opinion we are in desperate need of primary health care. we are in desperate need of dentists, desperate need of other medical personnel. you will all be happy to know the number of administrative personnel in this country over the last three decades has ground by 25 times more than number of physicians. we need doctors, we need versus, we need medical personnel. you know what we are getting? bureaucrats and companies sitting there telling you you thought you were covered for this procedure, your not. that is what they are doing. as we are seeing an explosion of bureaucrats when we need people who treat and deliver our babies to take care of us when we are old. not surprisingly, while health

care costs are soaring and they have been in recent years so are the profits of the private health insurance companies from 2003 to 2007 the combined profits of the nation's major health insurance companies increased by 170%. a lot of talk about that issue? are we about to maybe suggest there's something wrong when we are the only major country in the industrialized world that has a system dominated by private insurance companies whose function is not to provide health care but to make as much money as possible and while more and more americans are losing their jobs and health insurance i've got some good news. there is some economic growth. the top executives in the health care industry are receiving lavish compensation packages. there is good some news. it isn't just william maguire, the former head of the united health the several years ago

accumulated stock options worth $1.6 billion. anybody have a problem with one body in the health care industry getting $1.6 billion in stock options? you have on average on the top seven companies the average is $14.2 million that is the insurance companies. the drug companies' ceos make even more money. i am not going to tell you that is a huge percentage of a $2.5 trillion health care bill but it does send the message and the message is the function of health care in our country isn't quality cost-effective health care, it is to make money and the people on top are doing just that. now, in my view, there is a solution to the crisis that we have. but a requires us to do something that in congress we don't do all that often. and that is to say all the lobbyists who are here and all the big money interests to give campaign contributions who

lobbied successfully put the 32nd ads on tv that your time has come and gone. we are past that now. we can't deal with your hundreds of millions of dollars that you have spent in recent years lobbying congress and all of your campaign contributions. enough is enough. our job is not to represent you. our job is to represent the american people. and i think when you throw all of that and what of the studies show is there is one way that we can move toward universal comprehensive quality health care to all of our people and that is in fact through single payer medicare for all approach. private insurance companies don't like it, drug companies don't like it, medical equipment suppliers don't like it. that is the way we can go and in my view should go. now let me conclude, mr. chairman by saying this, putting this whole debate in a

different perspective. in my view, the fight for comprehensive universal quality cost-effective health care is in fact the civil rights struggle of the moment. and we all know people who for decade after decade thought for a nation regardless of the color could flourish. we know the struggle that took place for women's rights for other efforts to make us a more space and just society and i would argue that the fight for a comprehensive universal national health care program is that fight this time. and right now, in order to do the right thing in my view, we are going to have to take on the insurance companies, the drug companies and all of their money and stand with the american people who want to see a national health care program. thank you very much mr. chairman. >> senator mccain, john, welcome to the committee.

by the way i enjoyed working with senator mccain in the past on campaign finance reform issues and i'm delighted to have you be a part of this. >> thank you. thank you for your patience during this very long process and i like you and all others very much miss our dear friend and beloved colleague, senator kennedy. and so, i & we was supposed to have five minute opening remarks. i will try to keep mine down to about half an hour or so. i will be brief. a lot has been said already. we have a bill or did before us over 600 pages and almost consistently with that we got a letter from the cbo. it's been gone over before but the operative paragraph is on the first page. because it runs directly contradictory to the eloquent remarks of the senator from vermont just a minute ago in the

intent of this legislation. it says the last line in coverage at the same time the number of people that had coverage through an employer would it declined by about 15 million coverage from other sources would fall by about 8 million so the net decrease and number of people uninsured would be about 16 million we are supposed to have 47 million people uninsured in this country. i question some of the aspects of that, but we have before us a bill that ostensibly is supposed to have every american provided with health insurance, and yet some 30 million do not under this legislation. that doesn't mean we should go back and revisit and find out why we are not carrying out the intent of the legislation? shouldn't we also i think look at this whole issue of pay or play? i like to call it to pay or pay because either way the employer would have to pay whether or not

they can afford it. but if we are trying to provide insurance for every american how can we proceed with the cbo estimate and other outside organizations that were not? shouldn't we go back and see if we can craft legislation that aims to were the goal of providing health insurance for every american. second thing i think we ought to mention is the elephant in the room to some degree malpractice reform. the president made it clear he was against caps. why don't we look what happened in the state of california. they passed a law that put caps on malpractice and guess what insurance premiums for malpractice have gone down and costs for malpractice have gone down to the tune of some 100 to $180 billion a year can be saved by medical malpractice reform. but obviously -- and it's not directly within the scope of the committee. but i have been on lots of

committee and i'd seen this comedy act we haven't always necessarily adhere to that. but look, here we are with three major holes. one of them is pay or play. obviously the other one is how we pay for it. and it's very clear that the finance committee who is in peril supposed to be marking up along with ross has decided they won't until after the fourth of july recess. why? it is obvious. how do you pay for it? how do you pay for it. those of us that want health insurance, health care reform and obviously all of us do are not interested in adding another trillion or $4 trillion on to already what has been the most massive debt and the history of this country. if the cbo estimate, which leaves two-thirds of the people who are without health insurance

out and costs $1 trillion, let's do the math. you want to ensure the other two-thirds? that's $3 trillion. where do we come up with the money? and to lay an additional tax on the american people is something certainly i don't think the american people would welcome. so i hope all of my colleagues will go back and read the congressional budget office report, will look at the fact in their assessment we are not cheating to become achieving the goal of the legislation and go back to the drawing boards and get legislation at least that will provide health insurance for every american. and then argue about how we pay for it and whether and we years will be forced into a government auction. so, mr. chairman, let me just say i don't believe the government option is an option. i don't think that the government should be running

health care in america. i think they do a great job defending the nation. i don't think they do a good job in a lot of other areas and certainly we shouldn't be shaping legislation and passing it through the congress that increases in already unconscionable debt on future generations of americans. thank you for your good work. i'm deeply impressed by your patience and courtesy as always. thank you. >> thank you. senator brown? >> thank you mr. chairman. thank you for your work and all the members and their dedication as we have had these discussions and hearings and walk-throughs and this is the way the process should work and i am proud of all of my colleagues in this institution and i appreciate senator dodd's comments about the history in this room, the mccarthy hearings, mcarthur hearings -- this is the room where senator kennedy, both of his brothers announced presidential campaigns in this room in 1960 and in 1968. and this is a room just down

paul in the office even when he was vice president had an office in this building much of that time then senator harry truman and vice president and harry truman who in 1945 president truman said millions of americans to not enjoy good health, millions do not have protection or security against economic effect of sickness. the time has arrived for action to help obtain the lubber to eddy and that protection. it in a dozen years before president truman ordered those words franklin roosevelt made a momentous decision as this conagra's was about to enact social security that he was small when to be able to enact health care reform at the same time in large part because of his fear of the american medical as initiation knowing the doctors oppose including something that later became medicare and beyond that in the social security act.

it was only 20 years later after president truman's comments that president johnson pushed through with huge democratic margins in the house and senate over the opposition of the american medical liz's negation again and the opposition of almost all republicans was able to enact medicare in july of 1865 president johnson signed it. we heard accusations than from opponents that it was socialized medicine and was too expensive and that it wouldn't work, that the bill was too long, it was too complicated, what ever. and we know the popularity of medicare and put me illustrate with a story i know senator alexander will particularly appreciate. my first year in the house of representatives in 1993 was a figure that this house and senate tried to enact serious health care reform and i remember getting at least half a dozen perhaps ten letters that read something like this from constituents in my ohio district

and northeast ohio. people would say i'm against the clinton plan, i don't like socialized medicine. please keep the government out of my health care. i've been on medicare for 15 years and works just fine. so we know how well medicare has worked and we understand middelkerke's popularity and we know that government can in fact deliver health care with the private-sector. it's not socialist medicine. medicare simply as senator sanders suggests it is assisting in paying the bills. they don't hire the doctors or the nurses, they don't run the hospitals. they simply are the government in sure to displaced insurance companies and one other fact that really tells you how while medicare has worked is the simple fact. according to most surveys, virtually all surveys i've seen in studies of the richest countries in the world, the united states ranks near the bottom in terms of outcomes, in

terms of life expectancy, in terms of the infant mortality, in terms of internal mortality and diabetes and in terms of obesity. but in one category the united states ranks number top and that category is life expectancy at 65. so if you get to be 65 in this country for chances of living a longer, healthier life are better in this country than they are in almost every other country in the world. what is the difference between life expectancy at 65 and overall life expectancy, the fact we of medicare and everybody's covered by medicare. today nearly some 60, almost 65 years after president truman called on congress and the joint session when addressing a joint sessions to move on health care reform we are still waiting for a health care system. we have made progress in 1965 with medicare but other than medicare and medicaid in so many ways we are still waiting for a

health care system that delivers on the promise of affordable quality coverage. we are waiting for reforms that were cost for businesses and families who are buckling under the weight of every climbing premiums. we are waiting for reforms that foster competition and the insurance market and gives america better choices including a public health insurance option. we are waiting for the reforms that bill accountability to the system in shoring patience that they get the highest quality care in the world. we are waiting in other words for reforms that fix what's broken and keeps what is working. that's why this is a historic time and this historic room because i think the weight is about over. it's not a moment too soon for many of high winds who are one illness away from financial catastrophe. take for example ann from dayton ohio in the southwest part of my state she wrote with me to share her story. the past five and a half years she paid $125,000 climbing in health care bills.

how can this be? was she on insured? in fact when her illness struck she was a partner in a law firm and had good insurance but once she became too sick to work she lost her coverage and was forced to fend for herself. she and her family went on cobra, as expensive as it is when you are unemployed, for as long as they could and then paid $27,000 a year for insurance in the individual market where medical underwriting runs rampant and the cost of the bureaucratic cost of a single policy and individual market is 40, 40% off. she recently traded at plan because of the expense for a bear bones policy that cost her $15,000 a year but doesn't cover prescription drugs and has a 5,000-dollar deductible. so she starts off paying $20,000 for medical care. that's just the start. she writes in the letter this is not what insurance is about. the bill of course today takes a number of steps to ensure

americans don't make the same fate as an mcinturff panel. it provides better regulation of the insurance industry banning existing exclusions and preventing insurers from denying coverage based on medical history eliminating annual and lifetime benefit caps. blogger will be allowed insurance companies to stay one step ahead where those insurance companies will ensure you if you are healthy and inexpensive but well, you off if you are not so healthy and much too expensive. no longer will the insurance companies be able to select for cover only those who pose little or no risk of leading health care briefing everyone else in the lurch. health insurance are not supposed to avoid health care costs. they are supposed to cover the costs. but as senator sanders said that isn't what it's been about. second the reform effort will extend to the health care system and protect those that have no health insurance today. let me tell you about jacqueline

know how you. jacqueline used to work in a child care center that her employer as often is the case particularly when companies take care of children, the lowest paid people that work with various schools or daycare or pediatrics tend to make the least in this society. her employer wasn't able to offer health benefits so when she discovered a lump in her left breast she had nowhere to turn. she tried to state medicaid program but despite having an income in 2006 of $4,500 she dignity quote qualify. per daughter was grown, she had no dependent. she started chemotherapy but doesn't know how to pay her bills. the bills were developing in the senate would expand medicaid, this bill and working on in the house would expand medicaid and offer premium subsidies to those in need of help. the bill will increase competition. the bill will increase competition in the health insurance market by establishing a federally backed health insurance option for those that won it. there's nothing like a good

old-fashioned competition to reduce premiums to improve customer service to keep the health insurance industry on its toes. on surprisingly the health insurance lobby's launched a massive campaign to prevent inclusion of a public health insurance option in which they would have to compete. my friend, the senator from georgia said a moment ago when talking in opposition to the public plan option he's never seen that it's always been government regulation that has played to become ever the government objecting competition the government -- the congress noticed as american students noticed both the price of student loans and the service of student loan companies, the banks in most cases, was --

their interest rates in an knott shell of the banks decided they had to compete with the direct student loan program set up by this congress so we saw anonymously we saw in the banking system with students loans the way we can see the public option, the public option will simply keep the insurance companies more honest and help keep prices down and help keep premiums down and help keep the copays and deductibles and check and in a word keep the insurance companies honest. today, private insurance competition insurers talk about and the defenders of private

insurers and the opponents of public option talk about the private insurance competition but it's a bit of an oxymoron in a lot of places. in ohio the two largest insurance companies in my state account for 50% of the market in some cities it's literally 89% of the market. this bill -- we know that a public option but again discipline the market better in a way that wide-open competition would do. finally, mr. chairman, this bill would give providers the tools to improve the way health care is delivered in the country. improvements will help americans with chronic conditions to manage those conditions, improvements that can dramatically reduce medical errors and overcome on justifiable disparities and health care outcomes. these reforms drop in sight and inspiration from the work already being done by dedicated and individuals within the health care system. individuals like dr. derek who heads the cancer center at the cleveland clinic. he's devoted himself