in cleveland he's been instrumental combating significant francis in cancer between african-americans and caucasians. .. : think of the lives these young women with little education, with little opportuni think of the lives they save, the lives they may better, think of the millions of dollars this save in the health-care system.

this bill would address shortages across the spectrum from nurses to pediatric specialists to, of course, primary care physicians. of like to commend the chairman and staff and the other members on both side of the aisle, senator coburn and hatch and everyone for their good work. i'm optimistic and looking for to the markup. >> thank you senator. senator hatch, former chairman of this committee. and his thinking when of the proudest moment i had in the seventh about 25 years ago was coal offering with orrin hatch, the first child care legislation since world war ii in this country. if the cord blood issues together and senator kennedy doesn't have a better friend in the senate. the list is along the matters you have worked on together over the years to take the next half hour to get on that list of matters you have worked together on despite coming from different

parties in different ideological point of view the have been able over the years to find common ground on matters of no possible and i have a quarter-century ago. you have this appearance of building this calcine of the difficulty and also the means by which you can achieve common results so i'm delighted to part of us in this effort can i thank you, i'm delighted to be part of this. we have been friends for a long time and when we fought for the child care development block grant bill the first child care bill in history nobody thought we are going to get through but we did it in large measure because of your leadership. and i have to say that i am pleased that senator kennedy has delegated this committee to do and tom harkin and who i have worked with him very strongly on the health and other and barbara mikulski worked on the american

action everybody on this committee. this is a committee that this war to help people in america and i came to for the first for years we got into some scraps and we have been scrapping all these years we developed a great love for each other and frankly i pray for him everyday and wish him well and we do miss them. there are so many bills to put together that he is a master legislator. in answer you in some of the others in this committee. this committee does build good leadership because of the myriad programs -- the largest authorizing committee and the congress and was a privilege for me to chair the 21981 and 1987. lme take some time today and not be too long and take a few minutes to talk about them affordable health choice act. first and foremost the may make this point again even though

concern to summon a broken record very reforming our health care system to insure every american has access to affordable health care is not a republican or democrat issue. it is an american issue. when dealing with 16 of our total american economy is absolutely imperative that we address this challenge in a bipartisan manner anything less would be a huge disservice to our family and nation unfairly health-care spending continues to grow too fast. this year will mark the biggest largest ever one-year jump in health care and chair of our gdp and full percentage point to 17 plus 6% here and you can think of this kind of like a horse race between cost and the resources to cover those and the sad reality is that cost when year after year. having played ever found role in every major health-care legislation for the past three decades and worked in a bipartisan manner with everyone from senators kennedy and got to

congressman waxman and know something about getting things done for their families and a thoughtful manner. and to advance the legislation by working on areas of compromise and unfortunately we're beginning in partisan exercise and perhaps the most important legislation of our lives. i am personally naturally very disappointed because, of of of a bipartisan compromise that could have become a lasting legacy for a dear friend ted kennedy. before a focus on some of my broad policy concerns and want to spend a minute on process. we're getting ready to debate a large the legislation probably the most important legislation of our service here. something that will affect one sixth of our total american economy and the impact every american life. we have a bill that is incomplete, no final cbo scores, not technical assistance from hhs or cms and we are still

headed full speed ahead. those things are absolutely mandatory. if you're going to do good legislation of that to know where you're going and certainly have to have those kind of scores and technical assistance for people who deal with these problems every day. and even though we might not agree with some of the conclusions that they made it is extremely important that we have the best ideas we can and those people who are in the best position to give them. why? what are we rushing so much? what are we trying to hide. this is a much more serious situation than that ill-conceived stimulus legislation. if we fail to do this the right way to simply shut the health reform box we will all suffer the consequences for the rest of our lives. the preliminary cbo's korea today and it is a preliminary estimate was another clear indication at this is moving in the wrong direction amid the point that it did not comply

with the democrats' own plant them to keep you have asthma than 22 american -- 22 million americans will lose private coverage and this is before the details of the government plan which isn't in this bill and this time. it also scores at $1 trillion to only cover 16 million americans. that is in accordance with this preliminary estimate. that is disgraceful. mark my words, you'll see a lot of budget cut -- this increase however will not hide the true impact on our future generations let me go over my key policy concerns -- and discipline of the president and my friends on the other side of al have chosen to pursue the creation of a new government run plan, one of the most of us of issues and health care reform. rather than focusing on the

broad areas of compromise seconded just for a bipartisan health care reform legislation. keep in mind was that isn't even a written yet for this bill. at a time when a major government programs like medicare and medicaid are already on a path to fiscal insolvency creating a brand new government program will not only worsen our long-term financial alec but also a negative impact american families who will enjoy for who enjoy currently private coverage of their choice. to put this in perspective as of this year medicare has a liability of almost $39 trillion. admit the senator from vermont this it ought to turn to medicare and as the real answer to everything and a single pair system but it is already $39 trillion in debt. which in turn translates into a financial burden of $300,000 per american family.

it's easy for a liberal person to say let's take care everybody but we've got to do with reality here and with add to do with our budget and deal with the cost. well, think about it. $300,000 per american family, and our current fiscal environment with the government will have to borrow nearly $0.50 of every dollar it spends this year is putting our deficit by almost $1.8 trillion let's think hard about what we're doing to our country and future generations. the impact of a new government program on families who currently have private insurance other choice is also alarming. in a recent study, very important study estimated that the cost shifting from government pares specifically medicaid and medicare already costs families with private

insurance to the $1,800 more per year. a reading another government plan, a public plan call if you will, but it is a government plan, açç federal government n -- in washington inside the beltway plan that will further increase the cost of our families in utah and across the country nonpartisan matlin group that we always turn to about here, that group has concluded that a government plan to open to all and offering medicare level of reimbursement rates would result in 119.1 million americans losing their private coverage. the polls show people love their coverage for the most part. 119.1 million americans lose their private coverage. this is almost three times the size of the entire medicare program. think about that. marra brennan this would run counter to the president's own pledge to the american dramas about allowing them to keep the

coverage of their choice. proponents of this government plan seem to count on the efficiency of the federal government in delivering care for american families since it is already doing such a great job with the banking and automobile industries. if you believe that, medicare is a perfect example. it is on a path to fiscal meltdown with part eight already facing bankruptcy within the next decade, and it pays doctors by 20% and hospitals by 30 percent compared to the private sector forcing increasing number of providers to simply stop seeing our nation's seniors. according to the june 2008 medpac report, an attendant of fisheries have to get additional benefits beyond their medicare coverage. nine out of 10. we have a broken doctor payments

system and medicare that has to be fixed every year so seniors can continue to get care from doctors. this year alone this broken for mccall's for the more than 20 percent cut. i can keep going on but the point here is simple. washington is not the answer as much as i love my colleagues on the other side, you love washington too much. i love it too and not that much. and i think it is not the answer. i think is a problem. the supporters of the baruah plan as these facts so they're trying in their approach by claiming that the government plan is simply competing with the private-sector on a so-called global plainfield. this rehash on us that for some of the free-market plans to compete with this government run a plans always creates a not

level playing field and tubes competition. the medicare program provides an important lesson here and as a political compromise medicare was set up in 1965 to pay doctors and hospitals the same rates as a private sector. faced with rising budget pressures congress quickly abandon this level playing build approach and an active presence is for doctors and hospitals. today medicare payments are 20 percent less as an engine for doctors and 30% for hospitals compared to the private sector and many doctors won't take them on. i have been told by doctors from utah that discontinues they will simply stop seeing patients altogether. and now to mention a few words about comparative and effectiveness. this is a wonderful set of terms that we do a lot with in this debate. clinical comparative effectiveness if done right can

provide us with the label information while protecting patient and medical innovation. the key is to focus on what worst that where an internet -- for inpatient not simply what is the cheapest option. unfortunately the language included in this bill the latest down the path of rationing care and i don't know many people who are experts in this field would disagree with that. rather than improving care. senator enzi and i have shown a willingness to work on this and others have as well and will continue to do so. and here is the bottom line. if we are not careful we could walk down a path for stories like a jack tag can become increasingly common in our great country. in 2006 jack tag a former world war ii pilot suffered from a severe case of a molecular -- macular degeneration. this is a guy who risked his life for all of us.

the regional government bureaucrats rejected his request for treatment citing high costs and that is the disease that his other eye also appear in. it took three years to overturn that decision. three years. let's all remember that a family member with cancer in an intensive care units would probably rather have the time of the resources to appeal such an egregious bureaucratic decision. but that we're going to see a lot more of the something like this ever passes. and when a tremor of the real implications of these policies not simply in terms of political spin in interest but in terms of its impact on real people who are our mothers, fathers, husbands, wives, brothers and sisters, children. follow on biologics is another important session that is currently missing in this bill, they tell me they will put it in the bill.

i sincerely hope that we include the f-16 95 language unless congress which was the bipartisan compromise between myself and senators kennedy, and say, clinton, schumer and i believe senator broad as well and others. as the author of the hatch waxman act, we know what a great african -- ever that has been the saving lives $10 million to consumers. that is billion with a b and since 1984. this is the hatch waxman act or the kennedy and the act and clinton and brown in schumer if they stick with that for the buyout industry which is one of the few areas where we might be able to save on health care costs along with a very good system of working on all steps

of research. let me just say and i personally believe that this bipartisan agreement on the biologics in bill that that bipartisan commitment is to be kept and has been a long history between a lot of kennedy has compromises. we're going to work together to protect this compromise is to the entire cost process and a dozen new can't work on the part of that bill which is something of concern about we need to do that. that is one way might find money. also through treatments and/or caris this them some research which must include embryonic stem some research and a priest that he give an executive order to take in the sense that we need to really get and i need to involve more than they are in

helping us to fund the trimmings for years, if that is the only thing we got a cure for it would save as jones of dollars and we wouldn't be sitting here worrying so much about where the money will come from. to fund this really very expensive bills. to enact to health care reform will have to come together as one to read irresponsible bill for the american families who are faced with rising unemployment, out of control health-care costs. i think it is pathetic our country is not the number one health care country in the world on all issues. and we are on some and not on some very remarkable areas of health care. now afford to working together tisch's former r6 system into a to health care system. and i continue to hold deep open-heart that we will soon move beyond these games and work together to fix main street. i think we can. but we are not moving in that

direction right now and i personally believe we need to all stop me consider, work together and if we do we can come up with a system here that would work to bring together vast majority of senators and members of the house of representatives which is a way this bill should be. if it passes with just one sign passing in which one or two republicans in sticking get them i don't think he will on this bill but if you do it is not going to be a bipartisan bill nor is it going to have a happy life. i know enough about this history in this area and health care to know that that is a true statement. i have nothing but love and regard for my colleagues on this committee and on the finance committee as well were and also served. good people every one of view and i respect you. but look it would sure doing here. this is in my opinion something that is going to be too costly

and isn't going to the job we hope we can do is really dedicated people on this very important committee and i might add on this finance committee as well which is extremely important role the money is unrated to work together and i just felt that we can but what i have seen so far in the case we are not and that may turn not to be a disaster for everybody concerned and, once again, we may lose the edge opportunity and the chance of really do something that will make marvelous difference in our country. lucas senator schakowsky, she is nodding your head and the reason she is as we did on the save america act. that is a bill that brought the best of conservatism and liberalism together in the hopes will get seven or eight millender additional volunteers that will save this country jones of dollars. and i enjoyed working with her

and, of course, our beloved chairman as well from this committee. senator dodd, i don't know how use it to all this but i respected, we are close friends and i expect you to use her immense influence to listen to me is the biggest be a bipartisan bill. thank you so much. >> i been listening to you per 25 years. >> you are a lucky guy. >> i keep saying to myself every day that i feel the same led. >> thank you. senator casey. it is a pleasure, we served together on the banking committee and now you are here as a real asset to the institution the max mr. chairman, thank you very much and they're grateful for your leadership here and as we have her from so many of our colleagues about senator kennedy i think it is evident the impression that we hold for him but also he is. so many ways, he doesn't have to be physically in this room to help the center and guide us.

i think his inspiration is here years of work we would not be here without his leadership, his passion and his work ethic is evident in this hearing room and in the work that all of us have done. and now he called this morning and i'm sure he may call tonight and i want to make sure we're doing a good job for him but i do want to thank you for your leadership in the midst of some of the other challenges that the nation has and you have been working on directly. i also want to thank the members of the democratic side who have been, have the working groups, two years with senator mikulski and harkin and senator bingaman and mary, so many who have worked for many years not just in the last couple months on this issue. i also want to thank the staff. remarkable work on both sides of the aisle. senator enzi, the ranking member and our republican colleagues as well in your staffs, all the

work that went into the bill long before the last couple weeks. hearing after hearing in january and february and march leading up to this probably 25 hours at least last week of republican and democrat sitting down and i also want to thank the president for his leadership. in my judgment if you could pick one thing that has been missing certainly over the last eight years on the issue of health care was leadership from the white house barrett of leadership and the president and the kind of leadership that only one person can really provide and president obama has provided that it is critically important we do. i believe like so many of us that now is the time to pass health care reform. it's not late 2009 to pass it, not 2010 or summer down the road -- it is now and have to make sure that we take it managed of this moment. the shells remember that all of us have health care.

every senator, all the staff, all the house members have it -- we should bear that in mind when people talk about let's wait a little longer and see if we can push this into next year. to sum of nearly one to do that. is a fundamental choice in my judgment, is a complicated tough problem with the choice is simple. his interest in the status quo unchanged. a choice between the status quo and reform in my judgment the status quo is the enemy of reform and change so we have to choose sides. we're all conspired by people in our home state. i get a letter back in february from tricia urban inverse county pennsylvanians in the eastern side of our state am going to reach large segments because it tells us about this challenge in a way that i can never do in many hours of testimony. she talks about the fact that her husband andrew in order to

complete his piece she had to enroll in a complete requirement for an internship and because of that they cannot afford covert coverage and she says and i quote a letter, quote, because of pre-existing conditions either my husband's health issues and on my pregnancies having been pregnant at the time would be covered under private insurance. she goes on to say a word for part-time jobs in the letter says on the medical bills on to add up to insurance company decided to drop our coverage. stating the internship did not qualify as for the benefits. we are left with close $100,000 worth of medical bills and then goes on to say the burden of current medical expenses because of a the burden my husband missed his last doctors appointment less than one month ago. one month before february and the other concern he had was paying for the birth of a child

and then she goes on to the tragic conclusion and. and she says my water broke the night before, we were anxiously awaiting the birth of our first child and a half hour later to ambulances or in my dry white as the permanent sources in the health of my baby and me the paramedic from the other ambulance told me that my husband could not be revived. she goes on to conclude this way -- she says -- this is tricia urban from pennsylvania -- i am working class americans and do not have the money or the inside two legally fight the health insurance company. we had no life insurance. i will probably lose my home and my car and everything we worked so hard to accumulate in our life will be gone in an instant and she goes on to say i am telling this story to help others. she concludes with this line -- quote, i am willing to pay the

price of losing everything. the question we have to ask ourselves and the next couple of hours and days and weeks and months is what are we willing to pay? what are we willing to sacrifice to get this done with this bill? now i believe the legislation before us is good legislation. it is not perfect, there are problems no question. but i think a lot of issues the tricia urban raised a lot of issues we all care about speaks directly to them specifically. affordable health choice act does a number of things -- it does reduce cost by way of prevention, better quality, information technology and rooting out ways, fraud and abuse and of the finance committee has ever to do another part and will get to that and we will all get to that but this bill to the law to reduce costs and the way that we can on our jurisdiction. secondly is affordable health

choice and preserves a choice. if you like you're doctor in your health insurance company you can keep its. if you don't like it and don't have insurance is our obligation to help. it. thirdly, the affordable health choice act ensures quality, affordable care. we know the numbers. by one estimate by 2025 at our system will cost us $7 trillion from where and is now at about two and half are close to two and have. next we're going to build on the system have, no reason to dismantle the system we have but we do have to build it. senator brown's and we have to fix what is broken in keeping works. we will protect the doctor patient relationship. and we will at long last for tricia urban and other people cover pre-existing conditions. unfortunately for her it is far too late because of her loss of her husband andrew. i wanted to talk about two other

major issues went into a about another constituent. one is that we should have in my judgment a public auction like medicare. and when i think a public auction i think of two words, a lot to talk about and not enough time in opening statements but i think of choice and competition. but we really want competition we should have that in the bill and have that in the final bill that we work on. and we ought to give people a choice with regard to their health care. the major point that i'm going to be making like a broken record is about our children. our promise in this legislation not just in the bill in front of us. i believe the bill in front of us lars and it's his promise but in the larger legislation when we get to working with the finance committee and a final comprehensive bill the promise should be this. no child worse off the especially children that