because we have an uncontrolled tort system in this country. yet we don't offend the trial lawyers with this way of looking at it. just read the bill. if you want to eliminate low birth weight babies, read our bill. it does. it takes every medicaid patient out of medicaid and gives them real insurance with real choice at the highest quality level at the highest quality hospital every time. if you want to solve theññq;z;wñ

and make indian health service have to compete with them. give them real freedom but also meet the commitment you've made to them. today we take indian health service an we underfund it. we undercare, and then have the pictures every year given by our colleagues by north dakota and south dakota about how bad it is. yet we don't give them what we promised in the treaty we would, access to affordable care. let me tell you, accessing de d is care denied. having to wait is care denied. we can live up to our commitments and we can do all of it and not spend a penny more

and we can get everybody in this country countried. we can eliminate low birth weight babies. we with can do the prevention we need, control chronic disease. but we can't if we won't listen and talk to each other and touk talk to people outside of washington who knows what's going on. like dr. cooper in texas. look at el paso schools. they put an exercise program in there that has dropped bmis, dropped the dropout rates, raised education, decreased drug use, and increased graduation rates. just through exercise because the new neuroscience today says that you learn 20% more if you've been exercising before you go into class. but we ought to incorporate all of that, all of the incentives to help us do what we want to do. but we haven't taken the time to listen. we've said, we've got to be on this schedule. so my appeal to you is, i honor you for your desire.

you have the same desires i do. how we get there is very different. i would remind you of the three tenets of medicine. listen. they'll tell us what's wrong. if it's been done, don't do it again. and, for god's sakes, don't do any harm. thank you, mr. chairman. >> thank you very, very p much, senator. >> thank you very much, mr. chair. it is a real honor to be here in this marble hall addressing the question of affordable, accessible health care for every single american. we've heard a lot inside this marbled hall about what health care could be or should be or is now. but i want to take us back to what health care looks like to the working families of america.

over the last six years, first as democratic leader, hen as speaker, than as senate candidate, then as senator, i have been traveling the state of oregon holding forums and knocking on doors and asking folks about what's on their mind. and two things rise to the top for our working families. the desire for a good family wage job and desire for quality, affordable health care. i am particularly remembering a woman who owns a small breakfast and lunch cafe in mill city, oregon, rosy's mountain cafe. a bit more than a year ago, i went into that cafe and sat down and had a series of tables and

it had then a counter, cafe counter, that folks were gathering at from the local community. and the woman who owns the cafe introduced me to her daughter who works there, introduced me to her grandson and her granddaughter who work there. three generations in that cafe. and she said to me, we're doing just fine as long as no one gets sick. because we can't afford health care. and in that cafe sitting at a table was a woman who came over and talked to me, and she said, jeff, my husband had a heart attack and died last year. with his death, i lost my health care. i'm getting by in terms of housing because my kids are pitching in, but we need to have affordable health care.

and town after town and town hall after town hall at door after door, americans are pleading for us to do something about this broken health care system. mao, i'now, i've heard comments about what a fine system we have. and it may be just fine if you happen to be in this hall and you have health insurance or you're working in a job and you're fortunate to have health care. but even then, even then, folks with health care are concerned that they're just a pink slip away, a reduction in force away, from losing that health care. so it remains a stress. and if they have health care, they're still worried about the overruns, the co-pays, running out of coverage, and they understand instinctually that a

major health care disaster might well wipe them out even with health insurance. in fact, half of our bankruptcies related to health care are from folks who have insurance. and our bosworking families witt health care, they're worried about finding a job to get health care. they're worried about somehow getting access to health care before they get sick or if they're already sick they're worried about how they're going to afford to get well. there was a story in the paper just the other day, and i think it characterizes the plight of millions of working pales inin our nation. man actually had health care, but the drugs cost different levels in co-pay. and so he took his five or six prescriptions and he went to the drugstore and said, how much does each one cost me for a month?

and those ones that were cheapest are the ones that he purchased, and one of them -- this man had suffered a heart attack -- was for a drug thinner. he said that was too expensive. i can't afford that one. we all know that the odds of him having another heart attack go up significantly if he has to sit there at the drug counter and decide which prescriptions he can and can't afford. and the article went on to describe a conversation with people at pharmacies saying, this is being seen more an more an more and more in our broken health care system. so let's ask ourselves, what is the family value? is it a family value to say to 50 million working americans, you you may not have access to health care in our society?

is it a family value to have three generations in a cafe who are doing just fine if only they could afford health care? health care an a good job are essential to success of our families. and if you care about strengthening families, then you've got to care about seeing what we can do to make the system work better. now, our status quo system, it's broken in so many ways. year before last, one of our major health care providers in oregon, their rights went up 26% for small businesses. if you are a small business struggling to get by in america and you want to provide health care to your employees because that is the major way folks get health care how do you do it when health care goes up 26%? and this year the same program went up 17%.

add them together. 43%. huge, huge increase. it it's not two years of increase after ten years of small increases or creases. it's year after year after year-double-digit inflation. our small businesses which are unable to be part of a large pool as we've structured health care in this country can't benefit, have the highest administrative cost, nearly one out of three dollars goes to private health care for a small business. that's an incredible wasteful use of our health care dollars. prevention. many have mentioned prevention is essential for health care. and yet our current system doesn't value prevention. we treat illness. we treat disease. but we don't invest in prevention. disease management responsible for 70% of the costs in our health care system.

and yet we with treat the disease when it becomes a major disaster. it's a broken health care system, and we can do much better. well, now our former president george bush said, i'm not sure what everybody is talking about. we have a health care system for everyone in america because you can always go to the emergency room. the emergency room is not a health care system. it does not invest in prevention, disease manage. and it certainly doesn't take very good care of patients. we do poorly on readmission. it it's been said in testimony before this committee that often one of best health care dollars would be to pay a social worker to work with a family, a family member, when they are sick and when they go home from the hospital so that they can

establish a regime to take care of themselveves so they won't b back in the hospital 18 days or 30 days later. but our system doesn't provide payments for social services in that format. so we're not spending our health care wisely. we have a largely cost hi-plus strategy, which is great if you're a provider. the more proceed ur you'res you perform the more you make. but it's terrible for the efficiency of cost in a system. we can look at places like mayo which gets glowing reports everywhere by anyone who examines it, and they have disposed with the cost-plus system. they have bundled their care. they have worked to create an ethic of a holistic health care system that puts the dollar to

best use. so this is our window of opportunity together to address this broken system. if we are concerned about the current care being inadequate, the quality of care, then doesn't that argue that rather than sit by and embrace the status quo, which is the source of that inadequate care, we look and work together on the quality of care provisions of this bill to improve quality? if we are concerned about patient choice, then does it make sense to sustain a system in which 50 million americans have no choice outside the emergency room? and instead create a system of choice, a full range of choices. you know, every person at this table participates in a medical exchange where they can choose from a range of plans.

what works for people sitting at this table will work for all americans to give them a full range of choices, including a public option. now, there's been a lot of criticisms today of a public option. the good senator from oklahoma said that the indian health care system ought compete with private plans. well, that as an insight. what if we create a list of options, private plans and a public option and let them compete? and let our citizens have the full choice. let them decide with their feet which program is working better. now, it's been pointed out at this table that often we have a challenge with medicare in which a lot of providers don't accept it. we have that problem in oregon. i can tell you not everyone in oregon wro choose a medicare-style option because in their community it's hard to get

in the door with your medicare card. but i can tell you what, i think we ought to give them the choice. let them choose. promote competition. we have in oregon a competition between private providers and@üe brunt of double-digit increases

over the past decade are asking for help. our large businesses that compete internationally are saying to us, those of you you on this committee, please, we need a more cost-effective system so that we can compete internationally. our citizens at the door, at the public forum, are saying, this health care status quo is broken. it is a daily stress. it is a disaster. we need your help. let us not turn a deaf ear. let us not miss this window of opportunity when so many forces are coming together to take and dramatically improve our health care system to succeed in delivering the vision that truman laid out more than 60 years ago of saying it is time

for an afforaffordable, accessi health care system for every single american. >> senator, thank you very, very much. senator roberts. >> thank you, mr. chairman. i think i'm going to nominate you and senator enzi and senator harkin for the perseverance award of this session of congress, at least to date. i would remind you that dr dr. coburn over here indicated that exercise -- with appropriate exercise you gain 20% more in intelligence cog any distance. i think with what you've had to do this afternoon, listening to virtually all of us saying the same thing over and over and over again, it might be time for a seventh inning stretch.

but don't do that because i'm the last speaker. and with all due respect to my colleag colleagues, i've never seen such three sad sacks in my life trying very hard not to fall asleep hearing the same thing over and over and over again. that also goes for the staff in the back who are now you starting to come awake. let me give you just a hint. this has nothing to do with the bill. maybe it does. if you find yourself falling asleep -- and i used to do this when i was chairman of several committees -- i would hold my feet about one inch off of the deck like this. and you cannot fall asleep with both of your feet raised above the deck. you might give it a try. >> depends which of my colleagues is talking. >> yeah. the other thing is to get yourself a reporter's notebook, which scares reporters and

scares everybody else, and write down things like, why am am i here? how long is senator roberts going to talk now? et cetera, et cetera. except i found that i would go to sleep and there would be a mark down on the reporter's notebook. so i'll try to make this as succinct as possible. you've heard it before. if you read my bio, senator dodd, mr. chairman, in cq, i am described as being pleasantly harassable. will try to be pleasant, but this process that we've come through would make anybody arasable, including yourself. >> moreover, i think this bill costs too much for not enough results. i think apparently the cbo has, in effect, stated the obvious. there's simply not enough health care bang for our buck. finally, my worry is that this

bill will increase government control over health care and will cause health care to be rationed, especially for our seniors. i went keown to the senate floor to express my discontent with a process, made a wonderfulful speech. i think probably senator harkin heard it and that's why he's leaving. and i expressed my discontent with the process, the cost and substance of this bill. marvelous speech. i know that i am not alone in this sentiment as the american people it seems to me start to realize what is actually in this legislation, despite the goal so eloquently put by me colleagues to my left. and you're right. on process, my republican colleagues and i recently made very reasonable requests from the chairman and finance committees as well as senator dodd who has done a very good job in serving in senator kennedy's absence. these requests appeared in a letter, my letter, i wrote it,

which every republican member of the finance add health education and labor and pension committees signed. every republican. hard to get every republican to sign anything. in that letter, we asked the chairman to release the complete details of their plans to reform health care. we asked them to do so in a timely manner to allow us time to read and understand the policies to get reactions from our constituents. we asked them to give us you estimates of how much their complete plans would cost and how it would impact everyday americans and finally we asked them to identify how they intended to pay for these plans. in this committee that has not been done and in the finance committee it has not been done. but at least senator baucus has said, whoa, stop, slow down. don't think we can get to the mark up that quickly. i think that's progress. if we can slow down, maybe we can get more bipartisan support. it was my hope that by receiving this information we could better

participate in the quest to ensure this every american has meaningful access to health care. because changes to the health care system, as everybody knows, has the potential to impact every single american citizen. we must ensure that we protect the best of its features when we consider changes to shore up its deficiencies. careful consideration is required. that is why we asked for more details and more time to date our request for more information have not been met. i know there are problems in trying to do that in terms of staff and trying to put that together. there's always problems. but this bill is enormous. absolutely enormous. and it's incomplete with the most controversial items being left out until tomorrow's delayed release upon which time we will have approximately 30 hours to digest it and file amendments. we call that staff full employment. 24/7. it only has an incomplete score of costs and effects.

of course, it does not identify any offsets, although from president obama's remarks on saturday we can assume that at least part of it will be financed through more cuts to medicare. let's don't do that right now, please? there are health care providers out there who are not serving medicare patients because the reimbursement does not even remotely come to what it is costing them. so doctors and home health care people are making wholesale changes, saying, sorry, not going to serve of medicare. some even medicaid. so if we go some way, or you're going to have -- yeah, we'll reform medicare, all right. but you won't have anybody on medicare. this is not the way i think that this committee should do business. and i would submit to you that it is not a smart strategy to gain popular acceptance fare the enormous mandates and disruptions that appear in this

reform overhaul. now, that's the end of my process rant and that's good news for the chairman and the ranking members. on to cost. monday afternoon the congressional budget office released its first analysis of the bill we are marking up in the committee today. i said i was done talking about process but it must be said this report, its timing fell far sort of my process expectations on a pill this large and this significant. cbo's analysis of the kennedy/dodd bill before us is also incomplete because, as i noticed previously, even today the full language has not been released. so we don't really know how much the entire bill will cost, which is an issue in and of itself. this leads me back to monday's cbo release, analyzing the cost of just one of six titles to the health care reform bill. and an incomplete title at that. everybody's heard this by now. i think every person who has testified before you, sir, has

said this. it's worth repeating, according to cpo. the incomplete sections of title i will cost $1 trillion. whoops. $1 trillion and that's just for one incomplete title of this bill. what will we get for this staggering investment for a title whose purpose is ostensibly to expand health insurance coverage to the estimated 47 million americans currently lacking insurance? let me say that i know that's the number everybody deals with in this debate. 47 million americans. however, though, we have had testimony before this committee, senator enzi has pointed it out, in the committee similar testimony, the true number is about 27 million. i'm not going to argue that point. we're going to take the 47 million. and that seems to be the record that we're using in the public debate.

but according to cbo, we'll only cover 16 million more americans. that doesn't seem like a very good return for a bill that seeks to cover three times that many people, with 37 million people projected to be uninsured in 10 years. in addition, the cbo says that 15 million people would lose their employer-sponsored insurance, and another 8 million would lose coverage from their current source. president obama has consistently promised that if you like the health insurance plan you have you can keep it. well, under this bill, according to cbo, 23 million americans who may like what they have, cannot in fact keep it. i can't even imagine how much more this bill will cost taxpayers when cbo figures in the rest of the initiatives in this bill. and those that are forthcoming tomorrow. and i'm sure that under the complete plan, millions more

americans will not be able to keep the insurance that they like. hope that's not true but that's what i think will happen. that's because in addition to the plans that are already in the bill, tomorrow new provisions will be unveiled to establish a new government-run, taxpayer-financed insurance plan that's estimated by some to replace private insurance for over 100 million americans. also not included in the cbo analysis, the bill assumes a costly expansion of medicaid. everybody ought to call their state medicaid director, figure this out. and facts dozens upon dozens of new programs. of particular note, not trying to pick on anybody, but title iii of the bill includes $10 billion per year, an additional $100 billion over 10 years, on top of the $1 trillion for title i in mandatory spending for a prevention and public health trust fund.

now, this is a fund really with very little direction on just what the money would be used for. that definitely should be clarified. another section, this is my favorite section. establishes something called a community transformation grant. plural, grants. that can be used to build -- i'm not making this up -- grocery stores, sidewalks, and jungle gyms. grocery stores, sidewalks, and jungle gyms. now, i really question whether a health care reform bill is the proper place for this type of spending. that ought to be under the rural development administration within the department of agriculture. however, i think i've got it figured out. got it figured out, mr. chairman. your feet up? got it figured out. obesity is obviously a national priority. so, if we fix the sidewalks, people will walk more. get more exercise.

if we build jungle gyms, they can stop by the jungle gym and exercise as they go on to the new grocery store to buy leafy vegetables, of course organic, and then come back, have a new couple of pull-ups on the jungle gym, then go home. and people will weigh less and we will achieve something with this kind of approach. i still think it belongs under the department of agriculture. in short, i'm very concerned by the numbers that have come out so far. some of the programs that are being proposed. and that's just the beginning. one independent group as people have pointed out, the hsi network, fair and balanced, in minnesota, has estimated that the total cost of the kennedy/dodd bill in its entirety could be $4 trillion. and i'm billing to bet the american public will be as shocked as i am once they understand what has been lurking under the banner of health care reform.