process and cost issues, i have some very grave concerns about the substance. and i believe the government-run plan will lead to rationing of health care. and i mean that. i think it will lead to rationing of health care. and we don't need any more of that. there is no way that the private insurance market will be able to compete with the golf-run plan which will have huge advantages of having the american taxpayer to both finance and bear its risk of insolvency. in addition the government will have an unfair advantage as both a player and a referee in the marketplace,@@@@'&#rra)"",rr advisory

council. and the comparative effectiveness research provisions will search to complement the government takeover of health care and will eventually be used as tools to ration care, unless we pass legislation senator kyl had legislation on the floor of the senate trying to protect from us something called cer, comparative effectiveness research. it's a good idea in regards to

care, covering care. also to control costs. but not just to control costs. could be very similar to the united kingdom's medical advisory council, which i have an example here where, in one egregious case, in the united kingdom they limited access to drugs to treat macular degeneration in seniors until the senior had already lost vision in one eye. i'm not making that up. that's another example. let me go back to comparative effectiveness research. and i beg the indulgence of the chairman. this will end. 25 -- more years than that because i've been a staffer on the senate side, house side, house member 16 years, now member of this distinguished body, third term. i remember the days of hew and

joe califono. i remember the days of hcla. i remember when some secretary came in and said we're not going to call hcla, we're going to call hcla mama, because everybody hated hcla and they can't hate mama. now it's called cms. those acronyms are going to ring in your ears. cms. cer is going to be the holy grail by which cms grabs this comparative effective research, and if we aim right at cost-cutting only, they will determine, not you and your determine, how many mris you might have, how many x-rays you might have. all the duplicate things we know add to cost. regardless of the circumstance, mark my words, the way it is written now and the way the secretary of health and human services, a good friend of mine, kathleen sebelius has stated it, cer is going to be used -- its

main purpose is going to be cost. if we do that, mr. chairman, we're headed for trouble. because that decision between you and your doctor will be taken away. i'm offering several amendments, mr. chairman, which i hope my colleagues will consider seriously and also hopefully accept. in an attempt to improve upon this bill. they'll include provisions to protect patient choice. the patient-doctor relationship. ensure that rural and low-volume hospitals are not disadvantaged by new regulations for hospitals. and secure equal footing for rural and urban health care workforce enhancement programs. i hope that these -- what i call commonsense amendments can find some bipartisan support. it goes without saying that this bill will affect every single american for generations to come. it should be better considered, it seems to me. it should even be bipartisan. and it must do better than this

in improving health care access for the uninsured. mr. chairman, this bill has too much wrong and on the topic of health care reform, we can't afford to be wrong. my time is up and i thank you for yours. >> thank you very much, senator. and thank you for those amendments as well. i'm sure the staff will take a look at them already and those are appreciated. we'll take a look and see if we can't reach some agreement on those ideas as well. i thank you for submitting them. senator whitehouse, i believe you're our 22nd senator to speak today and i believe the last. tied up earlier and is not going to be making an opening statement, at least today. you're our wrap-up senator, so to speak. we thank you immensely for serving on the committee as well. >> mr. chairman, it's an honor to serve, even temporarily, on this committee as it takes on one of the most important challenges facing our country, which is reform of our tragically flawed and broken health care system.

and i want to salute you, senator dodd, for the exceptional way that you have risen to this occasion in the shoes of your friend and our colleague, senator kennedy. the stakes indeed are high. as president obama said this week, health care reform is the single most important thing we can do for america's long-term fiscal health. saving in waste, confusion, unnecessary or defective care, and illness prevention could exceed $700 billion a year. in the coming weeks, we'll talk a lot about the details of health care reform legislation and those details are important. but even more important are the hundreds of millions of families in each of our states all over this country who have

experienced what can only be described as anguish firsthand. coverage lost or denied. hospital stays extended due to complications or errors. prescription drug bills rising, rising, rising. or losing everything because a loved one fell ill. a few months ago i launched a page on my website for rhode islanders to share their personal stories in our health care system. and hundreds of people have written in from all over rhode island. mel, a mother in lincoln, told me that since her husband was laid off in october, she and her family have found themselves in no man's land. no job. no coverage. no security. she lives day to day with the anguish that she knows she can't afford to send her 11-year-old daughter to the specialist that

she needs to treat a pre-existing condition. i heard from christine in providence. under the flawed medicare part b prescription drug plan, her mother's medication costs for adult onset diabetes totaled hundreds of dollars a week out of pocket. and required weekly trips for refills and diabetes supplies. christine shared the story with me after watching her mom's anguish as she struggled to afford medication and make it to the doctor week after week. madeline in pawtucket cannot afford health insurance coverage despite working two jobs. her family has a history of colorectal cancer but she cannot afford to get a colonoscopy. without insurance, madeline waits and hopes that she doesn't get sick. because that's the only option she has. for these rhode islanders and millions more americans silently

suffering all over the country, we must now be a voice. we must improve the quality of our health care. develop our health information infrastructure. and invest in preventing disease. we must protect existing coverage when it is good. and improve it when it is not. and the president has said, if you like your health care plan, you can keep it. we must dial down the paperwork wars. and dial up the information to consumers. and we must speak for the 46 million americans, 9 million of whom are children, who have no health insurance at all. for the rhode islanders lining up today at the rhode island free clinic to draw straws, in this great country of ours, to draw straws to see which ones will be able to see a doctor.

some have challenged the number of 47 million. there's a report from families usa that points out that 47 million is the number of americans who at any minute are without health insurance. if you look over the course of a year, it's more than 86 million americans who experienced going without health insurance. government must act, at last. the problems of health care in america are rooted in market failures. you can't wait for the market to cure market failure. we've got to change the rules of the game. you can't pay for one thing and expect another. we've got to change the incentives. we don't expect americans to go out and build the highway infrastructure in front of their homes and businesses. we can't sit around and wait for the health information

infrastructure to get built. we must act. and we can't expect quality improvement and prevention to flourish when we made them money losers for the people who have to implement and do that work. we have to correct that anomaly. opponents of reform are arguing that this process is going too quickly. that we need to slow down, wait, pause. but you know, we've been slowed down for years. we are the champions of slow when it comes to health care reform. we've been slowed down for decades. when i hear from rhode islanders like mel, like christine and madeline, i don't think we're going too fast. i think we're irresponsibly, even frighteningly late in taking up this charge. and if we wait much longer, we may be too late to avoid the

tidal wave of costs that threatens to swamp our ship of state. this is no time for delay. and let's remember, even when we pass this health reform, it's still a beginning. it's not an end. we will be at work on this for a long time. but let's get started. the anguish is real. and it is everywhere. the time is now. the moment is here. let's make this work. let's find a way to make this work. thank you, chairman. >> thank you, senator, very much. great closing remarks for today. and this discussion. i want to thank all of our colleagues. this is -- my intention was because of the seriousness of the issue, it deserved the time that members took and it was not

difficult. i was -- we heard a lot of different views and obviously of where we and are how we ought to proceed. but i think it's tremendously important as we begin the process that each and every member have a chance to express their goals in all of this, their concerns about how we're proceeding. and i think it helps us all to listen to each other to the extent members are able to be here for all of these conversations. so i learned a lot today and am very great to feel my colleagues, republicans and democrats, for taking the time and seriousness of this matter to be here and express their views and thoughts on this subject matter. senator kennedy, of course, as we all have pointed out, has been fighting for this issue for so long. and cares deeply about it. so we had a good discussion. i know that -- at least i'm told that the finance committee is taking a pause on all of this. i'm not sure exactly the timing of all of it but i gather it's

going to wait, maybe even until after the fourth of july break to pick this up. and i certainly respect my fellow committee members of different committees. my intention here is to continue working on this. i think we have an obligation to move forward. i'm going to give whatever time i've told mike enzi as we laid out. obviously you can't amend language that doesn't exist so we have to have the language down in an adequate time for people to assess and it file necessary amendments. i thinker? macaoski made a good point that we already embraced but will proceed accordingly to deal with this section by section, title by title, so we have a chance to thoroughly explore the various ideas that have been offered. i pointed out that even earlier today i know the majority staff indicated to the minority, or at least members, that there's some 20, 22 amendments or so that we're willing to accept that have been suggested.

and they're looking at that. in exchange we've asked for some amendments to be dropped because we think the amendments being offered cover a lot of that ground. ground. ssd& s exactly how iråsu)@ @ @ báhn%@ @ e,

proposal was made in 1948 for a national health care reform package. six long decades. as i said at the outset, every administration, without fail, over those 61 years, has tried to do what we've started to do here today. and have not succeeded at it. and as each year goes by, each week, each month, each year, the problem does not become less of one but more difficult to grapple with. so i agree with my colleagues who have expressed a sense of urgency that exists about this issue. we also express the seriousness of it. the importance of proceeding carefully so that what we do makes sense and works. and i'm heartened to hear, as others have expressed, the common desire of providing for an accessible, affordable,

quality health care system. i didn't hear any disagreement about those principles expressed, virtually by 22 members of this committee today. obviously debate about how you achieve it. but that's not a bad place to begin if you're agreeing on the principles of what needs to be achieved. i also heard a common desire to try to listen and work with each other to try to achieve those goals. grateful to senator enzi, mike enzi, we've worked together on other matters, who's worked so well with senator kennedy. i want to proceed the way everyone feels comfortable about how we're proceeding. and may not end -- we may end up with differences of opinion on some of these issues. but i want to make sure that everybody has a chance to be heard, that ideas will be debated and thoroughly discussed. and then proceed along those lines. so i'll turn to senator enzi for the closing comments he wants to make but then we'll adjourn for the evening and pick up in the

morning. >> i want to thank you for your tremendous leadership. i want to thank you for the flexibility that you've build in so that people can be heard, so that we can get it a as right as possible. there's no such thing as a perfect bill. this won't be either. but we'll come as close as we possibly can and i think there's agreement on body sides to work together to meet that. and the flexibility that you built in will help us to get there easier, and i think in a less contentious way than might be done otherwise. so that's really appreciated. i also appreciate the way that people are here for the statements today. that's better attendance than i've seen on any committee since i've been here. and that's very helpful. again, people know that somebody's listening. and that helps. that will help as the process goes by. so appreciate everybody's indulgence on it. and i learned a lot of things today. hopefully that will help.

>> i'd urge by the way, and our staffs, that everybody needs to do this. we need to go over these amendments, maybe talking, and we'll try and provide time periodically in this process as we have done where we get to an issue that requires one of those walk-throughs again. or maybe we just sit down for an hour or so and talk with each other about it. rather than offering amendments back and forth and flipping coins. that if i feel it's an appropriate time to do that, we'll adjourn and do that. i find those moments become very valuable. we get a chance to listen to each other and have that kind of a conversation on how to proceed. so that will be kind of a -- i think the moments will become almost self-evident when we arrive at those moments. we'll try and take a pause and sit back or pull off that issue, move on to something else, maybe we can reach some agreement so we're not just spending time logged in a situation where we can't find some answers. i appreciate it. >> mr. chairman. >> yes. >> i want to repeat what i said

before luncheon. about, first of all, i acknowledge that many of the amendments developed by the other side was because they got the bill and had not coordinated with each other on amendments. some were duplicative, et cetera. there are some i know i'm going to be able to take. there are some like on adding indian tribes that i believe we can accept frommer? macaoski, as well as senator bingham, that we hand language we didn't have unintended disenfranchising consequences to other services. we have several things like administrative simplification and comparative effectiveness. if the other side could look at their own amendments or talk with us. i'm willing to do every amendment so i don't mean to be misunderstood. in the interest of comity, and also if we could finish, quality tomorrow, that would be great. if not, i'm fine, i'm here friday, whatever you want to do.

if we could just really get to the meat of the matter on some of these amendments. and i like taking a break at repossessions working group

and provide advice who is facing court proceedings. >> allen whitehead. >> question number one, mr. speaker. >> mr. speaker, before listing my engagements this is your last prime ministers question. and the whole house will have a chance to knowledge your great contribution to public life in a few minutes time. this morning i have meetings with mine tearial colleagues and others in addition to my duties in this house i shall have further such meetings today. >> thank you, mr. speaker. may i add my appreciation of your kindness and generosity and everyone else and many other honorable members in your time as mer, mr. speaker. in view of recent speculation,

could the prime minister assure me that budgets relating to the support of groan energy development and combating climate change will be maintained and enhanced over the next three years and might he reflect on what would be the ability of the united kingdom to meet its carbon budget commitments if such funding were cut by, say, 10%? >> mr. speaker, we committed in the budget an additional $1.4 billion of support for the low carbon economy. that would not have been possible if we had followed the advice of the opposition party to cut by 5% this year. it would be impossible in the future if we went for plans that have been suggested by the shadow health secretary to cut departmental expenditure by 10%. mr. speaker, we are for investing in the environment, not for using the money for inheritance tax cuts for the very few.

>> thank you, mr. speaker. welcome to prime minister's planted questions. [laughter] >> some labour -- some labour mp's were a bit confused when they were told mr. 10% they thought it meant his opinion poll ratings. in our exchanges -- in our exchanges last week, the prime minister read out figures for total government spending after 2011. will the prime minister agree that using the treasury's own forecast for inflation, those figures means that spending will be cut in real terms? >> mr. speaker, i welcome this debate about public spending. i relish the chance to debate of

policy and the first thing he has to confirm that he is cutting spending this year. >> order. let the prime minister speak.úéñ that's the best way. i'm not responsible for his answers but just let him speak. the prime minister. >> mr. speaker, the first thing he is to confirm that he will cut spending by 5% this year. that means that vital services will be losing money so i welcome the debate that we're having in this country. we are investing to get ourselves out of the recession. they would cut and they would make the recession last longer. and they would lead to higher debt and higher deficits that have got to be spent for. as for spending beyond 2011. he knows the truth. he wants to spend less, 10% less than most departments. we want to spend more. >> absolutely, no answer to the question. and i have to say to the prime minister, for the time that peter mandleson allows him to go

on doing the job he should at least answer the question. every year at every budget he stod and read out figure after figure for total spending and told us it was an increase in real terms. now he's standing up there reading out figures for total spending without admitting they represent a real terms cut. the whole country will conclude that he's taken them for fools. everyone knows what matters is spending over and above inflation. so let me ask you again, will he now accept that his spending plans from 2011 mean a real terms cut? if he takes advice from the chancellor, the chancellor say they are a cut, do they? >> the first thing we're absolutely sure of is regardless of economic circumstances, regardless of ememployment, regardless of investment, regardless of inflation, they will be cutting expenditure by 10%. he said it last week himself. tory cuts versus labour