weather is a private insurance plan or a public insurance plan. choice is important for patients to be able to pick their own doctors. fourthly, we are taking comprehensive action to make sure that everyone gets more value for their health care spending. removing to get costs under control through payment improvements and delivery reforms and we're taking a number of steps to improve quality and reduce ethnic and racial disparities in and of this proposal at least 95 percent of americans will be covered which helps us proceed on both the cost and the quality front neared death, we are improving medicare. people who have medicare will have that available to them and also have a better medicare system. we're going to take substantial steps to phase out the dough a

whole that so-called don't hold the people face when they're pharmaceutical costs will break and we're going to address one of the major concerns of positions around this country and that is we are going to permanently reform the under physician payment cuts under current law. we're going to fix the sustainable growth rates are the sg are there the sixth, we are making a major investment in the workforce and making sure that physicians and nurses and other health providers are available to meet patients' needs and there is an even stronger network of community health centers that will be available as well. and finally, we are going to enhance prevention and wellness programs that are absolutely essential to a true health care reform. so we are ensuring coverage of preventive benefits and investing in major community

prevention initiatives. we are now ready to proceed. this legislation and i want to stress is important for the health and the financial security of all americans. we are going to seek helpful input from our colleagues, from citizens, interest groups. we're going to hold hearings starting next week and we are going to keep on the schedule of the president set out for us. we are going to be proceeding to figure out a final proposal to present to the house of representatives by the end of july. let me be clear, the time to act is now and the ones we can't make is two just delay because the status quo is unacceptable. we can keep the status quo or we can move to a new system and this new system will be based on a division of president obama. the mission he set out in his

campaign, the vision for which he had a mandate to move forward, and the vision for which we stand ready to be of assistance to him. we will now hear from chairman of the ways and means committee, charlie rangel. >> thank you, henry. it has been a real pleasure for me to work with the chairman of energy and commerce and labor in putting together this plan that hasn't been easy but has been really an educational process from all of us and to be working in the shadows of john dingell's father and recognizing the historic work than he has done over the years and the health reform system just reminds me of how many politicians, members of congress and presidents have said that they are going to do something about reforming health system. and now with the press time the president has pulled together all of the stakeholders, all of

the people that have fought against this over the years to come together and two recognize that we have to do it for our country, we have to do it for our citizens, we have to do with our economy, and we have to do it if we are going to remain competitive. everybody has a story, a horror story of somebody the high cost of health insurance and where was america blacks behind all the industrialized countries, paying twice as much for insurance and not getting access in not giving quality. when the committees did together is no small task and we haven't finished our work, but we thought it was a partner in nafta the members that they know

what are we thinking about. we have had hearings every committee the have a dozen hearings, and yet there is still members on the floor that have problems in understanding the difficult decisions that have to be made in modernizing the system and paying for the system, but we thought that america shall not have to wait. that we want to get this discussion draft out there. we want to get the maximum support for this so that doctors and health-care providers would know that we are sending all of these resources out there in order to have a healthier and stronger america. there is no question that we will be saving trillions of dollars in the industry stoping the hemorrhages there and having employers that feel they can do what they always wanted to do and that is to give some assurances that their workers would not have to worry about the health and health coverage for their families. small employers have wanted to

do it but could not afford to do will be provided incentives. poor people and working people who have no insurance and depending on emergency rooms will now know that they can negotiate a health system and then to have a public health program and option so that they are not a captive of the large insurance companies, but able to talk with them and compete and say that if you can't give me what i need i can go to the exchange, i can go there and deal with the people that perhaps would give us a better chance here it is this going to bring down the cost of health insurance? you bet your sweet life. i can't wait to tie to anybody that is fighting against this public health insurance program. it is going to be competitive. the health information technology is going to force them to provide more options for people. we are sending out a 48 million

people that have no insurance and they will have in the negotiating hands for the insurance companies who can compete with subsidies in order to get insurance year-and-a-half of the people have been under in short and be able to negotiate so what does that mean? and means providers will be able to know that the government is a friend and a partner of everyone seeking health insurance and so the industry is going to buy new jobs for the providers of nurses, primary care doctors, so that communities and never have access to health care would be able to do it and is going to mean a stronger financial country, going to mean a stronger health country and a strong moral stand that we will be setting in order to do what we should have done a long time ago. what an honor it is for me to present to you, john dingell, because i told him this afternoon his dad has to be looking down him saying, john, it is just about time.

[laughter] because for all of the years that he spent in this congress it can tell you the numbers of the president's that have said we're going to do it, but this time on his watch the dingell bill will be coming up and is my pleasure to present my mentor to you, john dingell. >> i love you, charlie, and thank you. dad i think is looking down smiling not only on the fact we're going to do this but i'm associated with such wonderful people and i'm proud to be here with my colleagues to tell you about how exciting this stage is here and i have worked 50 years on health care reform and the reason in this draft is a first up towards getting a bill passed this. what we have come up with is an american solution, but planning has gone to the discussion draft that you and the rest of the nation will see today. but now the real work begins.

the work of explaining to our colleagues in the congress and making the proposal available to the american people. we offer a greater choice to the american people. people will have the option to choose between plans to keep that which they have now and to keep their doctor or to make such changes as they wish as free americans to do. we will also give the people the choice of a high quality public health insurance option that will meet and provide the companies so as to provide a yardstick and a measure for people so that they can know what there is out there that will give them the best choice of health care. on tuesday and is part of a hearing in which chairman ask the heads of three interest companies what to do to stop the

terrible practice of rescission which is left thousands of americans burdened with costly medical bills despite paying their insurance premiums in the fashion and that they're supposed to. and they all said they had no intention of doing that. rescission is simply where you wait until i die is sick and then canceled his policy on him. this is something that has got to stop along with some of the other abuses. use of non committed to rating systems and what they called pre-existing conditions. there'll be no recent decisions in the public options and there'll be none of the other uses which we are seeing in the insurance practices that are now offered to the american people. in consumer protections will be established in that option that private companies have so far refused to do. so we're going to create competition and going to create

choice and we're going to see to it that the public auction included in this bill will not only see that people are treated fairly and have the option of having the kind of policy they might want available public or private but will also establish benchmarks regarding fair pricing and drive innovations that will help reduce long-term cost growth. the public auction will ensure competition in the areas where there are few private plans they're the only alternative two this that i see is counting on the insurance companies to fix the problem, they have had 50 years to do it in more than i can tell you that is a terrible thought to me. while there may be some differences in opinions on the specifics of a public auction we share the same goal. that is to fix americans broken health care system. something which used to be a matter of only humanitarian concern that now which is a

matter of desperate urgency not just american businesses who can't afford this anymore, but to the national economy which is going to go broke doing this arid and what we are releasing today i have stressed is a discussion draft and i look for to working with all parties as we move forward so that we can end up with the best bill possible and i want to repeat how proud i am two my colleagues appear. we're going to get the american people what they need and deserve and what they want. a good practical program of national health care. thank you. >> [inaudible] some of the members didn't even want to terminate resolution that would describe how would approached the bill. having gone any assurances from

the ama that they agree with the concept that to put forth today about public option that would compete with private insurance? >> i don't know what the ama position is. i want them to look at our draft. i think there's a lot of misinformation about the idea of a public auction. some people think it is going to big government takeover of health care as it appears system, that's not what we intended. we want to be giving people a chance to choose their own insurance plan just like federal employees get to do, members of congress. we get a list of available insurance policies that we can choose and one of the choices that will be available to those who go into this exchange our marketplace look at the choices will be a public plan that will be on a level playing field, it will be a choice, no mandate for

anybody to be an and will be for a lot of people who want to make sure that they can rely on it with a feel uncomfortable with the insurance companies and the way they have handled insurance over the years, but i hope when the ama looks at our proposal and when we hear from them and our hearings they will give it a fair evaluation and we hope they will be there, and presently can agree on. >> let me just respond to that because i am anxious to take on those people who are opposing the public auction. i cannot think of any dr. that is being told hundreds of billions of dollars are going to be out there researching the development that we will be providing nurses and doctors in real support team their doctors who are concerned about practicing medicine would be able to say that this president and this congress have presented them an atmosphere and that is

what they can do. for those people who are afraid of competition, they shouldn't be in this business. this is what we are trying to do. make an even playing field for all professionals to say they are getting better than the fair shake in what we're doing so i have talked with a lot of doctors who have said, thank you for giving us an opportunity to do what we decided to do when we went to medical school and that is to practice medicine. >> you are standing at their united in your position on public auction but there is a lot of decisions in your own party in the senate -- are you concerned about health care reform losing momentum and given the divisions on the public auction are you open to having discussions? >> we set out in this joint venture among the three committees to try to put language to the president's obama had campaigned on in front of the american people, what he has said since coming to office

and as you saw he has continued to stress the need for public auction and then the public auction. we have put again a draft of a public auction in this legislation for all of the reasons that chairman dingell outlined today. health insurance for most american families is just one big surprise. when you go to use it you find out it is not quite as it is represented and to spend hours on the phone with the discussions and referrals to other legal documents that you didn't have the time that you purchased it and we think ought to be a level plane killed, there ought to be honest competition and the benefits ought to be as our stated there when the families and businesses need them. so we think that this -- there are those of our caucus who don't fully agree with the public option. we've had a series of discussions about that and there have been modifications in this draft but we are at a point now where those discussions should continue in the committees and so people can make changes to

the draft am prepared to come to the floor. we understand have read different positions and had discussions back and forth but we continue to believe this is an important component of real health care reform and an important benefit to american families when they choose a public plan or choose the private plans in the exchange, they can do whatever they want and this is about twice. they will know that even the private plans will be better because of the public auction. >> the president has talked about flexibility -- >> that is why this is a discussion draft beer in the next zaps should be taken by the committees after and hearing from the witness says. >> could you explain settled on the 8 percent mandate? >> everything is on the table. this is nothing locked in cement and i don't even remember -- that is one of the ideas that are there, we talk to each and

every day, and i just want to report about momentum. i have been down here a long time working with three committees and over jurisdiction has an even,. we're working with medicaid, medicare and all these things so we have the momentum he meant to we have any figures as far as as cement our guesstimates about how far you can go before the price tag, what is the lament? >> we are waiting for the numbers. >> and how you plan to pay for it? >> we are working with the congressional budget office. in fact, every time we think of an alternative we have to have a different score, sometimes the congressional budget office tells us one alternative cost less than another one would cost more in it as a result of that interplay we are making our decisions. and so we don't have the figures of how much this is going to cost, but we're going to pay for

this bill and we're going to pay for two days a -- going to pay for it by cutting down on expenditures and some of the public programs medicare and medicaid, going to pay for it by reforms in the system that will hold down costs for everyone. reforms like choice and reforms like an emphasis on prevention and primary care and we're going to pay for it by revenues. be put out in our draft today a list of options for some of the cuts that could be made in existing programs. these are based on a menu of options to the president submitted to last and we put them out there and will have them on the table as we consider where to make the cats. the revenue parts will be discussed by the ways and means committee and will make sure that at the end of the day we have health insurance bill that will cover almost all americans, will hold down health-care

costs, will provide affordable go quality health insurance coverage, and we are going to pay for it. >> can you explain how you got equity by 90 percent of americans who have coverage? >> we put it somewhere between 95 and, again and see be unknown depending on the structure that can change and so that number is not set in concrete. we know there are people who are healthy and remain healthy for a long time and never encountered the system, they just don't show up. there will be for a time people who are not aware of this and people today still trying to get tv with rabbit ears after all of the hundreds of millions of dollars and as in rebates and the rest of that there and so i can you want to be careful about what you promise and we think this is in the ballpark. >> how is your proposal address the government data that shows over use of medical services in

miami vs. minnesota, but not necessarily any better quality? >> i think that is what chairman waxman was a with respect to the menu that the president's suggestions on cost cutting and efficiencies in the system and reorganization. i think when you read this legislation you'll see it's a fairly aggressive list of choices and determinations to be made by the committees. clearly we have heard these stories and they have been documented as they were in these different outcomes, not necessarily superior health care but tremendous cost and that is obviously what we want to attack because that is to the benefit of families and businesses and taxpayers. >> you have been talking about pharmaceutical industries -- [inaudible] >> we are simply going to ask the pharmaceutical companies to pass back the money that was a windfall to them as a result of the medicare drug bell. you know what happened on that

bill? there are people on medicaid and we got rebates will be paid medicaid costs for drugs because of the medicaid law said that the government will get the best price. well, under the republican plan a shift of the people who were on medicaid and medicare on to medicare so the same people who get the same drugs but the taxpayers paid more money for those drugs. it was a windfall of billions of dollars. we would like the drug companies to give us that money back and stop doing that kind of thing in the future, that is what we have in our draft. >> who defines what health care is? affordable and good quality is great. >> for health care services the physician will be the one in charge and people can choose their doctor and decide when needs to be done. we are trying to improve the

delivery system so is like the start indicated in other evaluations that have shown and that we have a variation from one part of the country to another. in fact, there was an article in the new yorker that show that even within texas there was a huge disparity of health care costs for similar populations. we want to change that. we want to emphasize more preventive services and primary care services and organize delivery in terms that are called the medical homes, providers getting together and figuring out the best care. too often what we're seeing is people go to a doctor who is overworked, has to see as many patients as possible giving as little time as the doctor may have, and then when there is a complaint they will send the not for another test which, of course, the system has to pay for or send them to a specialist. what we need our doctors to be able to spend time with their

patients and find out what is going on in prevent these problems from getting worse. >> you talk about havel and loving plainfield, does that mean and that's how are you going to save money and effort and saving without public plan? >> the committees are going to decide all of these issues obviously but the way we envision a public plan is and will operate the way private insurance plans do. they will have to work within the amount of money they raise from premiums, there will be no government subsidies for them. and they will have to negotiate with the providers of care and see which providers want to give care of that insurance plan as providers have to decide whether they want to do it under a private insurance plan hearing in the beginning i think the public plan will probably use medicare as a basis for the

reimbursement by publicly higher than in medicare because they want to be sure that they can attract the doctors and other providers to the public plan. but a public plan will be open and transparent and i think will be looking to be even more nimble than other insurance carriers because of ill try to figure out how to provide care in a comprehensive way and a preventive way and hold down some of those costs. >> as relates to the question of rationing, i imagine all of this as competition. the whole world, the whole country rather will be watching how these plans intend to work and you can bet your life with the competition of one of them getting a reputation not providing that health care, it won't be in the united states government that would be directing it, it would be the government for having it so that when henry said is true, we've got to invest that medicaid and invest in medicare come a ticket

apennines but at the same time be able to effectively compete here and i hope that most of the ama doctors will be fighting to get involved in the public health option. >> if i could just follow up on the last question about the public plan, you'll be shocked to hear the insurance companies have issued a statement criticizing the public plan. can you describe, start out that medicare reimbursement rate and somehow transition off into a more -- how does this work? is there a trigger? >> we are going to have to examine these details and are hearing process, but we want -- we have some provisions in the draft but we want these public plans to be able to provide reimbursements as they get started for those who sign up in the public plan. this is a new plan there is a private insurance plans are already in existence, they already have their group of providers, they have their

contracts with providers, that often have already negotiated their rates for providers of the public plan will have to get started and there will be a time for them to startup but they will then at some point compete just as every other insurance plan does there and let me comment on the statement that the private insurance companies still want the public plan. it seems to me what they are saying is they don't want competition. they don't want a plan that can offer services may be in a more comprehensive way, maybe in a more cost-effective way than they do. after all you have to recognize the insurance companies have operated on a simple principle that they are not try to cover those who need that care and then spread the cost. i have been tried to exclude people from coverage for individual insurance plans. they have been trying to see if you are sick and then making sure they don't have to issue an insurance policy to that individual. that won't change because we won't allow interest companies to do that, but there are a lot of people who feel that some of

those private insurance companies are still going to try to figure out ways to cut their costs by not covering some people there and i remember well the story of how there was a plan to send anybody who wants to sign up and sign up, you just have to walk up four flights of stairs to get the information. of course, you were not physically able to do that you never got a chance to sign up on that insurance plan. we want to keep everybody honest and competition is the best way to accomplish that goal. >> i wonder if you could talk a little bit about the medicaid expansion in the bill, there is obviously a lot of concern that medicaid is not working particularly well. california alone many providers -- how do you ensure that if you are expanding your not leading to this social program? >> medicaid is essential program for americans below the poverty

line here and many of whom have very complex problems. there are not the kind of clientele of the private insurance companies are eager to ensure at the present time. we want to keep the medicaid program in existence here is some day we may talk about them putting, allowing them to go to the exchange but not for a while and if we're going to keep existing medicaid program we have got to make improvements in that program. oftentimes and medicated the beneficiaries can find doctors, can find any help provided that will take the rates and with that to make sure that they are paid fairly and we have to adjust the situation with the state's arid in some cases we're going to have to have federal dollars to place the state dollars and going to have worked with the states to make the program one that will be affordable and will be there for those who are entitled to it