institution and how it works. >> mr. chairman i don't want to get to the end of do we can start this all over again. >> i understand. don't think that is what the senator was asking. i am going to try it-- i understand the senator's point. >> there could be something-- >> i hear you senator. >> mr. chairman? we withdrew an amendment on liability as well. is there anything being done on that? >> well, again, we are going to have a debate at some point. i expect the full throated debate in the senate when these comes together. capri want to have it here at some point we can. i suspect, i can tell you i suspect an outcome of that debate. i suspect it is going to be a debate we are going to have on the senate floor. is one that needs to be thought out because there are a lot of aspects of that question. my own encouragement would be to

defer the debate to the point where i think you are going to get a broader participation by all of our colleagues want to be part of it, then leaving it to the confine to the committee. but i am prepared to entertain matters added a appropriate time. >> the reason i brought that up of course is because i withdrew it without realizing that the president told the american medical association would have something in healthcare reform that would deal with that in the amendment i had was oneth beddia jointly with senator baucus salahaddin more latitude than most. >> well, good. >> i will keep it withdrawn. >> question for the chair. in the german assurance that we will have an opportunity to offer an amendment on the floor? >> certainly. we will take the conceptual bill out of the finance committee in the legislative product interactive. >> there is some question as to what the floor processes. >> i agree. is a said earlier, i can't think

of another piece of legislation that any of us are going to work on our have worked on as important as this, so this is one where i think is going to be important that every member of this body feels as though they have got more they fear an ample opportunity to be heard. to make sure that we represent a quarter of the united states senate around this table, and i want to make sure everybody feels, whatever the outcome is to get to this process they felt they had a fair opportunity to be heard on this committee. i know senator committee would want that in his place i'm going to try to achieve that goal as well. >> mr. chairman? kristoff i appreciate your willingness to be flexible, relative to the way these amendments are brought forward. i do have to liability-- i don't wish to waive the right. at fae wischer i would get a shot at it on the floor i would say that is a good place to take them up by not sure that is going to happen.

because, in the prioritization, what we are doing on the floor, by the time we get to liability we may all be under closure. it may be appropriate to bring them up here. >> we have got, first of all i thank my colleagues and we are moving next to to the prevention section that senator harkin has worked very, very hard on. i don't know of my colleagues of be interested in having tom talked about the propension section. the vote does not occur until 5:30. over the weekend the staff worked very hard to break this down into themes within the prevention areas though it is more manageable to understand. actually, i gathered had some success in resolving effectively so we can have a good debate and discussion on this section. what i invite come to share some thoughts and views on a section of the want. it may be valuable for

colleagues to hear that before we pick up in the morning. essays said, before you came in and johnny came in, my intention is and again i'm conscious of people's schedules and other matters, but my intention would be tomorrow to move to prevention with the amendments, to complete that tomorrow if we could or by wednesday morning. i would like to complete as much of this bill is because by the end of the week and these other sections, other, and it may be difficult because we need cbo numbers. i can't we'll bring it up without cbo numbers so i want to make sure all of my colleagues are aware of those numbers before we go forward. the idea come as much as we can and therefore evening sicker it requires is to complete the section to be around here in the evening to get it done. ideally to get it done before thursday evening. i'm not sure what the schedule is on friday but it i can imagine people will want to beheading off to their respective states for the for the july, independence day

recess. so that is sort of, to proceed in that matter to try to cover as much ground as we can. thank my colleagues indulgence. after the vote, we won't come back after this evening because we finish this title. that was my goal, to finish up title tune we have done that south let's move on. tom, do want to take some time? >> anybody want to listen? listen, thank you very much mr. chairman. nally get on to the propension title. i am not going to get into a long speech about how important prevention is. we will said that the foreign don't need to be a dead horse anymore except to say that the title we just finished, the quality title that senator murkowski-- i just did it. center murkowski andy tie line prevention i think, and i said it is not because we work together on it. obviously we have some ownership

of anything you work hard on but i really do. i said this whole process months ago that this is really the guts of healthcare reform. what we are going to do one quality, and it and what we are going to do one prevention. and if we are just going to have a small prevention that is sort of an appendage, like an appendix, that is there but nobody really knows what it is for nweze sort of just give flowery words do it. would that be wonderful if everybody was healthy and all of that. that is so we are going to do them were not going to have healthcare reform. we will have something. we will jiggle how to pay the bills. we will pay the bills a bit differently and we will have some different coverage out there and we will have some co-op or not, what. we will have some structure, but we are still going to be pouring money down a rat hole.

we are going to be pouring money for patching, fixing in mending. so, unless and until we get a grip on prevention and wellness and changed the dynamics of it, we are just going to continue to pay more money after people get sick. that has been the history of healthcare in this country. so, i think you know, we have got to do a big thing. it can be small. it can't be small. is that to be big. is that to be something that makes a profound change, not just the way we do medicine. the rest of the bill, the rest of the thing we are talking about and what the finance committee is doing, they are talking about the way we do medicine. what i'm talking about is changing the medicine we do. that is not just a subtle difference. janesian the way we do medicine, how we pay the bills and how we set up a structure and all that

kind of stuff. changing medicine that we do means we take a whole new look at how we do medicine in this country. and that is what we are talking about and that is what we are going to be going through with this prevention. putting more money up front, for changing the way, a change in the medicine that we do. there is basically three subtitles of this. one is modernizing the prevention of public health system. sichta mink greising access to clinical, clinical part of the third is greeting healthcare communities in the fourth is basically research and public health information. i would say just the idea behind this is to, again, to make easier for people to be healthy. factor andy wild told me one time, he said and coburn is here

to hear this berkley said the human body wants to be healthy. it is in our dna, after all these millennia development of the human species. we want to be healthy. or body once the healthy. it is in our dna. what we have done is we have erected barriers to that. we make it easy to be unhealthy and hard to be healthy. it ought to be the other way around. dotsy be easy to be healthy and harder to be unhealthy. that is what we are attempting to do is to start to change the paradigm which is a nice fit to set word, so that we look up front first and start shifting more payments. we are going to have a lot of discussion and amendments on the investment trust fund. it is big, about $10 billion. well, if this whole bill comes down to a trillion dollars which

is about 100 billion over ten years, we are talking about 10%. 10%. we are at about 3% now, about 3%, 45, some more and the neighborhood of all of our healthcare expenditures go for prevention and wellness out. we are just making a modest increase to 10%. obviously if i could devise a system, if i were a dictator something like that, i would say start a 10% in work up to 30 or 40% of our healthcare dollars going to prevention and wellness. now we are going to have amendments to strike that. if you strike that, that is the guts of your right there so we will have a i am sure a spirited discussion on the investment trust fund. but, what it means is there needs to be a dedicated source of revenue there. it can't be competing. that is the problem we have always said in trying to get money for prevention the mullahs. a competes with the existing structure and the existing

structure is so demanding of our money. that is what we are all talking about. demanding of $2 trillion a year. for responding to chronic diseases. i think the figure is around 70, 70% of our money goes to chronic disease most of which is preventable. but, it is subtle thing about you know, this wamp and the alligators, that old story. i don't need to repeat that. but we have got to drain the swampier. and the idea is if we have got to have something set up so it is not competing against the everyday demand for dollars for people that are sick and need help. noaa mons to do that but we need a separate fund to begin to move this big ship, this sick care program that we have. it is not going to be done overnight but i will bet you in ten years we can make a big difference. in ten years, orin hatch, we can

make a big difference in shifting how we feel prevention and wellness in our society. it can be everywhere from school based programs, community-based programs, the workplace wellness programs and we are working with the finance committee on that come clinically base programs. making it pervasive throughout society, that we make it easier to be healthier rather than easier to be unhealthy. so, that is sort of my whole speech on that. i don't mean to belabor it any longer. i will be coming back to a. mr. chairman, what we have got, we have worked very closely, i think. or stack as worked very closely with republican staff on a lot of these measures. we had proper to them earlier, a couple weeks ago or a week ago when we were going through this and we had some suggestions back in a few areas. but then mommy started the process here of amendments, we got 171 amendments filed.

i did not think this section would incur that many quite frankly. so far, ours staffs worked diligently over the weekend on sunday and saturday. i think we are at the point now where, these are rough figures and don't hold me to an exact number, but we can except around 50 that they worked out. there's about another 30 that they are working on language. if you get the right comma and the right period of the right place, maybe it will work and then there are about 90 left. as i understand from my staff that the republicans that this said well, there's some kind of themes here and you referred to that earlier, the themes and maybe we can group some. there are a lot of different amendments to different people that speak the same thing sold were trying to group those together and see if but for a couple of nuances they can all these sort of offered at maybe

as one amendment rabid and aider nine comment maybe one, two or three covers the gambit of what people are suggesting. that is what we are working on right now, and hopefully with this evening, we might even narrow this down to even further than that. but, the one thing i will say, i have found from my colleagues on the republican side, a great deal of support for prevention and wellness. senator burr and i have worked together on this in the past a lot of different things. we may have different approaches on how to do it but i think-- i don't know if all but a lot of us really feel strongly about this. center hatch and i have worked on issues on mama is going back to 1994. when we both entered, will meet both introduced the shea bill. i know of his strong support for wallace activities.

so, i think there has been some really pretty good suggestions that i have seen from the other side on this. not all knowledge reside here with one person or one staff grouping, but the process i think it's going to lead is towards having some significant reforms, reforms, changes in wellness and prevention. but, i will again repeat, nothing comes free. nothing is free. there's no free lunch here. freer pointage dude we are going to have to put some bucks behind it and if we get into a match where to put the box behind it were quantitate the bugs out of medicare or medicaid or existing structures, propension will never get there so we have got to set the structure up, we have got to fund it. we have got to provide the kind of best practices that senator mikulski has come up with

intersection in terms of comparative effectiveness and we have got to do the same thing with wellness and prevention also. mr. chairman, thank you very much. i would be ready to go any time you are but i will tell you what. since they are working together to try to get these centers together, these groupings together, he would probably wise we are not going on this evening and if we could reduce them down or the staff can reduce them down that saved us from joiner around here. >> i am strongly encouraging that. i think he may have resolved 50 of them in 30 more on the cusp of being resolved. that is a sizable hunk and if you could do even more up bringing them together. there's a lot of them that are very similar so there may be an opportunity to group them so we end up having a healthy, full frauded debate about a couple of provisions i know very much, just on the comments earlier that we heard early on at the

opening statements. i think judd gregg maid, either there are one of recessions have some strong-- >> i think we got that worked out. >> so there will be a good opportunity to have not in abbreviated or truncated debate on the critical issues. so, we will do that. we will meet tomorrow by a the way in dirksen one of six. this room is being used for another event in the aft discipline would mind blowing for a day to another room and i agree to do that. we agree to do that on wednesday. center gregg. >> first off, let me associate myself, and i think folks on our side are totally committed to having a very strong and robust prevention title. i know senator enzi has been driving us in that direction. and, i think the senator harkin for his attention to this. there are a couple of areas where we think prevention, the

pressure prevention and a healthy lifestyle can be incentivize. and, especially in the area of hipaa we think the federal government disincentivizes bergen the area of the ability for people to pay cash rewards for folks who live healthier lifestyles we think there's this incentive in our system and we believe this bill in its present structure and i understand may be going through some mutation, moving during-- for direction of a healthy lifestyle and to allow communities of employees to participate in programs which basically give them the opportunity to live a healthy lifestyle and be rewarded in doing that. so, as the senator was saying there are groupings of amendments. there is certainly one grouping of amendments that i consider to be very important and i know many of my colleagues to. there is also a number of other issues in here. the issue of this preventive fund, i think the technical

budget issues that the center is tried to address, because it was a very creative and unique hybrid, what open with a pandora's box budget wise but now becomes a question as to whether not this is the best way to pursue this. i genuinely believe that there are a few chronic diseases that, if we create a public incentive to address those diseases through healthy lifestyle and a government incentive to benefit the research of those diseases, this disease is a loan if they are just aggressively, i believe for example that alzheimer's is going to be probably the biggest cost driver of healthcare because of the size of the retiring generation, which will double from 35 million to 70 million the fact we know the people over 85, their chances of having alzheimer's is extraordinarily high. i think it is over six year 70%.

if we can figure out a way to incentivize caretakers to not institutionalize those folks, that is important in obviously research and then of course we know obesity is a huge cost driver for society and we know that prescreening in the area of certain cancers, it to get them early you save lives. we know for example like expectancy of someone gets breast cancer in england is 70%. like expectancy in the united states is 92% because we prescreen so soon and that is something we need to incentivize for their threw cash rewards. so, there are a lot of issues out there and i just think this title should not be controversial title. i do believe we should be able to work out things that used the force of incentive to people, to create healthier lifestyles and also bring the government to play in the research areas

constructively. hopefully we can work this out, and we do have a lot of the amendments. we did not get to write the bill so we have got a lot of ideas. >> i thank the senator. any further comments on the opening remarks by senator harkin? >> mr. chairman? >> center mikulski. >> first of all i would like to salute the senator harkin and the work he is done in thank the senator from new hampshire, because i worked very closer-- closely with senator harkin and his ideas here, are just outstanding. and the whole idea of linking of both in saving or improving lives involving cost are intertwined with both prevention and quality, and if we looked at the threat of number one using health information technology and make the highest and best use of that for both patients

and research and bringing it all to bear, the number to cup, we really focus on the quality initiatives, particularly those that deal with the management of chronic illness and preventing it from deteriorating quickly and following the ideas of senator harkin, think we can make a significant down payment in both reducing cost to our system and improving the health outcomes of our people. i look forward to moving these forward, and he really held many interest in the hearings. we have a great idea and i would like to work with them to move it for. >> there is a bill signing ceremony on the debaca legislation and there's a good example, prevention and again i appreciate the fact that their number of our colleagues who were there and senator casey, senator whitehouse and senator merkley was there, senator

bingaman, senator harkin of is the ball. they saved $180 billion in lost wages and healthcare costs each year as a result of debuckle products being used. for the first time since 45 years ago, 50 years ago when the surgeon general identified tobacco products as a major cause of disease and problems. we finally have the food and drug adminstration to be able to regulate, to promote legislation or rather regulations in the area of the sale, the production as well as in the market of tobacco products particularly to children, and mike enzi was there as well for the bill signing ceremony. in fact, it is in many ways stronger than the advocates of the bill because it goes further in many ways, and what we have done with this. again, a good example of that kind of work that can come together and i think the people like tom davis and mike dine,

the republicans did a great job. i appreciate the fact, we have got to do something to help but. is not their fault and their economies going to suffer as a result of this and what we can do to help them. i don't know anyone who wants to see their kids take on health hazard and if we can do things to make a difference in that, that is going to really get to the prevention issue. so, it was the moment of some import and again i think the combination of incentivizing behavior for individuals to assume responsibility for their own health condition as well as the efforts that can be made in the larger context, to promote his efforts at thinker going to produce the results were looking forward to so i look forward to the discussion. >> mr. chairman, one other thing, it is just the old-- problem with cbo, but we have got good data out there from

companies. we have safeway, pitney bowes, to name two of the big ones. smaller ones that i have come to know that have only maybe two or 300 employees, some may be less than that but have then remarkable things and they can show the savings. for some reason cbo can't seem to give us the score on that. >> safeways said the other day, mr. bird said the other day, the ceo of safeway, with an obese person that works at safeway, for every 1 pound of weight they lose as a reduction of $50 a year in premium costs with the 38,000 people that they are presently covering with their healthcare plan. one example of where come and again some people struggle. some have when shuler issues or genetic problems. it is not a question of people working hard but it bears a direct correlation to a better lifestyle and reduced

healthcare. >> mr. chairman we have had that same problem with cbo for eight years. >> yeah, i know. well, thanks for reforming it. he said we have the same problem as cbo for the last eight years. the meeting will stand adjourned until tomorrow morning and i thank my colleagues. thanks mike. [inaudible conversations] [inaudible conversations]

>> how is c-span funded? >> through dalmations? >> i think you get a little bit from the federal government? >> grants and things like that. >> may be from sponsors? >> we might get government funding. >> viewers? >> how is c-span funded? america's cable companies created c-span is a public service. a private business initiative, no government mandate, no government money. >> monday's state department briefing included questions about iran, china and north korea. it is a half-hour. >> good afternoon. i think as many of you have heard, the secretary on doctors'

advice decided not to travel for the g8 foreign ministers meeting, and the osc meeting. is deputy secretaries feinberg said, just a few minutes ago, he will go for the osc meeting which is the back in of the trip and undersecretary burns "represent us at the g8 foreign minister meeting. the secretary was in the office this morning. she attended her morning staff meetings. she is already made a few phonecalls. she made a bunch of phonecalls over the weekend as well. the first call she made this morning were to foreign minister frattini of italy, and foreign minister of greece to express regret that she would not be able to attend this two