>> mr. speaker, isn't it remarkable that the conservatives are fond in alliance in europe that excludes the german christian democrats and the party of the president sarkozy and the italian party of of the italian leader. it excludes all reparable political parties in europe. >> order, order. >> and they are now isolated on the fringes of europe? >> susan kramer? >> thank you, mr. speaker. would the prime minister agree with me that the people of sri lanka that deserve a war crimes investigation of alleged war crimes in sri lanka and given the cowardly decision to resist any such inquiry, what steps committee take to make sure that this issue is not abandoned and forgotten? >> as she may have spoken to the president of sri lanka and have

urged to make reconciliation of the community, that those people have been displaced and given humanitarian help that the regime itself recognizes that they have got to make peace with their members of the community and action is taken as quickly as possible for that purpose. what we need not in violence in sri lanka. >> from london, you've been watching prime minister's question time from the british house of commons aired live every wednesday while parliament is in session. you can see this again sunday night at 9:00 pm eastern and pacific on c-span. for more information, go to c-span.org. at the top of the home page, click on c-span series for prime minister's questions, british parliament and legislatures around the world. you can also watch recent video including programs dealing with other international issues.

>> now a hearing on healthcare legislation being crafted in the house. witnesses at this hearing include union and business leaders and healthcare industry experts. it begins with testimony from the head of families usa, a healthcare advocacy group. this is 2 1/2 hours. >> mr. chairman, i want to thank you and particularly you and congressman wrangle, congressman waxman for coming up a bill. for those who have been around in other iterations in healthcare reform it's rather

unusual to have a uniformed bill and we thank you very much for doing that. we at families usa strongly endorse the house bill that's been introduced because we think it significantly deals with the key values that consumers are really looking for as part of healthcare reform. it provides choice. it makes coverage affordable. it assures that coverage will be stable. and it ends discrimination among insurance companies. now, with respect to choice, we've heard said numerous times that this plan, as well as the president's principles -- you can keep the coverage that you have if you like it. i remember mr. klein indicated early on in the hearing that he raised questions about 23

million losing coverage as a result of a cbo score of the senate help committee. of course, if you look at the cbo score, you'll see that they've said it's an incomplete analysis of an incomplete bill. and i don't think we're going to see anything like that with respect to the house bill. this provides new opportunities to get coverage if you're in a small business. it creates a health insurance exchange which does something which the american public wants, namely, they want to have the same kind of options that members of congress have and the health exchange is going to provide that opportunity and in so doing it'll provide accurate and helpful information about benefits and rights. it creates reasonable rules about how insurance companies should operate. so that if you have insurance, you actually know what you're getting as opposed to find out that you didn't have something at a point when you need care.

and it provides a public option that we think is very helpful because it not only provides more choice but it provides a real opportunity for getting costs down and it provides a stable, portable option. now, another value that consumers care deeply about is making coverage affordable. and one of the key ways that this plan makes coverage affordable is through the new subsidies that are provided on a sliding scale up to 400% of the federal poverty level. we think that is absolutely critical. it also places a cap on out-of-pocket cost. it's not simply the premiums that people pay in order to get coverage. they also pay deductibles, co-pays, and there may be a cap in how much an insurance company pays out. now when people have coverage,

they won't be bankrupted. they won't be surprised. and that care will be affordable to them. and it provides an important safety net through the medicaid program by establishing a floor on eligibility of 133% of the federal poverty level. mr. andrews and mr. scott were talking earlier about the kind of cost shifts that take place when people don't have coverage. and we released a study that the president cited last week that showed that in 2008, the cost shift, the hidden health tax if you will, for those who have coverage to pay for the uncompensated healthcare costs of theéí uninsured in 2008 was $1,017h0ñ and i would suggest t this year it's considerably higher because more people lost their jobs and in the process ñ÷ñ their healthcare. it's probably closer to $1100.

this plan also ends insurance company discrimination. you no longer can be denied coverage due to a preexisting condition. when you get coverage you're not going to have a loophole so that everything is covered other than your preexisting condition. it means that insurance companies are not going to drop you or raise your rates due to the filing of a claim. it's going to mean thatñ post-claims underwriting that happens all too frequently -- that you get coverage and then when you need care, the insurance company says to you, you actually didn't disclose certain kinds of things and they drop you from your coverage. premiums are not going to vary based on health condition. lastly, this plan provides coverage we can count on. it provides coverage for preventive services that are ll provide coverage based

on the best science. yes, there will be a health benefits council that will work with the secretary but that health benefits council will be charged with coming up with the tt so that health plansr are developed that reall make sense and, thereforañ we won't have enormous waste in our system which we have today. and it will provide a range of insurance options. in wtshort, i don't remember o of you talked about a health insurance coverage like a house. well, this plan doesn't make you get out of the house. it doesn't make you sell the house. but what it does do is it gives you tools. if you've got a leak

support the bill that has been introduced and we will work tirelessly to see that it is enacted this year. >> thank you. mr. shea, welcome to the committee. >> good afternoon and good afternoon to all the committee members. i want to start by congratulating by putting forward a bill which we think really addresses the issues that the american people are concerned about. and we look forward to working on this bill. our druthers might be talking based on the current system does provide a way to get the kind of reform we need. and what i want to talk to you about briefly today is what we think it takes to stabilize the employment-based system which is the backbone of both theñ coverage and the financing of healthcare in the united states as you know. it has proved remarkably resilient despite enormous cost pressure. it has shown that employers want

to continue to offer coverage and that employees highly value the coverage they get at work. but we've lost five percentage of points in coverage of people between the ages of 18 and 64 in an employment-based coverage from 2000 to 2007 and frankly this is a pretty fragile system at the moment. we think that it takes three things to stabilize the system and we think that your draft version of the bill is a very good start on providing those the;) o÷things. we need to control cost. that's the core problem that we're facing in healthcare, if we on your provisions

that all employers would be required to pay along with all employees. this pay or play kind of proposal is essential in our view if you're going to base the reform on the employment insurance because, one it, takes some cost pressure off the federal government for providing the subsidies. everybody we get covered in this is somebody who doesn't need to have a federal subsidy out of tax dollars. two, it helps stabilize those employers who are providing coverage because they're no longer picking up the extra cost of covering the cost of care for those people who don't -- whose employers are not covering. and the overwhelming majority of businesses do now provide coverages that have been cited here and want to continue

provide it. the only increase in cost is those firms that are not currently offering benefits. mostly small, low wage firms and your bill addresses their concerns in terms of -- in terms of subsidies and tax credits to provide benefits but also offers the option to pay into a fund that would allow employees to get coverage not based in the workplace. in terms of controlling costs there are two core issues here. one is -- or strategies -- one is the public insurance plan option. this is an important element in terms of assuring coverage and benefits but it allows competition in the insurance market. we don't have any bargaining health benefits for 50 million people a year. we do not have any effective competition in the insurance

market. but we believe that a public insurance plan would spur that kind of competition. i know there's a lot of issues and some of those issues have been raised here about the design of a public plan and you know the list as well as i do. i think these are design issues that can be addressed and they can be solved and we can do this in a way that protects all the interest in healthcare. no one has an interest in turning the situation topsy-turvy. the second strategy that's really key in terms of controlling cost is delivery system reform. and your bill makes a very strong start in that direction. you put an emphasis on primary care and that's important. we would urge you also to look at the quality improvement sections of the legislation to make sure that all healthcare workers are involved in this quality enterprise. we have no not only address the supply of physicians and nurses. we have to address the quality

of the jobs we ask them to do and, frankly, in the last 15 years we turned -- certainly for nurses and other front line healthcare workers this caring profession do some lousy jobs in many places. we can correct that but it takes addressing the work situation not just the supply situation of healthcare workers. you have vehicles to do that and we're talking with staff about the best way to approach that. there has been a strong collaboration between payors and consumers and people in the medical professions and hospitals over the past 10 years in terms of doing this delivery system reform and changing to a system that is based on quality and rewards value. it starts with measuring quality performance on standardized measures, reporting that -- those results and then linking payments to the performance in terms of quality. this is really the opportunity to take what has been developed

in the wake of and is based on president clinton's quality commission some years ago and put it actually into practice. and then lastly, mr. chairman, i just want to comment on the financing aspects. as i said we think that everybody needs to participate in this. and we believe that there's enough money in the system to pay for health reform and to cover everybody. but those people who want to say we have to pay for reform solely out of money in the system we think are just chasing fool's gold. it is not possible to do this without additional monies. we believe we have to look outside the healthcare system to do it. even though over time the system reforms will reap substantial advantage. and additionally, and finally, this really is a way to undermine the political and the public support for reform for reasons that have been discussed here earlier. thank you. >> welcome to the committee. your microphone.

>> i want to thank you for being here this afternoon. i'm here -- vice chairman and general counsel of wagman food markets. as i had the opportunity to travel around the country on behalf of the u.s. chamber of commerce, my number one issue was the accessibility of healthcare and as i would talk to audiences, large and small, this is what was on people's minds. the quality, affordability in healthcare. and they also want to have programs that they can understand and programs that are transparent. which we think is of critical importance. the two words that i'd like to share with you today are finding common ground and collaboration.

the united states chamber of commerce, the rochester chamber of commerce, we agree to at least 90% to what's in this bill and i think it needs to be stressed that's indeed the case. i'd like to share with you an example in rochester, new york, back in the early 1990s according to president bill clinton when he did a nationally televised speech on healthcare the last time around he said rochester, new york, was a community that got it right. it was the only community that got it right. what's transpired since is four years ago the u.s. chamber that i represented, the american medical association, the american hospitalization association, large insurers large companies came together in washington and their task was find programs and policies that can be rolled back to local communities. it didn't cost a lot of money. it could be done relatively

quickly. it didn't require changes in law legislation. we took that seriously. we put together a consortium of seven large businesses, wegmans is one of them and we had very good results. for example, we put into place a regional health information organization. we took efficiency experts from our manufacturing companies and put them in the hospital systems to make them more efficient. we developed a wellness program called live well that my company developed. we encourage employees to walk 10,000 steps a day. to eat five cups of fruits and vegetables a day. we turned it over to this group and last year we had over 200 organizations in rochester participate, more than 44,000 employees. it's the largest community-wide wellness program in the world. more recently, we've entered into a partnership, a consortium of business a health organization in this state that's given statutory authority

by new york. they represent all the healthcare stakeholders in our community. they also represent labor unions. they represent the religious organizations, minority communities, et cetera. we have figured out how to collaborate in rochester. common ground is the key to that. what we'd like to be able to do is invite members of this committee, president obama, to come to rochester to see how we've done it. we think the american people need to get collaboration right. a couple of points. we need to have enough time to digest the bill. each member of congress needs to do that. we do as well. i had 24 hours notice to be here today. two hours to write my testimony. my sense is we don't want to take so long that this idea gets killed but we need to take enough time where people will really understand and there are best practices in this country that you can look at. rochester isn't the only community. there are others as well.

costs, we heard from 1 to $1.6 trillion. either there are not enough rich people in this country to pay for that cost so directly or indirectly many more americans will pay for the cost of the programs. and also with programs like this and other ones that have been put in place in the last years there will be more inflation, inflation is a tax on everyone in america, including the poorest of the poor. in terms of of a couple other points, with respect to the healthcare government option for insurance, i disagree with that approach. i wouldn't want to have a government-run grocery store across the street from me. a manufacture wouldn't want a government-run manufacturing plant across the street from them. yes, there should be competition. but it seems to me the congress could figure out a way to change

state and federal regulation and law to enhance that competition, we think that's the important and the way to be able to do that. with respect to pay or play, we disagree with that approach. with respect to erisa, i know my time is running short. we think erisa works and works as well. there's many complexities to this bill. we think it should be left alone. so in conclusion, in conclusion, we need to find the common ground. believe me there's a lot of common ground for the good of the american people. the american people do want change. we want change. and we want meaningful change, transparent change. we should be able to buy healthcare the same way we buy automobiles and other goods and services in this country. healthcare should be no different. if you give people the information and transparency and equality, they will do the right thing. competition is the american way. thank you. >> thank you.

dr. hacker, welcome. >> thank you, chairman miller and members of the committee. >> your microphone, please >> thank you chairman miller and members of the committee. it's an honor to speak with you today. healthcare is at the epicenter of the economic insecurity in the united states. a reflection of our nation's uniquely fragmented and costly framework of health insurance. now, this framework is distinctively american and any effort to improve it must be distinctively american as well building on the best elements of the present system, large group health plans in the public and private sectors. but an american solution must also fix what is not working. by allowing americans without access to secure workplace coverage to choose among group insurance plans to provide strong guarantees of quality, affordable coverage over time. to succeed, these reforms must be based on three strong pillars. shared risk, shared responsibility and personal responsibility.

shared risk means we need a new national insurance exchange that allows workers without secure coverage to access good group health plans with premium assistance to assure responsibility. promote accountability this exchange must include also a choice a public health insurance plan competing with private insurers. now, this public health insurance plan is a linchpin of a distinctively american strategy. it will provide a backup for those without workplace insurance in all parts of the nation, indeed, in most of the country, especially rural areas, insurance markets are highly consolidated and private plans are passing on costs to enrollees and employers rather than bargaining with increasingly consolidated provider groups or improving their own efficiency. a public plan must also provide a benchmark for private plans. pressing them to focus on value and innovation rather than shifting cost or screening out high risk patients. and finally, a public plan will

provide a cost controlled backstop. they have lowered costs in private plans and obtained larger volume discounts and it has a superior -- now, i would encourage the committee to ensure that the public plan has an extensive network of hospitals and doctors immediately. and the simplest and most efficient way to build the network is to assume all doctors and hospitals that accept medicare payments are in the network but give them the choice to opt out. the plan should also have the authority to use modified medicare rates and to employ information technology and new payment approaches and care coordination strategies to improve efficiency and quality. if we are to truly bend the curve of health spending the public and private sectors will have to work together competing on a level playing field. this task cannot fall on private insureds or the medicare program

alone. make no mistake, americans want to have the choice of enrolling in a a public plan. 72% support this option including a majority of republicans. another recent poll found 83% support. the other two pillars of an american solution are shared in personal responsibility. this means employers and individuals should be expected to contribute to their coverage once affordable options are available. employer responsibility sometimes known as play or pay is vital in ways that are not always properly understood. yes, it provides an important source of funding. reducing the direct cost of reform to the federal government. but it also ensures that reform will not undermine employment-based health insurance. in the absence of a play or pay requirement, firms with large numbers of low wage workers who qualify for new subsidies for insurance within the exchange will have less incentive to

insure their workers. in play or pay proposals, employer contributions are not penalties. they're payments for the coverage of workers whose enrollment in the exchange flows from the employers' decision to contribute. this ensures that the roughly 95% of nonelderly americans who work or live in the family of a worker have access to good insurance through the workplace connection. and while there are valid concerns about small employers, a survey by small business majority found support for more than half of small business owners in california for reform along these lines. they were willing to accept the requirement to contribute to healthcare and return for the ability to access an affordable plan for their workers. concerns about small businesses where most uninsured workers are employed will be best addressed through a sliding scale requirement on firms rather than by excluding small firms from the requirement all together.

shared risk, shared responsibility, personal responsibility. these are the pillars of a uniquely american solution. together they will create accountability in american health insurance, expand coverage while making it more affordable for their workers and families and adequately fund our healthcare priorities while putting in place the preconditions for long-term savings to the government. >> thank you. >> is this on? thank you. thank you, chairman miller and congressman klein for the opportunity to testify today on behalf of the erisa industry committee whose members provide comprehensive health benefits to directly some 25 million active and retired workers and to families. the long-awaited reforms to the healthcare system in the way we pay for healthcare increase efficiency, reduce cost, extend health coverage to those who are

underinsured we released in 2007 a new benefits platform for life security that lays out an innovative national framework for health and retirement security. as we contemplate the issues that are before us the three basic principles that we think are important. first, do no harm. there's been a stated commitment to the employer-based system by the president and others. healthcare reform should build on the success of the system that serves 170 million americans and their employers not hurt it. second, control costs. spiraling healthcare costs threaten our global competitiveness as well as our national solvency. reform must focus on reducing these costs and ensure what we pay for has value. without cost containment effective cost containment we will not change the system. thirdly, expand access. access to the 47 million or 82 million, however you choose to count it, americans who do not have it must be expanded while recognizing that a chief cause of inadequate access is the high cost of care.

now we recognize as an organization that there's a lot in our current system that is not working well. to this end we created the new benefits platform that we released a couple of years ago. with these principles in mind that we just articulated and this new benefits platform we articulated the following things that we support that is part of healthcare reform and a large measure of proposals that have been considered by the president and congress. first, we support a competitive pleuralisic healthcare system in which employers and individuals had choices among plans that compete on quality, cost and effectiveness. ..