sixth, payment reforms to secure financial incentives that drive desired changes, and lastly, an individual mandate with subsidies to assist financially disadvantaged individuals. there are also some issues and concerns with the current proposals that we feel need more discussion. first, a tax cap is difficult to define so it can be administered in a fair and if credible way. it may mean some employers would redesign their plans so the benefits they provide would fall below the level that was taxed, might create an incentive to do that with the result of their employees would be provided less generous health coverage. other employers would choose to keep their existing plants which could result in young and healthy employees leaving to seek cheaper coverage elsewhere that would not be taxed.

this could compromise many rules and diminish an employer's ability to offer efficient and innovative health care coverage to its employees. as the cost of providing benefits increases, more employers would exit the system. a public plan. if a public plan could be fairly fashion. it must be structured in a way that employers plans bear the burden of additional -- to not get a burden of additional costs. there is currently, no question about it, currently unfair cost shifting from medicare to employer plans in the current system. expansion of cost shifting would cause employers to rethink whether they could afford high quality health care to their employees and compromise the notion of whether or not you have a plan, a fair and equitable basis. we are concerned about the adverse selection of the experience of individuals in sponsored plans, permitted to go into a public plan especially if

the employer will pay for the individual participation of the other plan and finance any subsidy to individuals who opted out. employer mandates including benefit packages which restrict the ability to devise and operate health-care plans that best meet the needs of our employers, mandate increased costs and limit flexibility and a difficult to define so they can be simply in uniform reapplied. coupled with punitive regulatory regimes which discourage employers from continuing to provide quality approval healthcare to their employees. finally, talking about preemption, without national uniformity, large multistate employers simply could not offer quality health care coverage to their employees. any future legislation much -- must have national uniformity in similar priorities. there are many employers that offer benefits in all 50 states. we can testify to the fact that

most states have some responsibility complied with state mandates, the administration is costly and complex and difficult to comply with. in conclusion, erik is committed to the goal of responsibly reforming the nation's health-care system to cover the uninsured, control costs and improve quality and wall street in a manner that does not undermine the system that offers quality health care to 1 seventy million satisfy americans. there's a major stake in the health-care system and we intend to play constructive role in this debate. thank you for your time. >> thank you, members of the committee. small business majority appreciates the opportunity to present the small-business perspective on health care reform. we support the effort to move this legislation through the congress expeditiously and thank you for bringing this forward in a timely manner. small business majority they non-profit, non-partisan

organization founded and run by small business owners, focus on solving the biggest problem we face today, the skyrocketing cost of health care. we represent the twenty-seven million americans who are self-employed. our organization uses scientific research to understand and represent the interests of all small businesses. i have been an entrepreneur for 20 years including 12 years zoning and manage internet communications company. together with the other senior managers in our organization we have a total of 70 years running successful small businesses from high tech to food production to retail. we hear stories every day from small-business owners who can't get affordable coverage. an entrepreneur in nashville, tenn. had to abandon her business after a few months because she couldn't get decent coverage. one company quoted her as $13,000 monthly premium. others, such as larry peterson,

co-owner of a mail-order bank rate, struggled to do the right thing and provide health care coverage. larry notes that, quote, the tremendous downside to being uninsured can be instant poverty and bankruptcy. that is not something by employees deserve. our polling confirms the health cost to small business owners's number one concern, on average, more than 18% more for health-care coverage than big businesses. the economic study we released earlier this month based on research by jonathan gruber found that without reform, health care will cost small-businesses $2.4 trillion over the next 10 years. we are pleased to see the house bill addresses key cost containment measures such as expanded use of transparency, prevention and chronic disease management. our polling shows that the key to controlling costs in the market place where there's

healthy competition, there must be an insurance exchange from the robust. the national insurance marketplace, to national rules. there are standardized benefit packages, without regard to treat existing conditions or health status. and marketplace transparency. a balanced set of reforms will require everyone to participate. 66% of business owners in recent poll in 16 states, releasing preliminary data today, support the idea that the responsibility for financing health care system should be shared among individuals, employers, providers and government. it should be noted that response to our surveys include an average of 17% more republicans

than democrats, 40%-23%, 28 identified as independent. according to the results of the economic modeling done for us, comprehensive reform that includes even modest cost containment measures and well-designed structure of employer responsibility, will offer a vast improvement over the status quo. a system with a program level of tax credits, sliding scales and exclusions would give small businesses the relief they need, saving $850 billion over the next 10 years, reducing lost wages by $339 billion, and it responds to the question that the ranking member asked, minimizing job losses up to 72%. we are pleased the committees have addressed the affordability concerns of the smallest businesses. professor gruber has modeled scenarios described in detail in our report and we look forward to working with you to ensure

the best balance between the need to finance the system and our ability to pay. another issue of great concern to us is the unfair tax treatment of the twenty-nine million self-employed americans. under the current tax code self-employed individuals are unable to deduct premiums as a business expense and are required to pay an additional 15.3% self employment tax on their health-care costs. we encourage this inequity rectified in the final bill passed by the house. chairman miller when you announce this historic bill, you noted that health care premiums had spiraled out of control, quote, place in our fiscal future in peril. we agree wholeheartedly. health-care reform is not an ideological issue, it is an economic and practical one. we are encouraged by the approach of this bill and look forward to working with you to make a reality this year. thank you. >> thank you.

cisco? >> chairman miller, members of the committee, i am out 22 your breast cancer survivor and i represent the national breast cancer coalition of hundreds of organizations, tens of thousands of individuals dedicated to ending breast cancer. we will not achieve that mission unless everyone has access to the quality care they need. we are grateful for the opportunity to present our physicians to this committee and we are excited about the possibility which we want to make a certainty, that this country will enact guaranteed access to health care for all now. we have a grass-roots board of directors, 25 of our member organizations. they spent several years working on this issue. we invested resources in educating them, our field that work and the public, about the various approaches and issues around health-care reform and we

develop a framework for a health-care system guaranteeing access which was submitted with my written testimony. we need a system of patient, centered care, a term that gets thrown around quite freely but you know the problems. there were some stories at identified in my written testimony, and so many more. when and sharing prescription drugs, delaying treatment, losing their jobs, losing insurance, facing a diagnosis of breast cancer. our focus as a nation should be on solving those issues only centered on the patient, the individual. how do we reform the system so that everyone has access to the quality care that they need, when they needed. it guarantees everyone comprehensive set of basic benefits based on evidence contributing to the evidence base. we know you have many pressures from many different fronts, but

we need to always keep focused on the patient, the individual, centered on that goal. we should not begin by figuring out how to maintain drug prices or physician reimbursement or maintain the existing insurance industry. those issues should only be addressed within the context of, first and foremost, the patients, the health of the individuals in this country. the history of health care reform is the story of all constituencies that don't want to give anything up. we all have to give something of to achieve our goal, money, certainly, and the national breast cancer coalition understand that. our framework makes clear we believe in shared responsibility, we should all share financial cost of reforming the system. perhaps we have to accept the longer wait for a test that would adversely impact our expectations, but not our health. what we don't want to give up is

our health, our lives. we have been working on these issues for many years. we know what to do, we just need the courage to do it. we applaud the approach outlined by this committee that meets many of the principles of our framework for access to care. our efforts in this area were led by carolina hinojosa, she died on sunday as a result of side effects from her breast cancer treatment. c-span3 her last days working on this. we will work our hearts out passionately committed for carolina, but also because we know it is the right thing to do. this system -- we need compared of offensiveness research to reach that goal. we have spent some time understanding the issue beyond

the sound bites, and recognize without question the need for this approach in health care. comparative research, is research in a real-life setting, all doctors and patients face. this is an extraordinary time, we are ready to change for the better the system of health care in this country. the infrastructure we build to get their needs consumers and patients at all tables, their perspective is necessary to inshore or decisions regarding health-care will have a meaningful, positive impact for those on the receiving end of care, the patients and their families. they are the ones who have to navigate the complex web of rules and requirements in any health insurance system. it is important that it is not just any patient or consumer, they must be accountable, they must represent to and report back to organizations that represent those affected by their issue, by their medical condition, and must be

knowledgeable about the health care system and well-trained. i didn't understand why in the 1990s, when the health care reform efforts failed, the american public did not storm washington and demand that congress and the white house make access to care a reality. this time we are ready and we are passionately committed to achieve that reality. on behalf of the national breast cancer coalition, we pledge to work with you to achieve the goal of guaranteed access to quality health care for all. thank you. >> thank you very much for your testimony and for taking time to be with us and sharing your expertise and your experience with us. we will pick up where we left off with members on our side. mr. hinojosa is next. >> i'll set another commitment and i will you back my time and

listen to my colleagues ask their questions. >> once you yield your time -- >> i yield my time to the gentlewoman from new york, miss mccarthy. >> i thank the gentleman for his time. listening to the testimony from the first panel and this panel, one of the things i'm going to be focusing on, i spent 32 years as a nurse, the nursing shortage in this country is severe. not only the nursing shortage that all health-care workers, plus primary care doctors. i don't see how this plan can work without the work force behind it. we have some initiatives in this bill that will work toward doctors and nurses, but the public health centers, if that is -- especially for those who

have the insurance. i grew up in the public health center. that is where i went for my medical care, my polio shots, all of that, my mother and father didn't have health care insurance. there's nothing wrong with that as long as we teach the patient, give the patient the dignity that they should deserve wherever they go to get an examination. to be honest with you, some of our hospitals which are overworked, have no money to improve their facilities and to see those -- a lot of people have gotten out of work. you are treated like cattle and the dignity is taken away from the person and that is totally wrong. they say that a country is only as great as the health of their people. i consider this a great country but i do not believe our health

care is the best. we have a lot of work to do. i hope that both sides actually come together because this is the time we need to have this done. it is the time to have it done. from the first witness, she talked about bundling. a lot of people don't understand or know how the bundling is going to work between the hospital and the patient. the waste and fraud, how are we going to weed that out to save money, but not punish the doctors that are out there? payment to the doctors in the hospital, i have to tell you, if anyone gets the health care that i have, i see what they pay to the doctor and hospital. it is outrageous. they don't get paid enough. you wonder why a lot of them are not accepting any patients. that has to be taken care of. i am hoping as we go forward to that we can work on this.

i am glad to see that the doe not hold has been closed. that is terrific. >> we have a contribution, it is not closed yet. >> the doughnut hole for all seniors is to be concerned about, the majority of seniors start getting their health care when they are over 65 to 75. that is when it starts breaking down. with all the witnesses, this is more of a speech and no one knows that i don't give many speeches but this is something i feel passionate about. when you talk about cancer patients and not being able to

get the care they need because they can't afford it, talk about a cancer patients, families will spend all of their money to take care of someone that they love. if we as a nation can share those costs, be helpful to the family and the people, i believe our country, i believe, our americans actually do believe in taking care of each other. with that, i yield back the balance of my time. >> the gentleman yield back to mr. thompson. >> thank you, mr. chair, ranking member, for having this hearing today. healthcare has been until january, 20 years in health care. i thought i would retire from there, it wasn't to be, find myself here today, i come to congress with many of my freshman colleagues with health care backgrounds. my commitment, involved in

public policy because of health-care and working to ensure access, affordability, quality, and choice, frustration of cost being driven not by government intervention as a result of regulations that were piled on like layers on an onion. the regulations made sense, but we have to go to the 1960s to find the roots of many of them and something we don't do is peeling away in government, we add layers on, the frustration that i have on behalf of my patients, how that was increase in costs and decreasing access. i appreciate this opportunity today, this is one of the first opportunity to engage in this discussion which has been very frustrating for someone who came to washington after almost 30 years in health care with ideas that we could do things a little better. i appreciate the opportunity

today. frankly, the change we need needs to be the proper change as a result of a full debate and discussion. we have not had that opportunity. it has been a real frustration of line and a number of my colleagues. serious concerns that i will mention briefly with a proposal on the table, the taxpayer federal government provider that will not really compete but only consume, private health providers will create, wind up with a monopoly, a government provider. most of my frustration has been the result of dealing with medicaid and medicare in terms of the access and quality of service to consumers i serve for 3 decades. i find the flawed funding mechanisms in terms of competition being named, ultimately decrease competition because of this new government entity, this taxpayer funded

savings, there are immediate gains obviously for health information record but in the long run, is it sustainable? that is the type of thing you have to be able to invest in after a new generation of technology comes along. i raised that question in a previous forum and there were no thoughts about what happens a number of years from now when the technology changes and our health care providers are without the resources to do that. marching ahead, my first question, you noted that an employer mandate will be to a loss of jobs. some studies found using economic analysis prepared by our previous witness, that an employer mandate cost $300 million over 10 years would result in a loss of 4.7 million jobs. can you elaborate on how many employer mandate, how an employer mandate would work in your company?

>> it provides full health insurance as it has for decades. one of the things we take pride in in fortune magazine, we will listed as one of the top 100 companies to work for. we have been through -- we are the only company in america to have the designation of number one through number five. our corporate philosophy is employees always come first and we mean it. our customers take care of themselves and customers are taken care of our bottom line takes care of itself. our view as it relates to our own business and our industry is we make our own decisions as to what benefits we should provide. if competition doesn't do that, we attract, we think, better employees, and another thing, i

talked about collaboration before, over the years, we have 39,000 employees, 2,000 are in unions. for years, it would be the company against the union and we changed that, we worked very hard. we have provision in our labour contract where there are enhancements in employee benefits and health care, without negotiation, the union people get them as well. if, unfortunately, there has to be a reduction in health care benefits without negotiation, that happens as well. we built a team that works. that is what i think america is all about. you make those choices at the lowest possible level which is company by company. if there are companies that choose not to do that under the present system they will pay the price by not being able to retain employees which is very

costly, or not getting quality employees. the only other thing i would say, testimony is that there hasn't been much said about the fact that we don't have enough positions, we don't have enough health care workers. why should there be -- i am a lawyer. do you know that there are 3 times more law schools in this country than there are medical schools? creating incentives for health-care workers, i would love to come back on another day when you are talking about education. if you want to come, i invited you with respect to health care, maybe you'd like to come back as it relates to education, we have wonderful programs to help economically disadvantaged children. we encourage them to go into the health-care industry. whether as physicians, anything else in health-care. my sense is what the market prevail as much as we can. that is the american way.

>> i appreciate your comments on the supply side of providing sensible, affordable health-care. my time has expired. >> thank you, mr. chairman. to mr. speranza. i want to call your attention a documented letter that was in the new england journal of medicine on june 4th, 2009, edition. it says that the insurance industry has ever $4.4 billion in investments in tobacco companies. the you have any comment on that? >> my first comment would be we with the first major change in the u.s. to stop selling cigarettes. >> i am asking about the industry. >> i guess i would say with respect to that, i haven't given that a lot of thought.

insurance companies most likely have a fiduciary responsibility to do the best they can with their investments. i am not an economist. >> milton friedman said this. i do not often quote him but it is worth quoting in light of what you just said. he said few trends could so thoroughly undermined the very foundations of our free society as the acceptance by corporate officials, of a social responsibility other than to make as much money for their stockholders as possible, that is included in this article in the new england journal. i would just like to say, the fact that insurance companies can invest in tobacco companies, seemingly contradictory assumption if you're talking about public health, of note to this committee when we mark up the legislation, professor

acker, i believe health care is a human right. everyone deserves it. that means no financial barriers, all medically necessary services are covered. the draft bill under consideration, many badly needed reforms, has a very strong public plan option. even with this, it is clear that millions will still remain uninsured and underinsured. what are the models for health-care finance that would be consistent with the principle that healthcare is a human right? >> i think that it is worth noting that the broadening of coverage that will be foreseen when we look seriously at the effects of this piece of legislation is going to be very substantial. the proposal that i developed some years ago, healthcare for america, which is very similar to this draft legislation, would

cover almost all americans. when i say almost all, my proposal would cover all but a tiny share. >> i use a invisible we have heard widely discussed, will soon be marking up the bill that has been well described? meets the test of health care as a human right? >> it meets the test of providing affordable quality coverage. >> does it meet the test of health care as a human right? >> that is a very high standard. i teach in my university the idea of democracy as an ideal. no system actually lives up to that standard. >> so you're saying some people have the right and other people don't even in a democracy? >> i am saying that i believe the standard of health care as a human right, this proposal will move us dramatically closer to that i deal. >> i am