health care and yes over the first ten years,@@@@@@@ @ @ @ @ health care and yes over the premium type of event, you are talking about independent actuaries who have looked at this saying it will cost $2 trillion in new unfunded liability. we already have as a nation somewhere around $60 trillion of unfunded liability. unfunded liability.

just in medicare, medicaid and social security. this bill is suggesting that we add another $2 trillion to that. in my opinion, that is totally irresponsible. the debt we are putting into this country and on to the children's back is going to bankrupt our nation, bankrupt our children and make our nation a pauper. we know that. the president knows that. he has even said it is unsustainable and for us to suggest or bring forward language that would aggravate that problem by $2 trillion is absolutely fiscally irresponsible. now i have listened to the president this week, as he has been aggressive in promoting health care. he says he has three standards. the first standard is that everybody in america should have access to adequate insurance. second standard is that we should bend the outyear cost curve so that we can afford health care in this country, and the third standard is that

nobody should lose their plan if they like their plan. i think that everybody agrees with those standards as purposes. i certainly agree with them, and i don't know of anybody on our side who doesn't and obviously the other side, but i don't understand if we are marking thup bill if those are his standards, because cbo on all three of the elements has on the issue of coverage after this bill is fully in place there will be 30 million people who don't have insurance, the 40 million that don't have insurance today there will still be 30 million. on the issue of cost when this bill is implemented not counting the class act cost, which is $2 trillion there will be a $2.3 trillion unfunded liability in this bill and that's just for the one-sixth of the bill that we know about. the blank section we can't score but we know that's going to be the most expensive so you're talking a bill that's going to spend three plus trillion

dollars. that's not bending the cost. you don't -- you don't control spending by radically increasing spending. on the issue of coverage keeping your own policy cbo says 15 million people will no longer have private insurance. so, to me why are we marking up a bill that doesn't meet the president's task and why would we even consider a section that's going to add $2 trillion of new unfunded liability to an already unsustainable relation of $60 trillion of unfunded liability? these are at the core of the questions we have on our side of the aisle. i appreciate the fact the chairman and members who've been having different sections have been very cooperative in taking technical changes and most of the amendments are technical and some are marginally substantive but on the core substantive issues, this bill fails on the

presidents test. something has to be changed. first on the area of coverage, second the area of cost drivers and third the area how you make sure people don't lose their policy or else the standards which we have signed on to are not going to be met, and i have spent the vast majority of the effort i put into the congress since i've been here is to try to control this rising cost of entitlements because i've seen it as such a threat to our children's future and nations sustainability and it is just i think a dramatic departure from a fiscal responsibility to have this class action in this bill and you can claim your ten year savings. you're going to be able to claim that, i don't argue that, absolutely but over 40 years you're putting $2 trillion cost

of the kids that you're not paying for. >> let me fundamentally disagree with his conclusions and that i think we do agree on the principles and the president's out late covers many fellow citizens as we can to have a quality program obviously and have one where people have choices. they don't lose the plan they have if they like to get to choose hospitals, doctors, insurance coverage but more important as well and the president said this over and over and over again, and i certainly feel strongly about what i'm about to say and this bill has to be deficit neutral. what we are talking about has to be paid for and my friend and colleague from the venture has identified which -- what we received earlier dealing with coverage and there are numbers that did provide sticker shock in terms of the cost and number of people that would be affected. those proposals are no longer operative and having been drafted. we are still working to find out how do we get coverage, how do

we get numbers down for the cost of this program so it is deficit neutral over the ten years, how do we get the numbers of those that are going to be covered and participate. that is no small challenge. seven american presidents and congress the last 60 years grappled with this issue and not have succeeded and yet as my friend just pointed out i agree and the president does and virtually all of us to the present system is unsustainable. it has to be addressed so we need to sit down together and work how we achieve those goals which we all embrace. senator enzi talked about basically 80% number which i agree with i think about 80% at least and the question how we get there and how we do this is where the debate is, and it's hardly a debate that's been concluded or over with or a fait accompli, quite the opposite in fact, grappling trying to figure out how to do the pay or play in a way that doesn't overload business that makes it attractive to stay in those plants. that's critically important.

we ended with a migration of employer based plants and got would be the first to admit this is a difficult set of problems to confront and grapple with and it is defied solution for more than half a century but the fact of the matter is 14,000 people today are losing their health care coverage and those who have it can hardly afford it and if they have it they have deductibles that make it out of pocket expenses and possible to pay as i mentioned yesterday 80 to 90 million people of fellow citizens any given period on the calendar year are without health care coverage. any one of loss in this room who are sitting at this desk or behind us here have health care coverage. we have the federal employees health benefit package and while we might get worried about health care crisis confronting not and they need that help and our economy cannot sustain a

system that is going to cost as much as 50% of people's gross income and if we don't respond to this. so it is a critical time that we come together and i'm determined to achieve that, and obviously this is a first phase is going to take belding bills together and then working with the house, working with the president and others to come up with the final package that will do the exact same things senator gregg has talked about providing insurance for a program as well as of course seeing to it that we have the ability for people to remain where they are if they like that or be able to have the kind of coverage they need so those are the challenges before us. but i would hope before we decide something is an abject failure even before we have had a chance to propose ideas and work with each other, the american people lighting are looking for optimism and for us now to sit at a table like this has we all unfortunately do where we are divided by republicans and democrats. i think they want us to act as

americans and come together where we can and knowing their differences on how we approach these matters but they expect us to try to work together to come to the solution. that's the challenge and virtually everyone at this table has been a chairman at one point or another of a committee depending on the majority minority status and it's not easy to pull this together to come up with a product. one-quarter of the united states senate is represented i had the finance committee and about half the senate working on this not to mention the other body and white house that tried to pull together to make sense. the easiest thing for me to do at this point would be to throw my hands up in frustration and say this isn't going to work and quit. no different than any other conference that preceded. we can't solve this. we can't figure out how to do it so let's go on to something else and maybe future congress will come up with an answer, but i don't think any of us ought to be indicted at history because we walked away from a situation we haven't come up with an answer how to pay for this in a way that this deficit neutral

that allows access to americans excluded from coverage and quality system that will allow people to get good health care in the future. that is the daunting challenges that face us. we've done a good job in my view and i want to thank my colleagues on prevention, quality, workforce issues and i realize not ephriam and and has been agreed to and we haven't reached a combination on every point but most this believe we are heading in the right direction on this matter. so i think it's time we take that break obviously with this for the july break coming up, step back, take a breath, have good ideas put on the table and ask our staff to work and listen to each other before we come back on the sixth of july and confront the remaining issues this committee has a responsibility to deal with and then work with our remaining colleagues on the committees to try to put this thing together. in the and it may fail. it may not make it. i hope that's not the conclusion believe in declaring failure when we have hardly started the process. that's not an answer the

american people want to hear. they want to know we have rolled up our sleeves and gone to work and are doing our best to come up with an answer every single day we are here we have an obligation to get this right. everyday we are going to be away another 40,000 people every day are going to fall through the cracks every single day that many will lose health care and imagine if you will for a minute that you are that father or mother or family and lord forbid something happens in that family that puts them at risk and all of a sudden they find themselves without ability to care for their child or spouse none of us want to be in that position and see our constituents in that moment. and we are not going to solve that problem even if we pass a bill five minutes from now. i realize there are provisions that don't kick in for several years on the road so i realize what i've said isn't going to solve the problem immediately but the idea to come up with an answer that would provide the kind of security that family is counting on is something we can't quit, not at this hour,

not at this hour. i and stand at some point others may say i'm sorry i can't support this bill is put together and walk away but let's not say that in the first 15 minutes of this conversation on what's going to happen and the coming weeks and months. that is a conclusion the american public doesn't want to hear boznic at this point. the expect us to get the job done. >> thank you very much, mr. chairman and i agree with almost everything you said. the essential problem we have is that unlike every other major country on earth we don't have a health care system. we have some people say the cost of health care is stressing out the federal government. that's an important point but you've made an equally important point. you've looked at millions and millions of people who today don't have any coverage who are also being stressed out and we have an obligation, moral obligation to look at them. one statistic you didn't mention i think we need to put on the

table -- i know some of the insurance companies will be putting ads on television telling the horror stories but let's talk about one other for a story we don't talk about in this country according to the institute of medicine, close to 20,000 americans die every single year and you know why they die every single year? because they don't have access to a doctor on a regular basis. every person here has heard that, talking to physicians who said to a patient why didn't you come to me earlier? you are now very sick and they lose those patients or the patient is run up huge bills in a hospital because they don't have access to a doctor. is that what the united states of america is about? frankly, one of the questions that we have not dealt into at great enough length in my opinion, mr. chairman is a very simple one. we can argue, and people do, medical economists argue what health care system in the world is the best? what health care system in the world is most cost-effective and

frankly people disagree. generally speaking, economists have looked at countries like france which relied universal coverage to all of their people. people do not go bankrupt in france. by the way in terms of bankruptcy this year when we talk about financial problems, some people might be interested to know there are estimates of to 1 million americans have gone bankrupt this year as the result of medical related costs. 1 million. is that an issue that we should be concerned about? i think so. 1 million people see in their financial resources to run away. why is it -- why is it out for health care system is so expensive and least 46 million without insurance or underinsured, close to 20,000 a year by? do we talk about it? and one of the reasons i think we've got to talk about it is we have 1300 private health insurance systems and what is

the function of a private health insurance system? does anyone think it is to provide health care? it's to make as much money as it possibly can. i want to touch on a few issues i haven't heard discussed. people talk about the problems of government and at this and that. let's talk about something. yet when you talk about the high cost of health care is inappropriate to talk about some of the salaries people in health care are making? do we think it is a good idea people at a time when 46 million americans can't afford health insurance there are people in the health care industry making huge salaries? johnson & johnson, a major pharmaceutical company found the cash to pay the ceo $31 million in 2007, not a good way to spend health care dollars. ron williams, who testified before this committee, concerned about cost effectiveness. $38 million a year. not a good way to be spending health care dollars. in my own small state of

vermont, 630,000 people, the fellow who left blue cross blue shield was the head, got a $6.3 billion golden parachute. think that's a good way to be spending health care dollars when people can't afford health care in this country? the reality is ceo compensation at the top seven health insurance companies call home averages over $14 million a year. okay. now in 2009 hhs inspected general reported 80% of the insurance companies participate in medicare part b the prescription drug benefit have overcharged subscribers and taxpayers tooling estimated $4.4 billion. how is that? is that a good way to be spending taxpayer money? typical estimates of the level of medicare and medicaid fraud around $60 billion. now, i want to just touch on because we haven't gotten into this to make a simple point.

we have uniquely in the industrialized world a health care system dominated by private corporate interest. i just want to touch on a few of those aspects. when you talk about health care cost american you always talk about the cost of medicine, prescription drugs are expensive in america. we pay the highest prices in the world for prescription drugs. let's talk about some of the major pharmaceutical companies and the role they play in making our health care system by far the most expensive in the world. let's start with the largest, fisa. some of you may notice but this year a jury found flies are owed the state of wisconsin $9 million for violating wisconsin's medicaid fraudulent all more than for wheat 1 million times. the company faces potential fines between 140 million or 21 billion. and 2004, a division of pfizer

plan guilty to two felonies and agreed to pay $430 million, $430 million that fraudulently promoted a jog, one particular drug for unapproved use and include was a criminal fine of $240 million. in 2002, pfizer agreed to pay 49 million to settle charges that a subsidiary defrauded the medicaid program by overcharging for lipitor. huge fines. johnson & johnson was charged -- the texas attorney general charged johnson & johnson with kickbacks to texas health officials. johnson johnson. glaxo smithkline signed a corporate integrity agreement that paid 88 million in civil fines for overcharging medicaid.

r roche, $500 million in 1999 criminal fine for leading a worldwide conspiracy to raise and fix prices on allocate market shares for certain items. [inaudible] of and is paid $95 million to settle charges that have violated the false claims act. wyeth joined in to whistle-blower suits against for reciprocal giant wyeth, the drug company failed to pay hundreds of millions of dollars in rebates to the medicaid program. you know, i hear a lot of fraud, and i hear a lot about waste but what i don't hear about is the role that the major corporate giants in the health care industry are playing and ripping off the american people to the tune of billions and billions of dollars. i don't know why we don't talk about that issue the drug companies, huge fine after a huge fine and let's be clear especially under the bush administration whose competence isn't widely respected and also

known as being sympathetic to corporate interest every falling, every charge we have seen probably you could multiply many times they are sitting out there with an aggressive attorney general's office might have gone after. let's look at some of the private insurance companies some people here see as a model that we want to support. united health, 20 or nine, united health paid $350 million to settle lawsuits brought by the ama state medical society doctors and patient spigot these lawsuits allege the company shortchanged consumers and physicians when paying for medical services outside of its preferred network. wellpoint, the 2009 cms board wellpoint from participating in medicare part d and medicare advantage stating they've demonstrated a longstanding persistent failure to comply with cms requirements for proper administration of medicare advantage prescription drug program. aetna and 2003, agreed to settle

a class-action suit brought by physicians by paying $470 million overhauling business practices that doctors say were shortchanged patient care. amana in 2000 he managed a 14.5 million to settle federal charges of overcharging government health programs. sigma, and 20 of repaid $24.5 million to settle allegations of medicare fraud at a hospital that it owns. that is some of what insurance companies do. then you've got hospital change. many people here are familiar with. that in fact in 2000, the hospital corporation of america agreed to pay $745 million. 745 million to settle civil charges that it systematically defrauded. medicare, medicaid and other federally funded health care programs. later that year they agreed to pay criminal fines of around

$95 million. finally, and 2003, hca agreed to pay $631 million more in civil fines, total of 1.7 million. tenant healthcare corporation, 203 -- in 2003 paid allegations for to doctors that performed on necessary cardiac procedures on patients in the interest of profits. imagine that. cardiac surgery in order to make money when the surgery was not necessary. 2006, ten and agreed to pay 725 million in cash in order to resolve claims that defrauded the federal government over billing medicare claims during a six year period. and on and on and on it goes. so when we hear -- and mr. chairman, i would ask an analyst consent to enter this information into the record -- >> without objected, so ordered. >> i got a little tired hearing about how the government can't

do anything. government can't do anything. well you know what? what you're seeing many years is a systemic record on the part of private insurance companies, private drug companies, private for-profit hospitals to the tune of many billions of dollars of ripping off the american people and the taxpayers of the country and then you wonder why in "the new york times" people say overwhelmingly they want a government plan to compete with the private sector. no kidding. isn't that a shock? very few people in the country have a great deal of confidence in private insurance companies, they know that we are paying the highest prices for pharmaceuticals that got ripped off everyday by the drug companies. so i just say these words, because i don't have an offer today to deal with these. but we need to think about how we are going to stop -- how we are going to stop the illegal systemic illegal behavior of many of these large corporate interests who are costing our

people, our tax payers billions and billions of dollars and that is something -- thank you. >> i want to respond to your points which were off in response to light once i don't think. my point was we should proceed with health care reform but it should be based on the president suggested which is everybody gets coverage, the people that we did the of your cost curve and people don't have to give up their own insurance. this bill as it has been brought forward has been scored as leading the 30 of the 40 million people that don't have insurance are covered, hasn't been in the altar cost curve as radically expanding the cost of health care by $2.3 trillion when it's phased in for scoring only one sixth of the bill. we still know it's going to be more expensive on the additional

items coming forward and by having 15 million people move off the present plan. there are -- there is language out there that all i am a sponsor of which is generally bipartisan that accomplishes all of the president's goals which we could have marked up on for example the white in-bennett bill. there's language proposed by senator coburn that accomplishes all of the president's goals which we could have marked up from. but why we chose to mark up from a bill which fails on all of the main proposals of the president, something i have trouble understanding. we can do health reform and a bipartisan way. as the president set up a very legitimate goals which we all subscribe to. but what energized my concern was this new entitlement that's been put into this world, buried in this world which scores positively the first ten years but dramatically aggravates what

is an unsustainable situation we confront as a nation which is unfunded liabilities in health care accounts and it aggravates it by $2 trillion so i'm not suggesting we not proceed and i ma suggesting that we truncate the exercise. i'm suggesting we go back to what the purposes of our and address those purposes as being the cord drivers of the process. >> i thank the center. senator harkin. >> thank you. i ask unanimous consent but before i do that i just want to respond first of all to senator gregg. you know, somebody just said the president wanted to accomplish. there is one way to accomplish and that is a single payer national health insurance program. peery simple. >> if you want to bring that forward obviously senator sanders agrees why don't you bring that forward and we can bring forward senator coburn's proposal or my proposal and then we will at least be working off product which gets where you want to go, where i want to go,

different philosophies but this product we are working on today does not accomplish what single payer would accomplish. >> i say to my friend i am sure we have if chance to vote on the senate floor when we were the other. but i also want to say to my friend senator sanders, thank you for when you pointed out that the inspector general reported 80% of insurance companies participating in medicare part d overcharged subscribers and tax payers and estimated $4.4 billion that has to be factored in i think to our thinking process are not here and how we are building this system. we do what we can i around here, and while i have long been a supporter of single-payer -- my record is clear on this going

back to paul wellstone in the early 90's -- that that was the simplest straightforward i probably recognize there's not the votes for that. that doesn't mean we shouldn't talk about it and let the american people know what it would mean to have a part single-payer type of system in this country. i think people ought to factor that into their thinking process it is true, a recent poll said 72% of the american people responded positively to a public plan like medicare. they even used the words "like medicare" to describe it. 72% said yes they would be for a public plan. i hope and trust we will come out of here with a strong public plan out of this committee, and i sure we will. and hopefully we can keep that as we go through melting the two bills on the floor and on to the

president's signature. while i recognize it may not be there, you know, i've said before i want a chance perhaps on the senate floor to vote for single-payer. not that it's going to go anywhere, i understand that. i just, you know, when we finally get to that 20, 30, 40 years from now and i want my kids to say my old man voted for that a long time ago. so why do want to have that opportunity. sali thank senter sanders for again, bringing a little dose of reality as to what the parameters of our on health insurance. mr. chairman, our staff has continued to work on these, on the prevention title and a forked up the two amendments with senator enzi, amendment number 50 and 51 and i would ask unanimous consent be adopted as modified. >> witho