budget is. you know, our situation is we don't have a budget. and so the alternative, you know, isn't to have somebody who is an elected decide the budget. and i think one possibility here as a part of health reform is we have always individual saving items. you set a medicare, medicaid budget for the next 10 years. and then you say to the president, your budget has to include a package of things that assures we are on this path. that package will be evaluated by medpac and by the eo and then we'll go on a fast-track basis to the floors of the appropriate committees and then the floors of congress for an up or down vote. and if the vote is down, then

there's some kind of automatic mechanisms that will cut provider payments or increase premiums or whatever to bring the discipline that you didn't have before. . .

i would like to thank everyone for coming and i would really like to thank the panelists for their time. i would like to offer a round of applause. [applause] the purple sheed norpac was an evaluation. if you could fill that out and slides will be on our web site, www.nihcm.org. thank you. [inaudible conversations]

[inaudible conversations] >> it is the last thing congress before the july 4th recess. the house gavel then this morning to complete work on the 2010 anterior environment spending bill for ago that legislation providing $32 billion for the interior department, epa, u.s. forest service and related programs. also today climate change measure that aims to restrict emissions of greenhouse gases while requiring the use of alternative energy. the legislation targets greenhouse gas reductions of 17% by year 2020. live coverage of the u.s. house is on c-span. also senators have already began their july 4th recess. the chamber will not return until monday, july 62:00 p.m. eastern. when they get back we expect

more work on rebrands spending. that bill appropriating $3 billion for entities that include the library congress, the capital policing government accountability office. live coverage of the senate continues here on c-span2 when members gavel back in. this afternoon in look back it 30 years of close-up television programming on c-span. we will hear from current and former associates of the show including john oleskey and marcus artman. the guest take questions from students and teachers of the close-up academy. you can see that today at 7:00 eastern on c-span2. >> as this year's supreme court term comes to an and, here chief justice roberts talk about the court's work, then a panel of experience court watchers including linda greenhouse, jan crawford greenberg and ted olson review the decisions handed down this past year. live coverage on c-span saturday morning at 9:00 eastern.

>> now elizabeth edwards talking about patients' rights. she spokane washington at the patient's advocate foundation. this is about 40 minutes. >> good evening.

good evening. i would like to invite all of you to continue to enjoy your dinner, but we certainly want to have adequate time and attention to enjoy the remark that elizabeth edwards is here to share with us this evening. i would like to introduce her the way all of us as advocates i think know her. i think elizabeth that if there was one thing this audience could say to you is that we see you to be a woman of substance. bctv someone that is an advocate for children. [applause] you are passionate about sharing your experience with cancer. we see you also as someone who is reached into your community and established scholarships and in honor of your son, wade and also an honor of your father and we also have scholarships for

survivors. wees seawall so as someone who decided that he would record your thoughts and your emotions or all of us to learn from. your first book was saving graces, pining solis end-strength from friends and strangers. your memoir after your diagnosis. how many of us in this audience have read this book? let me hear a round of applause. i think it is also very special that tonight you have signed for us your newest book, resilience, reflections on the burdens and the gifts of facing life's adversities. you are a woman of great love. you have demonstrated that for your commitment to your family, your commitment to your four children, door commitment to your scout troops coming to the march of dimes and all you have done during your life to help others. we find you also to be a woman of grace and courage. and it is a real privilege to welcome you to this podium this

evening. thank you sincere-- sincerely. >> thank you all very much and a special tank as to nancy and jack for turning entrainment to something so incredibly powerful. i came up from north carolina. i had actually matt a lot of north carolinians here. the north carolinian diaspora stent everybody out. nobody was.com. some people write the beach and some people were at camp, so i was at home and you would think that be the perfect time so i would be incredibly organized. i was not. i pulled the folder where i'd put my speech and the schedule

of what was going to happen in my bag and the speech was for an event in montana. [laughter] i write this beaches separately for each event so it was a problem. the opening of this wonderful cancer clinic in montana was something i wanted to talk about but not here. so this afternoon i got to rewrite the speech. so, i will probably look down a little more than i should but i am doing it because it is important for me to say something that was a particular to what ewald do. it is honestly and immense honor to be with you tonight to say that i admire you, i applaud how you decided to spend your lives would be a tremendous understatement. when the high school chorus often sings the angels ominous. ifill that i am among angels when i sit with you and i am amazed by that. nancy was saying that lia has a halo over head and i honestly

think that is true of most people in this room. you represent the best of boss. from compassionate cam angerame and a hope and with determination, and probably the hardest thing is that longstanding every day getting it done year after year, the hard work of making a reality. again, you have made an immense difference providing not only better healthcare but great peace of mind to millions and millions of americans and i heard i think in 2007 a quarter of million of those for children. it reminded me of watching a family under stress in the waiting room at my public hospital in north carolina about a year ago. i had to drink that terrible drinked drinks before scans. it looks like coca-cola, it is not. [laughter]

you trinket and then you have to wait a little while. i am waiting with a lot of other people who were drinking a miserable drank and waiting for my turn for the scant. there was a woman across from me who was on the telephone. and sheed, her daughter, i could tell she was pretty quiet and impossible not to listen to this conversation. heard daughter has 30 gone back for hers can come up but had not started it when the insurance company called and said the scan would not be covered. she was called as well and told it would not be covered so she was on the phone and your voice ranged from pleading to crying to anchor to confusion and back to pleading. i left before the resolution of that, but this woman's voice says stayed with me. it echoes in that this is exactly the kind of thing that we can't have tappen, get it happens over and over again, as you all know. i am not telling the audience hear anything that you don't already know.

our healthcare system has holes and shortcomings. every system in the world has shortcomings but this is more than that. are health insurance company particularly the 60 million americans with individual coverage or for the 25 million who are underinsured it's certainly the 30-- 47 million hickham for the premiums at all and therefore have no health insurance. that system is really broken. we can call the contact of the insurance company reprehensible and immoral and i sometimes do that i have to admit. we can bemoan the fact that the loss of the insurance company has a fiduciary obligation. a relationship of trust with their stockholders but has no fiduciary obligation to its insurance. but we must also say and we note that we know that the system exists, that we know that some insurance companies give bonuses to their claims managers who do not deny claims are resent policies and we know this and yet we have done nothing to correct this heartbreaking misconduct.

these devastating eventually terminal diseases are difficult. we know this too. and, you know this because your case managers walk hand-in-hand with a lot of these stations through this difficult process in their care and treatment. statistics being what they are and also because i met a lot of you as they did book signings earlier, i know that they are survivors of my disease in this room and i want to thank you for being my companions on this road. [applause] and i talked to at least one of you on this. the rollercoaster of it went on that right, the news is not good and for some of as we know there will likely come the day when the news is not good. it is all we can do not to drop to the ground because of our foundations and so shaken. even when the news is not devastating we still need life fines to keep a steady. some things we know our

constant. like our insurance coverage. [laughter] this gann results or the seed in the chemotherapy regimen that we know we are going to be able to go to. take those away and we drop again, but just as the floor beneath us in shaking an insurance company polls not the rug but the whole of the earth out from under us from to many of my brothers and your brothers and sisters. you are tired of it, i am tired of it and i think we up on the gun to the point that america is really sick and tired and wants to do something about it. i often talk about the importance of commitment patients not to see themselves as victims. i will tell you the story about, the stories frivolous but there's such a truth in it and it is 1956. i was seven years old and i was walking to church with my parents taught sunday school. we were all going to sunday school together. my parents gave us our loans and are donations to the church here

on sunday morning. and, understand that it is 1956. i think they gave it to us on sunday morning so we would not spend it on saturday because the stores were closed on sunday. we were walking with hard times, one for the addition one for our pockets and my sister has taken the dimes and shaking her hands the way children do, a rattling noise. as we stepped up on the curve one of the times popped out, roll down the curb bad and down into the drain. my sister is five years old. it takes are not a second to say, there goes the lord's time. [laughter] [applause] she was not going to be a victim. [laughter] and i will tell you that nancy has grown up and she is not a

victim. i often talk about the importance of this because the questions of people living with cancer bombarded sometimes was sobering diagnoses, which pitying looks with some pretty somber statistics now and again. and you are undergoing physical and mental burdens of treatment with the disease, both of which are sometimes overwhelming. sometimes there's so encumbered that it is hard for them to muster the strength of spirit to recognize they still have sober in their hands and that is their own human dignity but you know sometimes it's even harder than that. you have more taken away then just the years at the end of your life that you think this treatment is going to at least give you, that you think you have got a difficult path during treatment but you are going to have these years after it. but, some people face greater hurdles than that and that is when they think they can get treatment at all.

their resistance to the word victim is the glory and a power. i felt empowered because i had those things. ifill empower diggins my disease. but the truth is that it is hard to resist when you don't have any weapons against it. the newly diagnosed woman said i sat next to actually in that exact same waiting room. she was hardly able even to stand she was so frail. hershel there shuddered, as she wondered whether she would be able to work and if she couldn't work which you have health insurance. in order to get the treatment she needed. in addition to all the other problems you have how was she going to be able to drive for self here or drivers sell there? who is going to take care of things that needed to be taking care when she was too ill? there was a mother told me she had sold her car because she needed the money to cover the costs of insurance co-pays, but she said that was okay, though her voice was not particularly convincing. she could always take the bus. lee's stations need in these

moments to have some certain days, some lifelines. we are trying to find a cure for cancer. we can always do more of course a we need to find a cure for health insurance system that leads to many of the shuddering in fear. we can, i know we can do this. we up to fix the things we can fix. it is simply wrong not to. we connect with up one another. the reason i was inundated with e-mails and letters, stem mell after mike diagnoses was because i think people have this disease want to share with other people. they want to make that connection. that becomes of lifeline for them. when we try to connect with incredible support groups like the patient advocate foundation. they are all useful and all-important but the problems still exist as long as there is a need for the advocate foundation to help individuals get the care and the health insurance policies and the actual conduct of the insurance companies that they need. we as a society, as the country to make certain that something.

this is a simple rule it seems to me and this is, when you ask what it is you want, you want people who are sticking get the care that they need. it is not-- it is just as simple as that. [applause] sorry, as a fool with my hair. a lot of people in this room know just what i mean. [laughter] at this moment in time, we are on the crest of trying to wrestle out of healthcare and the health insurance system that follows that role. what do i think that means? our healthcare costs a larger percentage of our country's monetary production than any other industrialized nation of our gdp and any other nation. do we have the best healthcare? if you measured by our finest institution scattered around the country, i think the best healthcare in the world is available right here. people traveled here from distant places in order to get the healthcare that we have.

though we know this clinic doors are not open to all of us. i wanted to celebrate the life and lament the death today of the farah faucet his courage was even larger than her celebrity. [applause] she live longer than anyone predicted she could perhaps in part because some of the treatment she got was right here in this country where we have such good care. people come from around the world as i said but not all of us get it. some of us get no. alper coe we are measuring as a nation whether we have the best healthcare, we need to look it something other than the isolated cases of somebody flying in for some rare and difficult procedure. we need to consider-- that might be your children, answer your phone. [laughter] we are measuring as a nation with a we have the best

healthcare in the world. we have to admit that we are far from it. in terms of longevity, we are 36. first and how much money we spend, 36 and longevity. and we are far from the top on infant mortality. when a quarter of the population, one in every four of us is either uninsured or underinsured perhaps it is no wonder we have the statistics of the first thing we need to do is get healthcare costs down so it doesn't represent such a huge burden on the hour, on individuals, families and the government. there's so many places not engaged, so many places that are not in the healthcare delivery system that are not actually involved in providing healthcare itself. some of those drain money from the system, and in a blade that we can address and six. the administrative cost of insurers, when medicare and medicaid are three to 4%, some insurers are 30 to 40% you have to figure there is some way

stinner that we could tap. profits even in good times, perhaps taking a fiduciary obligation to stockholders babies too seriously. we are providing healthcare. if layers of administrative health coverage in people, most people would never heard of, people like health benefits administrators were not administering health benefits but in fact your managing profits for the participants and the healthcare system, not your profits but the profits of the businesses involved. i don't mean to pick out only a few places though because many to look at the entire system of something, anything that does not provide direct care to patients and see whether we are doing them in the most efficient way and whether not there are necessary profits at any of those levels. any cost that does not result in direct efficient and effective treatment of patients, and i want to emphasize effective treatment of patients or the training of healthcare providers

need to be considered by each of the political parties and by everybody involved in the process, as they evaluate honestly whether not because they are paying needs to, needs to be reduced because the government needs to look at it because in terms of dollar we are the largest purchaser of healthcare policy-- health care services and the country. the healthcare providers and the insures all need to look at these different levels. lia party got the promise from the insurance companies that they will plead out some of the excessive costs over the next ten years. i think it was $2 trillion. i don't know what did they want a quid pro quo for that but why would they not want to eliminate $2 trillion of excess costs right now anyway? why didn't they do it last year? [applause] i mean, thank you but some of the cost savings that we want to

see happen are actually going to cost us money in the short term. we need to get healthcare costs down in the long run. by being healthier, we need to, we can be healthier of course of we live and eat better which we need to do but also if we get screenings and diagnostic test that will be feel any deterioration in our health at the earliest possible moment so we can get treatment and we called stop the progression of those diseases before they become debilitating and costly to treat. it is much more cost effective to treat diabetes than it is to treat the results of diabetes and treated, and on diagnosed. for example of someone has suffered from kidney failure or a stroke those are extraordinarily expensive things, much less expensive and so much better for the lives of americans of we can address these problems before they get to that case yet insurance companies have thought that the state level, the covering of testing for diabetes and even in a couple of states successfully, the coverage for the supplies

for the treatment of diabetes that has been diagnosed. we have wehrey too, and it is one of the topics i am sure that those of you visiting have heard about the strain of the baby boomers on medicare but you know that medicare, many people entering medicare has as many as five chronic conditions, some untraded because they said i don't need to get health insurance and in three years i'm going to be on medicare. so it's something hands up not getting treated and it gets worse, so by the time they get into medicare we are talking about a much more expensive treatment then we might have if we had more timely diagnosis. understanding this timely diagnosis is not going to say this money in your one. it is going to cost us money but what does it do in your five? what is it due in year ten? beacon make an enormous difference by our willingness to understand you have to fix the roof before it gave sin. we almost always sill to consider the cost of the uninsured among us.

and, this is another thing i think a lot of people americans are uninformed about. if you have health insurance today you think you are paying for your family but you are paying more than that. about $1,100 of the insurance that you pay for your family actually goes to cover the uninsured. in order to cover their costs healthcare providers have to spread the cost to provide services, have to spread the cost among their other patients. and, the result is that the pay that $1,100 more. i am not happy. i am disquiet did. buy does it create a fear in all americans that all americans will be taxed by healthcare reform. those of us with health insurance are being taxed right now. at $1,100 a year. just because we don't have healthcare reform. we want to get healthcare cost. we want to get this down and we

need to make certain everyone has health insurance for ago the second thing we need to do is to make sure when people are sick they get the care they need, whether not they get sick the day before the day after they got health insurance. the patient's advocate foundation-- [applause] has been a true leader with respect to preexisting conditions and so you will know that the coverage of preexisting conditions with premiums that are based on committee dewhite ratings is essential. imad a woman in cleveland in march 2007 and i will talk about your little later but i was giving a speech in cleveland and at the book signing it was afterwards. she came up to me and because of the direction she came, she came to me from the elevator so i thought perhaps she had not been to the event. she was dressed in a suit and stockings so i assume she didn't work. i assume anyone wearing stockings must have been a work because why else would you wear them?

[laughter] and she spoke to me in a whisper. she said my name is sheila. and i am afraid for myself and for my children, because i found a lump in my. but i don't have health insurance so i can't go see the doctor. her employer did not provide it, she could not afford it and the lump was cancer and she did not get it treated. was arguably a death sentence for her. in america, in 2007, a working mother. shame on us. and shame on a system that actually disincentivizes, and i say from getting treatment. if she had been intended to the rules on preexisting conditions sheila would no not to get dep biax dabashi was uninsured. and that she would know not to engage in those pesky self examinations he should do monthly. because she identified a preexisting condition before she had insurance, she was not going to get it covered when she did have insurance. we have created this system that

makes it absolutely no sense, if the purpose is the delivery of healthcare. the purpose is something else to make profits for somebody maybe this make sense but the purpose is to deliver healthcare this is completely packer's from the way needs to be. the final thing i want to talk about but unfortunately the final thing we need to do. this has been one of the major sticking points i know and certainly a sticking point for-profit centers to have no interest in healthcare reform debate moving forward. cheek of those would be some of the health insurance to surely do not want the competition better health insurance premiums have gone up 119% in the past ten years. there is a number from, i think between 2000 and 2006 their health-insurance premiums