so without further ado, we'll get started. let me introduce george burke who's the directer of communications for representative connolly's office. [applause] >> what a crowd. the health care reform is an important issue that impacts every amerin, and we know it is particularly important to all of you gathered here today. there are a lot of myths being circumstance rated -- circulated, and there are also concernsnd questions about health care reform. today we want to try and address your concerns and your questions. we thank all of you who chose to attend today's health care forum, and we apologize to those who could not getn due to the physical limitations, obviously, of the venue. as we open the meeting, congressman connolly and our distinguished panel will deliver brief remarks, and then i will hand over the microphone, and

they will field your questions. there a two microphones in the audience. if you prefer to stay seated and stay at your location, steve elliot will have a roving microphone. raise your hand there, please, steve. ank you. so just raise your hand, and steve will find you. as will mentioned, we hope you'll limit your questions to 30 seconds so that as many residents as possible have the opportunity to ask questions. .. your question is not answered

if we cannot get through all the questions there will be index cards that will be passed out to anybody who asks one. we ask if you have your name and address and ask the question that you were not able to ask. i hope we can get through them all but looking at this room, it may be tough. it's my pleasure to introduce someone as many of you know, 11th district congressman jerry connelly. during his 14-year career of a member of fairfax downtown l.a. board of supervisors, the last five of the largest jurisdiction, he accomplished the agenda that earned fairfax the best managed large county in the nation. i think many of you already know that. he has a long record of achievement on many issues

including issues affecting seniors. since taking office in january as your congressman, mr. connelly has already earned a reputation as an expert on state and local government issues, and on budget issues. and he was recently recognized by a national magazine for his work on issues concerning the federal work force. recently, he was elected president of the freshman class in congress. without further ado, i give you congressman jerry connelly. [applause] >> thank you. thank you very much. you know, i'm irish and i can't resist telling the story of mrs. murphy in fairfax county. she was driving around and too fast in a residential zone and e stopped by a very young police officer just three weeks out of the academy, and he stopped her and said, ma'am, you were going 50 miles an hour in a

25 miles an hour zone and he said i need to have your license and she looked up at him and she said i don't have one and he said i'll have to see the car registration and she said it's a stolen vehicle. he said ma'am, i'd like you to open the trunk. she said you don't want me to do that, there's a dead body in there. [laughter] >> he's flustered and calls for backup and his sergeant says ma'am i need to see your license and s said with that sweet irish brogue, no problem at all and she hands him the license and what about the car vehicle registration. it's ceo in the love compartment. no problem. he said open the trunk, please. she said sure and it's clean a as a whistle. you told my young officer you didn't have a license and the car was stolen and there was a dead body if the trunk and she looks up with that sweet irish face and she says i bet he said i was speeding, too, didn't he? [laughter]

>> so the irish ways thinking. thank you for opening -- giving us such a warm welcome at green spring as you always do. i'm a familiar face in green spring. i've been coming here for the last eight or nine years as a public official representing this area. first on the county board and, of course, now in congress. a few things i want to tell you about in terms of healthcare. first of all you need to know that your congressman has not endorsed any bill. i have not said i like this bill or that bill. in fact, as the president of the freshman class i've raised some concerns about some provisions in the major draft in the house of representatives. there are three bills that need to be reconciled in the house of representatives so we don't have a final draft but the working draft we're all looking at is this one. [laughter] >> and in case did y want to know, did i read the bill, i took notes.

and i've read a lot. i've read hundreds of articles. i'm reading a book called "overtreatment". it's a great book. i've gone throughots of briefings and lots of other things trying to make sure i'm educated in healthcare and that we're looking at all the right issues. i have some concern about the funding of the bill. i have concerns about the nature of coverage in the bill. i have concerns about some of the reforms. when i look at healthcare reform, let them just share with you what i start with and maybe you do too. while a lot of us like the coverage we have now -- and by the way, how many in this room have medicare? [laughter] >> and i know that the republican precinct captain, wherever he is, knows that's a federal program. right? but a lot of us have medicare. i just talked to my dad -- everyone is lobbying us, of course, on healthcare. i just talked to my dad who said, you know, i've been using medicaid now for 17 years.

he and my mother are in frail health and they've been great consumers of healthcare but he said to me, i want you to know that -- i don't know if this is your experience but he said in 17 years of being a consumer of medicaid, not once had they made a mistake. not once have they failed to make the payments that they needed -- you know, that they were required to pay. i'm a happy customer. that was important feedback to get from my dad. who as i said is a big consumer of healthcare. i think if you look at the economics of healthcare, we're in trouble. it's costing too much. in the united states we spend $7,000 per person per year on healthcare. that's twice the median of all of the other industrialized countries. so we're paying twice what they're paying. we're now spending -- in 1960, when i was 10 and john kenne was connected president we spent 5% of our gross domestic product on healthcare.

today we're spending 18%. and if we do nothing by the time i'm 100 and maybe living here in green spring, we'll be spending 48%, almost half of our economy on healthcare. that's not sustainable. you have even seen it in medicare payments. they are going up at at the point % a year. it's taking a bigger and bigger bite out of our seniors' incomes on limited incomes especially. deductibles in the last 10 years have doubled. premiums in the last 10 years have doubled. copayments in the last 10 years have doubled while insurance company profits have gone up 428%. i want to look at three things, broad things. there's lots of particulars we're going to talk about today. i nt to make re that the 47 million americans who don't have healthcare coverage and we're not concerned about it not just

for humanitarian reasons, they represent a tax on you and me. what healthcare do they resort to if they don't have healthcare coverage in insurance? they go to the emergency room. uncompensated care in amica cost $43 billion. you and i pay that tax. in higher premiums and higher billings. now, i want to address that 47 million who don't have healthcare coverage to bring them into the system and believe it or not, that can help lower cost by having bigger risk pools. the second thing i want to do is have meaningful basket of healthcare reform. let's start with medicare. i want to close the doughnut hole on prescription prram and i want to make sure seniors have access to the medication they need and that nobody in america over 55 or 65 has to make that terrible decision, you know, do i buy a meal or do i buy the prescription drugs i need? and you and i both need there are some specialized prescription drugs that cost a lot of money.

i want to make sure catastrophic illness doesn't bankrupt families in america. in our district alone, the 11th congressional district where you and i live, last year, 1430 families filed for bankruptcy because of healthcare costs. and any family in america, young or old, could be one accident or one illness away from catastrophic healthcare costs. and so catastrophic costs so that no family is forced to be in that position, i think, is an impoant reform. portability of healthcare insurance is an important reform. preventing insurers from cherry-picking for previous existing condition. now, you and i are of a certain age but a lot of my staff, some of whom are in this room are in their 20s and what i say to them if you're lucky enough, everybody in america will have a previous existing condition.

because as we get old, we develop conditions. and some of them are more serious than others but let them just tell you 45% of all insured americans have a previous existing chen my wife is a diabetic. she developed diabetes because of a asthma attack a few years ago they put her on a drug that triggered that diabetes. cost a lot of money, you know, to maintain her health and as she get oldert will get more aggravated. so we care a lot about that previous -- it's now a previous existing condition. and millions of american famili face the same thing. and all too frequently insurers have actually exercised rationing of healthcare by denying coverage for that previous existing condition. we need a reform that will end that, that will make that illegal. you cannot do that. and believe me the insurers can afford it if their profits alone have gone up 428% in the last

decade while you and i are forking out more money for healthcare. and the third thing i want to see is that over time, we get control of that long-term healthcare curve so that the cost to the economy, to the federal government and to families the costs go down so if the costs are more affordable for businesses -- let them give you an example. the cost of doing nothing is that these costs continue to rise and more and more americans can't access the healthcare they need. let's take small businesses. now, maybe most of the people in this room aren't running a small business but you know somebody who is. or maybe you ran one. 60% of small businesses just 10 years ago provided healthcare coverage to their employees. today, it's only 55%. 45% do not provide healthcare of any kind. if we do nothing, the cost of small business, just small business over the next 10 years will get to $2.4 trillion.

what that means is, we're going to have probably less than 35% of small business providing healthcare coverage to their employees in 10 years if we do nothing. so i want to make sure that whatever we're talking about in terms of healthcare reform do those three things. now, let them make one pledge to you. i will not vote for any healthcare bill that in any way, shape or form does any harm to medicare. thank you. [applause] >> i think that's an important principle. i want to vote for a healthcare bill that, in fact, improves medicare care by closing that doughnu hole on prescription drugs and allowing us to pursue preventive healthcare. the draft bill here, for example, would eliminate the copayments for people who go in to seeir doctors for preventive healthcare. and i think that's good reform because the more we can focus on preventi care we can

effectuate savings in the long run in our healthcare system. i have an open mind and i'm here today to share with you and to also listen to you. i know we're going to do that in a civil and respectful way as green spring always does. and when we're fished and you see all these cameras and the press, hopefully, the residents of green spring wl show the rest of america how a town meeting ought to be held. vigorous debate debate, strongly heldviews, listening respectfully to one another and sharing civilly and respectfully with one another and i can't thank you enough in advance. thank you so much for having me here today. [applause] >> thank you, congressman. it is now m privilege to introduce former congresswoman barbara cannelli. she's the president and chief executive officer of the national committee to preserve social security and medicare. mrs. cannelli has spent 25 years in public service at the local,

state and federal levels including 17 years as a member of congress from connecticut. she is a former ranking member of the house andays committee on social security. she was the first woman to serve as chief majority whip in the u.s. hse of representatives. she's also the first woman to serve on the house commiee on intelligence. throughout her career, mrs. kennelly has advocated for social security, medicare and other health and retirement issues. it's one of the reasons we have her he with us today. after leaving congress, she served as counselor to the commission of the social security administration. she served on the 2006 white house conference on aging and in 2006, she was appointed to the social security advisory board so iould suggest she knows her stuff. without further ado, let them give you congresswoman barbara

kennelly. >> thank you for having me at your beautiful place. your congressman certainly knows his stuff and i've been to a number of town hall hearings and hear him go through that bill is just music to my ears. i want to tell you that aam here to preserve social security and medicaid. we have 4 million supporters and they come from all walks of life but the one common thing they have in common is their absolute passion about social security and medicare. and before i get into medicare, and i'm not going to speak that long because i know all the questions that you want to ask but i want to mention social security. i think some of you remember a few years ago when our president bushecided he wanted to privatize social security and as a matter of fact, it was not a good idea. and i went around the country talking to our members and i

would have audiences similar to this audience. and they knew their social security wasn't going to have anything happen to it. it was safe. but they might have a daughter who's 47 years old and three children and things haven't gone too well and they knew that daughter would need social security so every time the president went out to have a town hall meeting, it grew and grew the people decided privatization was not a good idea so now i have people saying to me all the time, barbara, you don't have to worry about social security, privatization is dead. well, i got to tell you something. we do have to worry about social security and the reason we do is the deficit we have in this country. and the people that were against social security in 1935 and all through the years are the same people who are for privatization and now they're saying you know what? with that deficit the size it is and it is big, we can't afford social security and medicare and that is absolutely not the truth. it's not social security that caused the deficit.

as i recall, we all paid into that every single paycheck. but let them get on now to medicare. do we have serious problems with medicare? yes, we do. is it the fault of medicare? no, it isn't. it's been onof the most successful government programs there are. but the fact of the matter is, medicare is a healthcare program. and it's immune to what is happening and what the congressman was talking about, the high inflation rate that continues for healthcare. and we have to remember that medicare uses the same hospitals, the doctors, the same mri facilities but, you know, although it is so efficient, and it's not perfect, but it's certainly a lifeline for most seniors and although it is as efficient as it can be, it can't pull the tide of inflation. so it's awfully important that any healthcare reform bill strengthens medicare and certainly doesn't weaken it. like the congressman, my

group -- we have not taken a position on healthcare reform. do i want heahcare reform? of course, i do. but you look at the three bills that came out of the major committees in the house, and they were all different. there's different little pieces. they have to go to the rules committee. that's the procedure and they have to be melded together. then they go to the vote on the house. senator kennedy's health education labor and pension committee -- they have a bill i love. i just love it. but it's very, very expensive. and i know there's going to be changes that bill. now let's talk about the finance committee. those six senators must just love each other 'cause they meet and they meet and they meet but they don't tell us what they're doing. and that's why i can't endorse a bill and that's why the congressman can't endorse a bill 'cause we don't what the bill is going to look like and remember, the house bill that's voted on in the floor and the senate bill at will be voted on the floor

of the senate, then it goes to conference and i remember in 2003 when we had the medicare modernization act where you had part d, the prescription piece, that went to conference -- i read the bill. it came out of conference i didn't recognize the bill. it had totally changed. so that's why we're kind of holding off. and my organization for the last 25 -- it's 25 years old, for the last 25 years has been protecting medicare and fighting against medicare cuts and we're certainly not going to stop now. and here's what i'm trying to say to you today. i know tre are those who are saying, seniors, retired people, don't be for healthcare reform. medicare is good, don't be for healthcare reform. i promise you, if we don't do healthcare in conjunction with the greater, broader healthcare siation, down the line, the only place they'll be able to cut inflation, the only place

because the only place the government has control over is medicare. so what i'm saying to you and my message to you today is, don't yet be against any medicare reform because unless we do it with the whole healthcare system, we're going to be out on a limb and what they call it, they call it entitlement reform. and that's social security, medicare and medicaid. and that situation is going to start in the budget committee and am i glad this congressman belongs to the budget committee 'cause i know he understands -- i just heard it, how important medicare is. but he also understands, you know, we americans could be very, very arrogant. we act like our social security system is the most generous in the world. well, let them tell you something, it's fifth from the bottom in industrialized countries. the average social security check for a year or how much you get for a year is $13,800. so let's not try to cut that too much. but let's talk a minute before i

finish about the $500 billion that we read about that is coming out of medicare. i have to tell you some of that $500 billion is really going to help medicare because come january, if the congress doesn't act, the doctors will be cut what they get f servicing a medicare patient will be cut by 21%. well, you know darn well if that's 21% cut for medicare, any doctor i know is going to look at the private person not on medicare and so that's why we have to keep thinking about what we're doing. the doughnut hole, i tell you. no insuranceolicy has a doughnut hole. no insurance polic does. and we shouldn't have it in medicare. now, the good news about the doughnut hole is the house bills closed the doughnut le. the bad news it takes 14 years to close the doughnut hole. so what has happened, it's very interesting, the drug companies have put on the table $80

billion saying, we'll give 50% discount for name brands when you're in the doughnut hole. obviously, they're making an awfully lot of money if they can put $18 billion on the table. we have to look at closing that doughnut hole 'cause some people get in it and it's so hard now to get out of it, you never get out of it. and there's other good provisions in these bills. it eliminates copayments for preventive care and that's a very healthy thing to do. and it improves benefits for low-incomed people. is it a perfect -- some of these suggestions in the bill perfect, of course, it's not. we fought very, very hard to have annual out-of-pocket expenses capped. that's what you have in private insurance, not in medicare and, you know, i've got to tell you something, i don't see why there isn't more about our ears, our eyes, r teeth. i think when we get older we need some help there. so the bills aren't perfect but my message to you really is,

don't close the door on healthcare reform 'cause medicare will be left out there hanging. you are looking at a woman right now who was in the congress in 1994. i worked just like congressman connelly works, studying, working, it was terrible. over at the white house, they wrote the bill and it was an incredibly complicated bill and they waited too long to show the congressnd the congress was upset because they hadn't seen it and it was too complicated and the insurance companies hated it. well, let them tell you something, i represented hartford, connecticut, for years. the insurance capital of the world for many years and let th tell you something, before 1965, they wouldn't touch anybody 65 or older guess what? becausef you have over 65 you have more claims but when the '65 legislation was passed for medicare, all those -- all of us over 65 were put in a pool so

there was risk-sharing and that's why the program has worked and so that's what we have to continue to do. and are the insurance companies happy about all this bill? of course, not. they put on the table i believe something like $155 billion but they even know this time -- they even know this time the inflation for healthcare insurance has got so high that it's absolutely impossible the many of millions of people to afford it. so i stand here as a woman who by the way voted for the bill out of ws and means. people forget there was a vote. there was a vote out of the ways and means committee. i voted for the bill 'cause i could see what was coming. i could see that the inflation on healthcare was going to break people and let me tell you something, the insurance companies never forgave me. so let's stick with healthcare. you know, before i finish, one minute, congressman, i was a politician for years. i represent now as i said independents unaffiliated

republicans and i understand why the opposing party is having a fit about this bill. they were in control for years. it's hard to get out of control and they don't a plan of their own. the thing is down the road, we need healthcare reform. and if we want to keep medicare strong we have to have good bill and you've got a good congressman who's going to help that happen. [applause] >> thank you, congresswoman. bill has served as aarp's state director for virginia since 1995. in that capacity he oversee the affrs of the state. he first served as a senior program specialist in aarp's program division. he directed aarp's national

widowed persons service. later he served as legislative representative where he organized aarp's federal advocacy activities and developed grassroots volunteer activities in six states. on behalf of aarp, let them introduce bill kallio. [applause] >> thank you, congressman connelly, for inviting us here today and thank you all for coming to the meeting. i usually start with an opener that won't work in this crowd. [laughter] >> because basically when you go out to the rest of virginia i can say to people for those of you who haven't noticed, there's a major demographic shift going on in the commonwealth of virginia. the old dominion is getting older. and it's true. let them share some data. today 14% of the population in virginia is 65 and older. by 2020, that will change to

about 20%. and by 2030, virginia's retirement population will look much like florida's looks today. so things are a-changing and that means the way we age today probably won't be the same as the way we age going into the future. and at aarp we ask this question, are we ready for this age wave? will virginians saved enough money to live the extra 20 or 30 years past normal retirement age? will people work longer? and if they want to work longer, will the type of jobs they're looking for be available? how are we going to stretch those healthcare dollars? and how are we going to develop the work force we need to deliver all that healthcare? what about our communities? are they liveable for people who want to stay in their homes and their communities as long as possible? and how will we deliver those

can tankus boomers. we tried to focus on what are the major issues we need to be thinking about today to prepare us for the future. and two issues emerged in a unique campaign that we called divided we fail. and those two issues were lifelong health and financial security. now, i want to take just a little bit time on this financial security thing but not a lot 'cause i know you're here to talk about health. but we know retirement security is built on a three-legged stool. basically, you have social security as the base, you have pensions if you were lucky enough to develop a pension during your lifetime and then you have your savings and investments. but, unfortunately, each one of these legs of the stool has gotten a bit wobbly over the years and many believe now that work might be the only alternative that many people face in retirement. with savings at an all time low,

investments declining in value, social security will become much more important to future retirees even than it is today. in virginia, over 1,161,000 americans receive social security benefits. you're not the only people receive benefits. half of those 65 and oer rely on social security for at least half if not more than half of their income. and 1 out of 4 virginians rely on social security for all their retirement income. so you can see we need to get that debate going again because this program is going to be much, much important in the future. we need to look at the system. we need to make sure it can deliver 100% of its promised benefits as far as we can see out. now, switching to healthcare, we know that our healthcare system needs improvement. and aarp's view it costs too

much, it leaves too many people out. it doesn't always deliver the quality we want for the dollars we're spending. we need to reform the rules for insurance companies, the way we deliver healthcare and how we pay for it. ..

aarp believes that if we all work together and if congress can move beyond partisanship, we can find meaningful, common sense solutions that are good for evy generation in society. we'rin the middle of the debate right now. i've been to meetings where there's very strong opinions, but citizens are enged and that's good. hopefully congress will pass legislation that moves us this year in the right direction. we've got to get this rob done. the cost of doing nothing is way too high. at this point, aarp has not endorsed any of the bills moving through the house or the senate. we're very much where other individuals are here. we've looking at certain things we'd like to see in health care reform and the final bill that we might endorse at some time will probably have the best things in there for both our members and for society in general, but as we zap for the right way to reform the health

care system and we have that debate, there are still some who do not want to see any changes in our health care system and they've been spreading a lot of mising in, which unfortunately clouds t debate and doesn't solve the problem. i'd like to focus on some of the myths right now in my talk with you. i'd like to share with you aarp's viewpoint on three of the most common myths that we encounter when we go out and talk wh our members. they are, health care reform will hurt medicare, we can't afford health care reform and health care reform means rationing. let's take a look at health care reform will hurt medicare. none of the health care proposals that aarp has looked at in either the house or the nate that are bng considered by congress at this point would cut medicare benefits or increase your out pocket costs for medicare services. it just isn't there. as a matter of fact, aarp believes that done right, health care reform can lower prescription drug costs for

people in medicare part d. close the doughnut hole in the coverage gap so people can afford the drugs they need, protect better protect seniors' access to the doctor of their choice, which is being limited now because of cuts and doctor reimbursement rates, reduce the cost of preventive services so you can stay healthy, and save pony by providing you new services that reduce unnecessary and preventsble hospital readmissions. we'd like to dialogue with you about those, but that's what we see and aarp believes that rather than weaken medicare, health care reform will strengthen the financial status of the entire medicare program. what about, we can't afford health care reform? both the president and congress have committed to producing legislation that will be paid for, so it won't saddle our children and our grandchildren with unnecessary debt. it can be done if we do it

right. but we have to hold the president and congress accountable to answer that question. but don't forget, as we search for that answer, the cost of doing nothing is also really, really high. if we do nothing to fix health care, families with medicare and employer-based health care coverage will likely s their premiums nearly doubt again if the next seven years. that means a greater share of our take-home pay goes to pay for health care every year. and it goes at a rate that outpaces both inflation and growth and wages. we have a chance now to make some real changes to slow down the rate of growth, while at the same time improving the overall quity of the health care system. becan't afford not to reform health care. finally t health care reform means rationing. this one has been kicking around for a while. as aarp looks at all the bills, none of the health reform

proposals that we see being considered by congress would stand between individuals and their doctors or prevent americans from choosing the best possible care. let me emphasize one thing. health care reform will not give the government the power to make life and death decisions regardless of a person's age. those decisions in every bill that we look at will still be paid by the individual, their doctor, and their families. health care reform will ensure that medicare doctors are paid fairly, so that they can continue to treat medicare patients. health care reform is not about rationing. it's about giving people the peace of mind of knowing that they can keep their doctors and always have the choice of health plans that they want. it's about guanteeing that you won't be discriminated against in the insurance market because of your age our preexisting condition. it's about introducing more

choice and competition so that consumers can use their buying power to better control costs, and get more, not less, health care for their dollars. there are several real and difficult choices that need to be me and we need to consider how to do those best. we don't need to get diverted by mis -- misinformation, which takes us away from the real issues and there are real issues which i hope we'll be discussing and giving alternative viewpoints on today. but weep in mind, when one in three americans face someone who skips pills, postpones or cuts back on needed medical care due to costs, with countless bankruptcies related to medical expenses, when the number of the uninsured approache 50 million, when government spending on health riseso rapidly that it threatens other priorities in our national budget, and with employers strgle to pay the costs for health care, the fact is, we can't afford not to fix our health care system.

aarp pledges to cut through the noise and find the facts about what health care reform means for you and your family. i hope you'll join us. this is probably the most important american dialogue we've had in a long time and we work together and work if a bipartisan way, together i think we can make it better. thank you. [applause] >> thank you, bill. charles plain is the former national legislative chair for the virginia federation of chapters of n aasa rf. charles wked forany years, i think 33 years total for the departme of agriculture, including with the foreign agricultural service. mr. delaplain joine served wars

president of the springfield chapter and as national legislative care for narp's national legislative committee. so please, met meelcome mr. charles delaplane. [applause] >> thank you. narf has a laundry list of issues, well aparts from health care. you'll find them outlined in this brochure that's out on the table in the back if the lobby and i wondered how much i would be boring you if i wept through some of them last week when george burke had the foresight and instinct to call and say charlie, don't talk about that, talk about health care, so

that's what we'll stick with and how narf views the current health care reform activity. >> that was next on my list. who i here is a member of narf? ok. pretty good percentage. how many in here are federal retirees? much larger percentage. let me say, narp does not have, like our other panelists say, a current position on health care reform, because there's no health care reform measure to have a position on. you've seen the phone book beings congressman connelly waved at you which represents a house bill. i assume the senate health committee bill is approximately the same size. i hear the senate finance

committee bill, when there is one, will be smaller and more streamlined. but as yet, we do not have that from the senate. narf's health care attite primarily is it's not going to afct u terribly much in terms of the current bills that we've seen. most federal retirees can take their health insurance plans into retirement with them and after they turn 65, they can combine them with medicare and medicaid. and so the health care reform measures which are aimed at covering uninsured people have very ltle effect on us, but there are a good many issues that we have some attitudes toward. for one thing, we support premium conversion.

which is a benefit federal employees have, which allows them to pay for their health insurance premiums with pretax dollars, and retirees do not have that benefit of -- it's a point with us to try to get that measure attached to the health care reform bills. congressman connelly supports a bill, a separate stand along bill which was introduced by chris van holland of maryland, but that is a long-standing sue and it will be affected by the overall question of whether the tax -- whether to tax the value of employer-paidealth insurance premiums. narfe certainly favors ending the doughnut hold. i assume everybody in this group knows what the doughnut hole is.

we favor expanding coverage for temporary and seasonal workers through the employee mandate feature, which the senate health care bill has and we favor expanding medicaid eligibility, but the problem there of course is how it's going to get paid for. we favor affordability credits for lower income and federal retired employees and increasing the health insurance age cutoff for coverage of dependent children up to 26. in fact, at our last convention, we included in that legislative program that we get the cutoff age raised to 25 and we're glad to see it's 26 in the senate house bill. we are concerned about taxing

workers and retirees on the value of employer sponsored health insance and wld oppose it. this is currently not part of any of the three bills, but it's certainly been talked about and talked about if the senate finance committee and so it's a cloud on the horizon that we are watching. we are concerned about opening the federal employees health benefits program to font federal civilians. -- to non-federal civilians, this is another measure that's not been included in any health insurance bill, and narfe's position on that is it we would not oppose it if separate risk pools were main taindz. we're -- maintained. we're concerned about the enext of employers on -- effects of taxation of health insurance, required benefit packages, for example, could affec employers' and carriers' ability to affect

competition and offer health care choices such as we now have under the federal employees health benefits program. as far as enhancing long-term insurance, we don't see that the house and senate health committee bills do very much at all for their current -- in the current proposals. and the prospects of slowing the growth of medicare and medicaid payments for providers worries us a bit,ecau of -- i believe theongressman mentioned the fact if we cut back on provider payments, you're going to see providers backing out of medicare and medicaid programs. that is a srt summary of our non-position on health care reform. and i'll wrap it up and we can open questions. [applause]

>> thank you, charles. i'm going to hand this meeting over to the guy you really want to talk to, congressman connelly. i may come back at the very end with i have to finally cut it off and we have to leave this room. we have -- we're doing something slightly different, in order to get as many questions as possible. steve is going to be on this side with a microphone. do you want to raise your hand, steve will come to you. sharon is on this side with the microphone, so rather than having people move all over the room and try to get to microphones, we are coming to you. we think that will expedite things and make it hpen quicker, so without further ado, congressman, the floor is yours. [applause] >> can you hear me? yes, this is on. ok, to be fair to the residents, this is a residents forum, we're going to take questions first from the residents of green spring. as you know, there are about 400 of us in this room. there are another 100 residents on the waiting list. so we want to be fair to

residents. i foe we have some outside guests and if we can get to some questions from them, we certainly will. so let's start rightver here. steve 7? >> and if you just give us your name. >> irene orange. a resident in independent living at green spring. i have concerns regarding hr-3200. hr-3200, section 1151, i'm opposedo it, i don't want to read it all because people -- >> why why don't you just tell us irene what the subject is that concerns you on toes pages? >> -- those pages? >> it deals with readmission procedures and that the will be no judicial review, the seetary of h.h.s. is above the courts, if your doctor

recommends that you need to go back into a hospital after a stay, that existed prior, the secretary of h.h.s. will be making that decision and not your doctor. i oppose that. section 1121, page 239. the government will limit and reduce fiscal services for medicaid and seniors, low income and poor are affected if a very negative way. i oppose that. hr-3200 permits -- i have seven questions here on h.r. -- >> well, irene, i'll tell you what. we've got lots of people with lots concerns. i think we take your point and if you want to give perspectives all of the details of what concerns you, i'd be glad to take those into consideration, as i'm trying to work through the bill. on the problem of readmissions, let me just say, one of the things i think the bill is trying to get at is that a very

high percent average people who are -- percentage of people who are discharged from a hospital, end up being readmitted within 30 days. very high percentage. and one of the reasons is because of infections, that they got if the hospital, or that the treatment wasn't adequate. i certainly have experienced that in my own family, where somebody i care a lot about, should not have been released initially, was released and then had to go back in another week, you know, through the emergency room. so i think the language here is designed to try to better manage that, so that people aren't released before they should be, and that the hospital takes responsility for making sure that wh someone is released, you know, they're well cared for and that the condition that they may have been exposed to in the hospital has been addressed. so -- debbie trapman, are you here? >> yes. >> let me introduce debbie

trapman. debbie trapman has been a part of the process of overseeing this draft on the staff level. by the way, is a nurse herself. did you want to comment on that provision at all? >> thank you. thank you. it's a pleasure to be here. can you hear me ok? i am a nurse and i'm very happy to be here and talk to you about health care reform and to see so many of you here to comment specifically about the readmission. what we're trying to do is improve the quality of health care. we just -- we heard a story that probably is not unfamiliar to many of you all in the room, but there was an 82-year-old gentleman that came to the hospital, his wife had recently died, so for six months, he has been on his own. he was discharged from the hospital on eight different medications, andas required to follow up with five different doctors. he couldn't do it. he didn't have the support, his wife is his primary support, he didn't have family support around. he ended up coming back into the

hospital. we don't want to prevent that man from getting care. we want to make sure that never happens. so that the hospital has responsibility before he goes home to make sure that his care is coordinated, to make sure that he can get the prescription medicines that he wants and also 's able to get assistance to the followup services. so the language in the bill is intended to prevent thatype of situation from happening and it's really all about trying to better coordinate car and having hospitals be more responsible. >> thank you. and irene, we'll take the other six you got and we'll try to get back to you on it. ok. all right. i'm going to take michelle and then we'll go over here. >> my name is michelle, i'm a former food and drug employee. my concern is mostly about the insurance company, that pay an awful lot of money to buy the

votes in congress, and i think maybe something like the feingold -- mccain-feingold controls might be applicable and set limits to how much they can buy with our money. >> in case you couldn't hear the question. the question was, what about those insurance companies and are they, a, making a lot of money and maybe aren't they also spreading a lot of lobbying money to members of congress as we're considering health care. clearly, the insurance industry does not want competition. clearly, the insurance industry is benefi benefiting from the sm the way it is right now and the way they're doing that and maximizing their profits is often frankly the denial of care. we just talked a little bit about rationing, and aarp talked about that being one of the myths, that the bill does not ration health care. the fact of the matter is though, that insurers, if you'd had to be exposed to private insurance, you know that insurers very frequently deny care. and very frequently for very

whimsical and capricious reasons and they jeopardize lives in some cases, and i repeat a statistic. the profit of the insurance industry, the top 10 if surers in the country that dominate 90% of the market, went up 428% the last 10 years. so they'reoing fine in the current health care system, but the way they did that is by jumping up premiums, jumping up deductibles, denying more care to more claims and in creation co-payments. i would point out, i think barbara pointed out, before the health care draft legislation was even developed, the pharmaceutical industry went to the white house and said ok, i'll tell you what, voluntarily, we'll promise to give you 80 to $85 billion of savings. voluntarily. the american hospital association said ok, ok, we'll put $130 billion on the table in savings. we'll voluntarily provide to help bring o savings in the health care system. the insurers put zero dollars on

the table. and they need to be heard from. we need to make sure that they're doing their part, and we also need to make sur that as we're listening to various voices, you know, on this debate, we understand who represents whom. by the way, i wt to welcome a vivian watts who has joined us day. former senator -- [applause] thank you. my former opponent from last year is here he today, thank you, former senator, my friend jay o'brien is also here. he maybe left already. he's going to read the bill i think. anyway, glad to have him. yes, sir. tell us who you are. >> we have a problem that i can't understand. the -- most of the industrialized nations have

universal health care and they've had it for many, many years, and they're not going broke. so how come we have so much trouble with this thing that we talk about many, many institutions and people saying we can't afford it? why is that? why can't we afford it? the other people can. >> what's your name? >> william. >> william, thank you. what areat question. by the w, tears a great book, if you haven't read it and you're interested, just came out last year, called overtreated by a woman named shaon brownly and she does an economic study of the cost to health care in america to your int. we spend virtually twice what any other industrialized nation expense, and for that money, we still have,ou know, a third of our adult population uncovered. and if you look at outcome, in terms of health profile, we are in the middle level. we don't have the best outcomes in terms of morbidity and mortality and life span, so

we're not really getting what we're paying for. we're paying twice what anybody else is pay and you would think that would give us gold plated health care and it doesn't. that's because they're huge ineffiencies in t system and the reward system is a fee for service system that rewards t wrong things. now, tre are lots of models in the united states that show us how it could be done, still using the employer based private insurance system. we'reot going to change that. but we could make our system a lot more efficient. now the draft bill here does attempt to effectuate savings in the exising system. forge, just overpayments to insurance companies, estimated to cost $77 billion to medicare. administrative costs. i just saw my primary physician the other day, he tells me his overhead is efor must, it's at -- enormous, it's just 30% of

what he does, billing out the right paperwork for everybody, instead of providing health care and he wants to provide health care and do a lot less paperwork and this documents lots of overtreatment, lots of unnecessary procedures, medications, imaging, all that stuff, that, you know, we have to get our arms around in the united states, to make it a more efficient system, that provides better outcomes, better outces, and as so you look at the mayo clinic, you look at the cleveland clinic, they've got some models that reay work well, are much more affordable as health care systems and have better outcomes, so we can even do it here in the united states based on our system but make it a lot more effective and efficient than it is right now. yes? >> thank you. my name is katherine feathe featherstone. and i'm a green spring residents. i am an ordinary american citizen but i have a lot of

common sense and i thi from what i have know about this h.r. thh.r.-3200 health care reform test, it doesn't pass the smell test, both for our personal health and it's bad for the economic health of america. my husband had alzheimer's disease for 10 years, sadly, he died last year, but i had the freedom to talk with his doctor and participate in his treatment. i would lose that freedom under this bill. and some panel of bureaucrats would decide what his treatment would be and whether or not it would be cost effective. i agree that our american health care needs reform, but we cano lots of things to improve our present health care. i don't think we need to throw out our present health care and have a whole new government system. i am totally against a government takinit oamplet. [applause] >> i wanted president obama to

succeed, but i am now terrified at the direction of this country under president obama, harry reid and nancy pelosi. they have spent billions of dollars in the lt few months and we are trillions of dollars in debt. congressman connelly, you are our representative. you represent we, the people. implore you to vote no on this bill, and prevent our country from sliding into enomic decline. >> first of all, i am sorry for your le's. my grandmother had alzheimer's and she in a sense unfortunately was healthy otherwise, and so she lived a long time with this debilitating illness that is so devastating to see someone you love gradually fadeaway fadeawaa person you know. let me just say, while there may be the impression out there,

especially if we watch too much of fox news -- can't help it, i'm a democrat, but there are no panels that are going to tell you or your doctors what a loved one is going to get suffering, for example, from alzheimer's. there are going to be studies looking at comparative effectiveness, so that we know what treatments make sense. let me give an example. we now know that inhe treatment of breast cancer, many, many women and maybe there are people in this audience who suffer from breast cancer. for many, many years, the prescribed treatment was a radical mastectomy. which was a devastating surgery for women. and their loved ones, but y know, it involved the entire removal of the entire breast, lymph glands muscles, the recovery was long, and painful

and there was emotional trauma associated with. comparative effectiveness studies have shown that actually a lumpectomy, removing the growth itself and aggressive chemo and radiation is just -- more effective than the radical mastectomy. and so we now know more about treatment. we know more about pros at a time cancer treatment, we know more about heart treatment, and so what this bill does is try to make sure that the treatment we're putting out is in fact effecacious, it's effective, to here cure the disease or manage the disease for the loved one. there's something else kathleen said that i want to say honestly to this audience. with i asked earlier, how many of you on medicare, almost every hand went up. when we asked how many were federal retirees? a lot of hands in this room went up. med compe is a federal --

pedestrian care is a federal -- med compare is a federal program. medicare provides something and some of you in this audnce are old enough to remember when senior citizens had trouble getting health care coverage in america. medicare in 1965 was a program put in place by a different president and a ifferent congress, over lots of opposition. i was a young man in 1964, i was a high school debater, and the topic that year was, does medicare equal socialized medicine. that was the national debate topic, and i had to debate both sides of it. but do we regret that we instituted medicare? i don't. it has saved lots of senior citizens from going into plenary and has provided increasing quality health care for millions of americans and we need to make sure it will be there forest next generation as -- for the next generation as well.

i haven't committed to any particular bill, but i sure am committed to making sure that we do, igree, we build on the system we have. we're not trying to change it and we're not going to federalize health care in america, but we have to recognize, the federal government already has a strong presence in health care and by and large, it serves a good purpose, in social security,n medicare, in medicaid, in veterans benefits and if military health care benefits through the tricare program. yes. somebody else? over here, sharon. i see an old friend. >> ralph green, tree. welcome, congressman. >> thank you, my old friend. >> my name is charles fletcher, i'm a born and bred northern virginiaan and i'm a resident of green springs. i have great concerns and would like to bring just a little different tact to this if i may. to this approach to medical

reform. the approach and much is being said today talking about government control and it's something that concerns many of . this government control with the new president we have has tendencies for us to think along the lines of socialism, which is not the best for this country. >> wait. green spring rules, civility and respect. go ahead, charles. >> tha you. now this, we have found entirely the type of government control with medical care and other countries has not been all that successful. we are looking for a reform in

medical care that is going to be successful for the type of medicine and the great medical care that we have in this country. we don't want to destroy it to improve it. we need to be very careful in what -- the move that we make, mr. congressman, and we ask you to be very careful as you move in that direction. >> thank you. charles and i go way back, charles and i were both civic leaders in our respective communities and i'm glad to see you again, charles. i think those are very useful warnings. i don't want to see wholesale change in hour health care system if america. i want to see government protect our citizens and try to extend -- encourage the extension of coverage. and i want to see that through a

series of rational incentives that don't entail government takeover of medicare. now the way we would do that, really, is a single payer system. you know, junkingverything and moving to a single pay he were system would be government takeover of health compare in america, although there are people who absolutely passionately believe in a single payer system and there may be some in this room. there is no legislative proposal that's going to pass the house and the senate, involving a single payer system. bu the most we're debating is how much federal regulation will there be to try to bring down costs and will there be a public option as one of a number of options available to citizens who are in that 47 million pool especially, who don't now have health care coverage and as you know, that's a big debate. the senate does not want a public option apparently. probably a majority in the house do. that will have to be debated out. i believe that if a public option can bring down the cost

of health insurance premiums and deductibles by providing rational competition and people want to opt into it, no one can be machine mandated to -- mandated to do it,e ought to take a lk at it and this bill does include a public option, the house draft. yes. how about over here, steve? you know what, sharon, i'm going to go back and forth. you get someone next. >> i'm millie, and i'm a residents of greensprings. we are considered and have been considered to be -- we are considered and have been considered to be the greatest generation and i tnk that this generation is kind of afraid of what's coming next, and i have several points to make. this has been kind of a very good pep ral for reform of health care, and i don't thi there's anyone here who would doubt that it needs to be reform. but whether it needs to be

reformed by the government taking it over eventually, or not. makes the difference. and the point being, that in most of the countries, where you find, for example, canada, britain, germany, italy, and some of the other countries where you have found government takeover of health care, that -- well, finally leveling place from 50% to 70% of the people do require -- or they actually opt for getting private insurance also. because their government health care does not cover everything that they need. they have to wait, it's rationed, they have long, long waiting lists. for example, inermany and the netherlands, there is sort of a subgrowth form of end of life consultation, and in the netherlands, it's even not -- >> ok, millie. thank you very much. >> but can i have just add a couple of things.

>> real quick. >> this -- i understand this program, it goes into effect, whatever is passed, will go into effect in 2013. and then will be revamped every five years, so anything that might be passed now could be revised by government controls in five years after it goe into effect and we need legal reform. we need portability. there's no doubt. we need catastrophic disease, preexistin condition. but many of those things can be done whout government control. >> ok. well, thank you, mill high. let me just say, millie has covered a lot of reforms i certainly support. now we might dagree about well, can we effectuate all of those reforms without legislation? well, let me just tell you, if the insurance companies wanted to pledge right now that i will never defy coverage on a

previous existing condition, there's nothing stopping them. but they're the ones who are doing just that. and frankly, we've got to have some protection for the government. sometimes the government plays a positive role if protecting the public interest. william asked that question and he's right, how come the other systems are less expensive and por effective than ours? whatever we do if terms of health care reform, it has to build on the existing system of private employer-provided insurance. of we have some big federal programs, most of you participate in one of them. but we have a vigorous private insurance program in america, that will remain the model. that's not going to change, we're not going to have federal government takeover of health care in america. but we've always had a strong presence of the federal

government in health care, since social security got started in 1935 and by and large, it's improved the health posture of the united states. can it be more efficient? can we do it better? that's what i want to do. i want to make sure medicare is not only available to all of you in an improved form, no benefits changing other than an improvement of those benefit, but i want to make sure it's also there for the next generation, the second greatest generation. >> i have a question, and not a speech. my question is, i am perfectly satisfied with medare, blue cross blue shield. will i, according to your understanding, be able to retain thunder the legislation that -- that, under the legislation that you talk about? >>bsolutely. if you're happy with now, the only thing that could possibly happen is it gets better. i promised sharon and then we'll come over here.

yes. >> i'm tom harrison. speak to you as a constituent. >> tom, if you could speak just a little controls to the microphone. >> very well. my subject is the constitution of the united states. when i entrepreneurered the military, -- entered the military, my oath of office was to defend the constitution of the united states against all enemies foreign and domestic. i don't think the health care bill is about health. i think it's about power. [applause] let's see what has happened to our country since the 20th of january. the financial sector has largely been taken over. we have legislation that -- the president does not have a constitutial authority to fire a c.e.o. of a large company and they've taken over three quarters of our motor vehicle.

cap and trade -- >> tom, have you got a question in there? >> yes. my question to you is, your sincerity. if you believe in this, i would ask you to cover congress and all federal employees with the same insurance tha you're enforcing on us. [applause] >> well, tom, thank you very much. like you, i took an oath, i've taken an oath six times representing this community to uphold the constitution of the united states of america and i take that oath very seriously. i will say to you, two points, your comment that since january 20th there's been takeover of the financial services industry isrong. it's plain wrong, sir. in fact, the takeover, if that's what it was, the intrusion of the federal government in an unprecedented way, in a financial services of -- dustry of america, occurred under the previous administration. tarp, the troubled asset

resource program, was a program of the bush administration, not of the obama administration. and it took over a number o financial institutions, and billed them out in unprecedented ways and in return, the federal government either got warrants or became a stock hole every, a major stockholder if a number of financial institutions. that was done by hank paulson, the republican secretary of the treasury an ben bernanke, a republican appointed chairman of the federal reserve who it's just been announced will be reaopted by a democratic president. it goes back to september 15 with the financial melown occurred in the united states and we were looking at the worst financial meltdown since the great depression. now, i don't know that there's anybody in this room that remembers the great depression. [laughter] but the largest -- here's a trick question. the largest bank failure in american history occurred in

1929, right? no. it occurred if 2008. the largest corporate loss in american history occurred in 1929, right? no. it occurred last -- in the last quarter of 2008. it's called aig, which had been bailed out by the previous administration to unprecedented degree and then their executives were allowed, as you know, to give out bonus, so dealing with the issue of fincial industry, even though it's not on health car i just want to make sure we get our facts right in terms of who did what to whom and when. now, with respect to should i subject mysel to the provisions of this bill, or the same kind of medical care that everyone in this room get first of all, i will be eligible in a few years. for medicare. i get the same health care that we often hear about members of congress get special privileges if terms of health care, so when i got to congress, i was kind looking for those special

privileges. where is the line to sign up for them. and i got the same health care benefits package to sign up for any federal employee gets. there was not a single he thing offered to me other than for an extra payment, i could use the services when i'm in congress, physically there, of the capitol hill physician, for a fee. i chose not to do that because i've got pinkerton own doctor and i live here. unlike many o my colleagues who have to live far away, i live here and i thought if i get sick, i can just go see oscar, but i don't get any special health care benefits any other federal employees doesn't get and the whole point of health care reform isn't to make sure everyone has de minimis health care, it's to improve everybody's health care and everyone's access to health care. so tnk you f yr question. steve. >> my name is erna, i work for

440 years as a registered nurse. i have very strong feelings that health care is a right, not a privilege. i think there is going to have to be something in the government section, there are millions of people who are above th medicaid level, but can to way afford health insurance and i think those people are maybe the most important to cover. those of us at greenspringy feel if many ways we're sort of fat cats, that we're able to livat a luxury level a lot of people cannot live at. >> thank you so much. nurses have a special place if my heart. my mother was a nurse for 45 years in boston, massachusetts, and she was a night nurse. so i saw her go so many years without sleep trying to raise a family during the day and work so hard as a nurse at night and it gave perspectives a profound

respect for that profession and the sacfices nurses make and by the way, if you've been if a hospital and i hope none of you have had to be lately, you know that nurses make the institution. they humanize what otherwise sometimes is a very impsonal health care system. nurses really care, and make such a difference. i agr with you. i think thas a great principle. in the united states of america, health care ought to be a right, not a privilege, and by the way, even if you get outside of the humanitarian aspect of that question, economically, it is a huge problem that lots of americans don't have health care coverage. some of them are young people, who opt not to have it. we wanthem in the risk pool. because they're healthy. some of them have -- work for small businesses that simply can't afford to provide at this employees they would like to, but they can't afford because of the rising cost of health care. i cited a statiic a little

earlier. as recently as a decade ago, 60% of small busesses provided health care. today it's a little bit less than 40% and in 10 years, it will be lesshan 30% if the health care costs trajectory continues. there are some stunning statistics about the consequences to you as an individual, if you do not have health care coverage. if you're a child in america, and your appendix burst, you are five times likelier to die from peritonitis,ecause the patients not having health care insurance, they hope for the best and hope it's just a bad time and by the time it's clear it's p more serious than that, there's a high risk the appendix has burst. if you have health care under a primary health care program, you're going to get the child this to the pediatricia and get

the care the child needs. there are real consequences. if you have cancer an you're uninsured, you're twice as likely to succumb to the disease an somebody who in fact is insured and can afford the treatment. we can go on and on. there's to question, there are economic consequences, therere social consequences to a system that allows 47 million people to be uninsured and all of us pay a tax on uncompensated coasts inest emergency room when people have to -- costs in the emergency room when people have to fall back othat. >> we who live in this country, which is founded on. basis of -- >> can you speak a little closer to the mic. >> oh, it's ofnl on. we who live if this country, the land of the free and home of the brave, ought to be feeling that this is really a moral issue and

the congress ought to feel that very strongly, because of the 47 million people who do not have health insurance, and we are our brothers and sisters' keepers an we really need to keep that in mind when we're talking about costs and about whether -- and feeling very comfortable as i do here at greenspring, because i do have good health care. i don't need to worry about that. my question is, who is responsible largely for the huge $70 million -- or billion dollar debt that we're in? >> well, i don't know that i want to get into blame here. l of us are now responsible for it. we all have to clean it up. and that's what this debate is all about.

health care is almost a fifth of the economy. and we want to keep it there. we don't want it to grow much more. we want better outcomes, we want more coverage for more people, we want to protect seniors and make sure those benefits are there for future generations, we want to make the system more efficient and we want to make sure that we actually irove health. onof the things the draft bill does do and it gets to credit for it, is that it significaly promotes preventive held care. let me give you an example. there are four things we know that if we did as a country could significantly positively have an impact on the cost of health care in america. don't drink so much. drink in moderation. don't smoke. don't ever start if you're young. watch your weight. don't get obese. and exercise a little bit. those fo thingsould have a profound impact on the health profile of americans. i talked to a business, a major

employer if our district, the 11th district of virginia about a months ago, and they told me, their c.e.o. had a congenital heart within that required heart bypass. after he had the bypass, he got religion about exercise and watching what he ate, because heart disease runs if his family. he's in great shape by the way after the surgery. so he started, as the c.e.o., he invited people come walk wh me at noon on your lunch break. don't have to, but if you'd like to, i'll give awe -- a pedometer. just a sple, voluntary change in their company, encouraging people to walk several times a week at lunch hour reduced the company's health care costs by 5%. so we know the preventive health care has payoffs, especially if we can start people young, if it becomes a lifetime habit, to you know, take care preveive of

their health, they're going to if cure a lot less health care costs than an older generation, but unfortunately, the congressional budget office can't get their arms around how do we quantify that in terms of dollars. so unfortunately, preventive health care doesn't get any credit in the bill, even though we know, we know, more than intuitively that preventive health care would in fact ebfectuate savings. we have to work together and get it right and that's why i'm dialoguing with you today and lots of others. we have to make sure we get it right before we vote. yes, sir, you've been waiting patiently. >> i'm a greenspring residents, i have a master's degree in government administration and finance. >> tell us your name. >> my name is edward demeter. i'm also a combat veteran,

fighter pilot, served my country with all these decorations, and i really am worried about the situation now, particular hi with my grandchildren and so forth. i think we will all agree, everyone here, we want t help and do something positive. i think -- i hope we agree that just like i, if i spend money i don't have, i'm if deep trouble, so while we're doing all this, i hope we don't bankrupt the country. i think, i you look at everything, this is what they're really worried about. now, i speak seriously now, from my own experience. look at what is the problem. soaring high cost of being ill but from the prescription drugs, the doctors, and when you go in a hospital. i can't believe they can suck up $100,000 of your money being

there for a week or two per person. for instance, my brother is just coming out of the hospital now with a second heart attack and i look at his bills and i can't believe it. now, let's look, what can we do? we all agreed, there seems to be excess profits by the three different things we have, either the pill makers, the doctors, and the hospitals, what have you, the insurers. remember in the hold days, that we used -- old days that we used to have price controls. my question nowo you, is there some way that that could be redone, to prevent excess profits? >> edward, -- thank you for your question, and by the way, thank you for your service to your country. i don't know that we're going to go to price controls, but what i do know is that the more we crea large competitive pools, we bring down the coast of services and drugs.

for example, the -- both medicare and the federal employee health benefit program have much lower administrative costs than do some private program. edward saying isn't that a monopoly medicare sort of is. i'll grant you that. but we -- if auceps, the federal government competing with the private sector. most americans, most americans have private insurance. and they're happy with it. but they're a little anxious, under ever understandably, about the rising cost of that and will it still be there if a few years. with respect to prescription medication you raised, again, i think competition would be a good thing. remember when the medicare part d drug program was adopted by a previous congress and a previous

administration, i want to point out two things, that congress and that administration did not pay for that benefit. this bill, for good or ill, according to the congressional budget office, is fully paid for. it does not had to the deficit and i believe that oucht to be one of the criteria for anything we're asked to vote on. is it paid for. we don't want to put that on the burden of future generations, so i agree with you totally on that. the other thing was explicitly in that legislation, creating the drug benefit, not only did it create a drug toll for seniors over a certain amount of mone it explicitly prohibited the negotiation of the price of pharmaceuticals. why do you think that was? how could such a thing happen. we go back to michelle's queson. that was the influence of the drug companies and frankly, in the congress. and it was unconscionable, because that means that your drug prices are higher than they need to be, even in your co-payment, you know, under

medicare and your doughnut hole is reached faster because the cost of pharmaceuticals are unconscionably high and we know in other countries, going back it william's questions, actually have the same drugs at much less cost. think about, for example, a few years ago. remember the whole issue of reimportation of drugs to canada. these were drugs produced in the united states. they were marketed for sale in canada, where they were much cheaper. they were reimported from canada back to the united states. they were still cheaper than buying it here where they were produced. how could such a thing happen? and so i think competition is a good thing and i think competition can help bring down the cost of health care, whether it be drugs, whether it be exercises, -- services, whether ip be doctor's visits and especially whether it be insurance. jamie, you're going to take over? who you got 7?

>> if you just bring it real close to your mouth. >> i'm joan, i'm a green spring resident. i'm just concerned about what are they planning on doing for the military veterans -- retirees regard regarding like tricare for life? >> the question is what are we doing for retired military benefits. the trice program is alive and well and it's not affected, and we're alsoooking at trying to make the veterans affairs provision of medical care even more efficient. now there are lots of other discrete things we're doing, depending on whether you're in the army or not. as you know, for example, right here in hour district, dewitt army hospital is building an efor must complex that's -- enormous complex that's going to have a lot of outpatient

services for army veterans that will be a center of excellence for medical care. in many case, it has set some standards that are very useful to learn from, because they've made some real strides in recent years, but we have to make sure tricare is there for our veterans and that health care is available, especially by the way, for -- i mean, the men and women who served our country, the deal was, they answered the call, and i think the other part of the deal is, when they come home, we take care of them. : have a question for you,

congressman. i know you are new to congress, you are new to public service. do you believe that americans have rights and freedoms that cannot be a bridge or controlled by the government no matter what kind of social programming seems to be good at any single time? >> yes. >> i have takenn oath to uphold the constitution of the unitedtates. lana passionate believer in the constitution an the american system. a passionate believer in freedom like we're having today. i wrestle with the issues i face

in terms of what is good for my constituents, what is good for the country, what is the right thing to do. i don't think we should take away any rights and i am always looking for ways to expand the rights in the constitutional system. america does that, we are protecting ourselves in ways that ought to be the envy of other countries of the world. >> i am a resident of green spring. i don't question the need to overhaul the medical care system but many of us feel that the overhaul of the tort system should be an essential part of

that overhaul. can you tell us if there's any anticipation? >> i agree with you. the question is, is it part of the high cost of medicine in america that physicians and surgeons and health-care providers are looking over their shoulders, someone is going to sue them if they don't provide the extra test or give you that surgery even if they don't think you will be effective and so forth. my answer is that is probably true. we know anecdotally that that is true. there are lots of studies about this question. what is surprising is it is not a huge contributor to the cost of medicine but it is a contributor, but it is not huge. in a state that rigorously controls malpractice, texas probably adopted some of the

most stringent limits on what an award can be for somebody suing the hospital or doctor or a surgeon in the united states. the dallas morning news did a study of every hospital in texas after they adopted that several years later. what they found was the alleged savings that were supposed to grew from such standards were not passed on to consumers. secondly, in my cases, health-care costs in texas rose at a faster rate than states that did not have such strict limits. i am not saying it is real, but what i am saying is we would be wrong to assume that somehow just by tort reform we can bring down the cos of health care dramatically. not really. it will affect positively, i think, the growth rate in the cost of medicine but that is not

the biggest contributor to our health care cost spiral. it is a factor. there are two provisions that were added to this draft in the mark opinion aegean commerce committee in july that address this issue. do i think they address adequately? no. but they do start to address th issue specifically. i suspect we will see more and as we see an evolution in it. yo side. >> thank you. thank you for this great discussion. my name is lea lockhart, of the lucky seniors who is able to afford greenespring. i wonder if those who sow fear government takeover of health insurance are also concerned about the 428% rise in profits

the top 10 private insurance compani companies, if i heard you correctly,congressman, who have 90% of the business. i think that we should be concerned about a private, greedyakeover of health care as well as other concerns, thank you. >> thank you. somebody recently asked, in some cases, isn't the federal government monopolistic? i said maybe you could make that argument on medicare, but there are whole states and regions in this country where one health care provider dominates to the tune of 95%, that is virtually a monopoly too. so iant competition in the system so that people have choices. that is one of the principles,

health care reform, we undertake. i have been dominating the answers here and i don't mean to. we have a wonderful panel so i want to give them an opportunity to comment on the questions and we will be back for more questions or answers. >> congressman, we have been quiet because you are doing such a good job. i listen andook out at you, you listen to the answers, the conundru the congressman has, you really reflect what is happening in the country. some of the one reform. some of you don't want reform. that is what he is going to have to deal with. this audience looks lot like me. moreover, we have medicare, i have medicare and blue cross. we will be ok no matter what happens. we will be okay. i have struggled and studied thir question. i have members of all walks of life and political parties, i am

convinced that doing nothing is not the answer. it has nothing to do with most of the people in this audience. what has to do with is my four children, my ten grandchildren, that is what we he to think about. it will be tough for the congressmen but to do nothing is not the answer. [applause] >> i have bn waiting for something the congressman said, now, wait a minute, i haven't found it yet. we are committed to being a protector of medicare as we go through this. when you hear that a particular piece of legislation will cut medicare benefits for medicare beneficiaries, check it out. we want to be that source of information that separates them from the facts when it comes to that because aarp has pledged we will not endorse a piece of legislation that hurts medicare beneficiaries. stay in touch in that area.

the other thing, this is democracy. nobody gets exactly what they want. whats wonderful is we go through these debates and find the common sense solutions and reach across diffent ideas and if we are committed to the same goal, we will come up with something uniquely american. the real problem is putting our heads in the sand and trying to move on. this problem is not going to go away we have been debating this problem for 60 years. this is not new with the last election. i hope we will stay engaged and come up with the right american solution. there is -- >> is there -- >> you can find more detailed information, helpedactionnow.org is the web site that will give you current discussion about facts and myths and information

that is being debated. >> i was struck early on by the lady who has the congressman not to vote for the phone book over there. that is not what he is going to be asked to vote on. it comes down to the nitty gritty. the phone book is going to have to go through conference, the senate bills will have to be with it. who knows what provisions are going to come out? we are all still in a very amorphous situation. if we're talking about web sites, there is a kaiser family foundation website which does side-bside comparisons of the varioubills that are in the congress and i can give that to

you if you're interested in looking at that. looked pretty good to me, www www.kff.org.healthrefo www.kff.org.healthreform. i will give it to anybody who wants it >> let me say one last thing. i know nber of these town hall meetings throughout the country, in number of members of congress, i have to say to you that your congressman conducted himself, you might not agree with everything he had to say but he is knowledgeable about what is happening, you're very lucky to have a man like that representing you in a matter what happens. you might not always agree with him, but he understands what is going on. [applause] >> thank you very much. thank you verymuch.

by the way, another 15 mites, people are getting tired, but if we didn't get to your question or you have anotherne, we have cards in the back. if you want to write them out, we will answer your questions by e-mail. give us your e-mail. we are happy to do that. i hope i got to everyone's question today. jamie? this lady there. >> my husband and i are almost three weak residents here at greenespring. >> is it dealt? is it del? >> zelda. we're residents of greenspring. >> you just moved into 3 weeks ago. give your new neighbor a hand, welcome. welcome. >> first of all, you said this is not going to get political,

you did a. badge -- bush bash. i don't appreciate that. when numbers are quoted in need to be verified. the debt it came to the obama administration from the bush a administration, i don't even know how to write $7 billion. people ought to -- we pay as we go, my parents got off the boat, nobody gave them anything, if we simply are going to be able to balance the budget, not go broke, and ensure every illegal and every person that thinks insurance is an entitlement, something has got to give. >> where are your folks from?

>> poland. >> my grandmother came to this country from ireland in 1920. let me say to you, i don't know what bush bashing you are referring to, but since january 20th, there has been an unprecedented federal takeover of the financial-services industry. this all occurred prior to -- the clinton administration has involved the takeover of banks. you brought up the issue of deficits. you just moved into green spring, you know my record, i've

balanced 14 budgets in a row. we have to balance the budget by law. most states have constitutional provisions that don't allow them to spend deficit spending, they're required to balance the budget. i am stunned, looking at the size of the deficit. this was just a report today, when you look at what was not funded under the previous did ministrations, you look at the economy, the inherited longevity $5 trillion of the projected $9 trillion deficit was inherited from that time period. i'm not bashing anyone. it is effective in 2000 experience for the first time since andrew jackson, two consecutive surpluses where the federal government was in surplus and we were projected

surpluses as far as the eye could see. we are paying down to the national debt to the point were alan greenspan, them chairman of the federal reserve, publicly said what would it do to u.s. treasury if there was no dead to be financed, what would it do to the u.s. treasury because that is predicated on having debt. in eight yea we double the national debt. we had a half a trillion dollar deficit last year and a projected, if obama hadn't done nothing, projected deficit of $1.3 trillion next year. there was not only 9/11 but an unfunded war in iraq and an unfunded war in afghanistan and they were very costly.

under the previous administration, they suspended pay go. moving forward, if you get a bright idea that costs money, you have to pay for it. hopefully we can exercise more fiscal discipline as we move forward. there is plenty of blame to go around to both parties. welcome to greenspring. somebody over here? we will come back to you. >> i am boin walton court 511. i have a question for barbara kennelly. i read letters signed by barbara kennelly since day one and my question is at this stage today, do you feel nccspm is making any headway? >> i do. our membership is holding

steady. we hear from our members, we have a membership department, we have a grass-roots department that goes out and meet with our members. i talked to our members, my number is listed in washington, i have an to 12 calls, we are making a difference because we are saying is medicare and social security are necessary for any industrialized nation. we have to have social insurance for our retirees, other wise things won't work. is not a big price to join us, $12 a year. we don sell anything, we don't endorse anything, we just go up on the hill with washington and around the country and say our country needs to subsidize and have social security and medicare not only for ourselves but r our children and grandchildren. that is our message. >> lane name is diane and i am

resident here at greenspring. i have been hearing a lot this afternoon about rights. everyone finds it very easy to get uptight very quickly if they think any of their rights are being threatened. i don't hear anything about responsibilities. with rights come responsibilities. we hear that there are forty-seven million people without health care. we hear that health care is a right. not a privilege. okay. i think almost everybody here would agree with that, or maybe not. the doctors, the drucompanies, and the insurance companies have

had no trouble at all exercising their rights. they seem to have had a great deal of trouble exercising their responsibilities. my question is, how can we, people generally with no great political connections -- >> right here. >> 2 shea. what can we do, what can i do to try to and leighton these folks about their responsibilities? don't tell me to write my congressman, hav already done it. >> you notice i wasn't encouraging you to write your congressman. we get lots of mail. you raise a profound question.

what is our responsibility? for our own health care? for our loved ones? fostrangers who are part of our community? a little boy a few years ago in the district of columbia died, he was 12-year-old, he was on in short, he had a tooth infection and his motherould not get anybody because lack of insurance atus. the cost of trying to treat him unsuccessfullyas $250,000. a simple dental appointment would save us a lot of money, would have saved that young man his life. it isn't just a nice thing to do, is a matter of life and death even for young people, not just the elderly. what is our responsibility to that young man as a society?

as a society? i don't want to take away anyone's medical care. want to enhance it. a want to make sure the families who have young children like that little boy, don't ever have to experience that terrible choice, this gentleman has been very patient, we would like to hear from him and get back to you. you are going to have the last word. i will stick around if people want to talk to me. panelists may have time too. we will make sure we get back to you. >> last weekend when his speeches, president obama, can you hear me? >> i can hear you. >> president obama last week referred to the publioption,

and he was joking about worrying about a good number of people, government getting involved in too many things, and he showed the post office, probably the greatest example of public option, was really down, fedex and ups running circles around the post office. my question to you is that he did not take a public option out

of the picture of the health program and want to know how you feel about the public option >> how do i feel about the public option? i didn't catch your name. roy? thank you. roy cited the post office, the competition among ups, federal express and the post office. , i think personally a public option is probably a good thing. no one will be forced ever to -- the congressional office looked at the number of insured people, everybody gets insurance, they figure may be a third of the uninsured would offer the public

option, 2 search would offer private insurance on the exchange. there's a menu available to me, for me, based on my health and my age and all of that, to simply create an option. we save $150 billion that it is a positive thing in terms of getting down health-care costs, specifically premiums. the insurance company is pulling out all stops to try to kill that public option because it represents competition. they even said it will drive us out of business. there iso study that suggests that is the case. in fact, they will get more business, not less, because we're dealing with 47 people. they don't want any competition.

when we talk about monopolies, essentially only one insurance provider dominates the market to the tune of 90%. that is not competition. that is why costs, we can't get our arms around the cost factor unless there is legitimate competition. is the public option the only way to do it? not necearily. we arekingt a series of non-profit cooperatives, sort of like we had for electricity, it has done very well. is that a model that will work? we have got to look at it, pretty in hammered with that model. i want something that will bring down prices for our consumers and create more efficiency in the system. the public option is what i will have to vote on a latin. i am supporting it for that

reason. it is not theology for me. >> i am a resident of greenspring. i am very happy with my medicare and my insurance. i can see a lot of problems that really need working on. someone mentioned germany. myoungest son had a heart attack, for several weeks, do you know the taxes he pays for all that? taxes were much higher for medical care. we are comparing apples and oranges, they are both true but not e same. just a minute.

i am not through. i hear all of this going back and forth in different things and i have some real concerns about small business people and the unemployed, about people who lose their jobs and they can't go on cobra. how will they pay for cobra? is very expensive if they don't have a job. after so many months, the cobra runs out and there they are with no medical insuranc with a family tha needs medical care. what is being done for these people? this is a good meeting. >> sorry, didn't mean to interrupt you. cobra, a federal law that requires employers, upon determination, severance of that employee, to make available to

them up to 18 months continued, private insurance coverage at their own expense. when you no longer have the cost of the premium, cobra is beyond their reach. they can't afford it. >> we'reoing to break away from the last couple minutes of his recorded event to take you live for a medical aociation releasing a study on the effects of spefic health conditions, those -- gross domestic product. the advanced medical association. >> we release the commission report by the center for health economics and science policy at united biostores corp. and the burden of disease.

i am pleased to be joined by two distinguish economists, greg de lissovoy and bryan luce. and dr. david cutler, professor of applied economics at harvard university and helen darling, president of the national business group on health. activamed believes the true burden is disease, particularly thcost of chronic conditions, conditions that are preventable or can be better managed. the goal of this study was to quantify the indirect cause and of disease as they relate to lost economic productivity as well as the up side that can be gained if certain steps are taken to improve health and quality of care. there is a certain costs associated with expanding

coverage to america's patients but just as importantly there are cts to american not providing quality health care. it is common sense. if workers are healthr, the burden of disease is reduced, the economy will do better. it is not a perfect analogy, but many of you will recall the incredible peace dividend that was gained in the soviet union in nearly 90s. it didn't happen overnight and there are many complex factors th had to come together for those savings to be realized. without stealing the thunder of are terrific speakers i will simply say there's a tremendous health dividend to be gained f we can prevent disease and improve quality of care. why are we looking at these indirect costs to our economy? these costs may be categorized as indirect but do not lessen their real a direct impact on the health of our economy. these indirect costs are not currently factored into the

congressional budget offics estimates for health care reform, because it is assumed that gdp is fixed. by holding gdp constant, bco this is the help dividends that can be reduced in the burden of disease. i would like to introduce our first speakers this morning, two of the lead authors of the record, and greg de lissovoy. and bryan luce. >> it is a pleasube to be here this morning. i am going to set up for greg and his wonderful team, and in time with the times, couldake it this morning. steve and valerie hutchins are in the office to give a little bit of work. so the title of our report that

you all have a copy of is the burden of disease in the united states, it is focing on the indirect costs. we also attempt to prove an economic case for quality improvement in medical practice. the purpose is specifically to estimate the burden to the gdp of our economy, both in direct costs, i agree with you, in direct costs is a misnomer, these are direct costs to the gdp of our economy. to estimate potential gains, gdp, moving from prevention of treatment, as we go through our study and the results, as greg does, i want to make a couple observations that might be good for you t think about. the first and foremost, as steve mentioned, it is obvious disease productivity, well know that,

it is obviously important to gdp for productivity. secondly, i want to stress the fact that measuring changes in productivity, especially e kind of productivity that we will call present -- people are at work or sick, is extremely difficult and not well dne. it is going to be one of the fine points we will be mang. that needs to be done much better. thirdly, the evidence that we will be talking about today is necessarily precise. there's overestimation and underestimation across the board. the precise numbers are not important, only the magnitude. the general level of magnitude

that is important. the health reform debates, the press and everyone else, that is not paying attention to the portance of productivity. that ireally the important point of the report we're going to be talking about today. it should be part of the discussion. so with that, let me just mention the concept of costs in termsf chronic and acute conditions, we have good data about the indirect costs, lost productivity focused on the study. when we say lost productivity, it really unfolds in a number of ways. the obvious way i absenteeism.

there's decent information about absenteeism. what is also extremely important but poorly characterized presenteeism. even the work that has been done in presenteeishas an really jelled in terms of methodology, although a lot of work has been done, disability, caregiver burden is a very important component of productivity, typically undervalued even as a concept. it is important, the numbers are large, it is important for families as well as the general gdp. we are getting to e hard part, we will turn this over to greg, the methodology and results of the study, were looking

forward to comments by the other speakers. >> i would also like to thank you for this opportunity, david nixon, his guidance. most of us like to spend the summer lying on the beach reading, and we had that opportunity. i am not reading what i planned on reading. we had a rather dry summer here. our studys primarily a letter to review. we lked at published articles, and our team here used an extensive number of search engines to retrieve more than 2,000 abstracts and published articles that describe the impact of chronic and acute diseases and that is an important point. we focused on conditions, we

identified 13 conditions that primarily affects working age adults which we define between 18, and 65. one implication of this is that we don't look at conditions such as heart failure that have devastating impact, but only affect older adults. the impact is not only on the older adult, but also on the younger child or family member who is caring for this individual. that is in our study in terms of impact that we did not address. once we identify the articles, we subjected them to review criteria, quality review criteria, then we extracted data and tabulated data across 13 conditions to identify the expenditures in terms of the categories of absenteeism, presenteeism, disability and mortality. the next part of our study made

an estimate of the pottial gains to the economy through more effective prevention and treatment. here we applied for epidemiology where we looked envisions, the prevalence in the working age population and then through the literature, the medical literature, we looked at the impact of best practice on reducing the prevalence, and gains and days of work. and reduction of premature mortality, and he's lost years of life and absenteeism, annual contribution to the gross

domestic product. the impact of the worker, this is not look at the ripple effect through others who are caring for people with chronic and acute conditions. it is well-documented, testimony, chronic disease across theconomy. everyone has to die at some point but seventy% we are looking at, among the working age population. one chronic condition and acute conditions, they have a smaller impact, a respiratory condition, which is a respiratory problem. the big ones, heart disease,

cancer, stroke, chronic disease is the impact of smoking. as to what are the top conditions, we have been can of --ighting the war on cancer, the new york times has added a series of articles about our progress or lack of progress, substance abuse, we are very surprised to see how substantial is the burden of substance abuse but you have to think that this is in the working a population, where this tends to be most prevalent and most devastating. the other conditions, hypertension, her disease, are well known. the mental and emotional conditions, i would think we are in -- we are mourning the passing of senator kennedy, one of his lifelongoncerns was to achieve parity i coverage of mental health for mental and

emotional conditions. these take a substantial toll not only on the worker but on the family and we have a long way to go in terms of coverage. we have a chart in our report that gives you some sense of the magnitude of the various conditions with the high bar being cancer, the lobar, chronic obstructive pulmonary disease. as brian -- as bryan said, the exact numbers are numbers with a certain margin of error, and it is not the exact numbers that count but the magnitude of the conditions. we estimate the 13 conditions we look at cou account for as mu as $1.4 trillion in annual costs to the gdp which is a substantl portion of the 2-1/2 trillion that we now spend on

direct medical costs. effective prevention and treatment, as steve said, in the debate over health-care reform, there is a substantial focus on reduction of expenditures. this is appropriate. we have a long way to go in terms of spending ou money as efficiently as manof our european neighbors do. but there is a great opportunity to improve the gdp through effective prevention and treatment. there is an important report that came out two years ago to look across chronic disease, and they estimated that by 2023, there could be as much as $1 trillion added tohe gdp through application of current technology and the trajectory of medical progress that we now maintain. the individual estimates for some of the conditions we showed

here, heart attack, sixteen million, the depression is even more of a gain that heart attack. through our report, there are two recommendations that we would make as an antecedent of our record. other people are going to be speang to the importance of addressing effective prevention and treatment in terms of the gd but our research team that looked at this made two observations. number one is the literature we find is extremely fragmentary, and the methodology is, by and large, inconsistent, and i would even say pour, and we find it very ironic th when we are focusing so much attentio on a

portion of the economy that is 17% of the gdp, we have so little guidance in terms of good, solid data, on what are the important conditions and what is the impact on this condition. the literature is very spotty and it tends to be driven by particular groups that have an interest in certain conditions rather than a systematic review of where is the great impact? i would say the exception to that is the milken report that looked systematically across conditions and we need more studies like this frothe cdc. the second observation we made is the confluence of disease, sometimes called a ball like -- that about, closelyelated and

difficult to disentangle, will pose a devastating burden on medicare and an employer's but long-term it will fall on medicare. this cdc, with the best technology, the best we can do is slow this academic. to try to change national behavior and national treatment and certainly health care reform and better access to care, better primary-care will make a great contribution to this. that is the essence of our report. >> thanks very much. would like to turn the podium over to dr. david cutler, who is

widely regarded, broadly published economic impact associated with health reform. dr. cutler? >> thank you. good morning. i am embarrassed to tell you what i did with my summer vacation. let me first start by congratulating the authors, very nice steady, very important topic. i want to make a couple quick comments to set the stage for ere i think this report fits in. the first is how i read the results. the results say there are three fundamental areas where we are losing a lot, not just in medical spending. the first is obesity, thankfully

smoking has declined so to a great extent it is of the city. you see that with the effects -- these things are related and many things associated with pain. there is a clear issue. i find it interesting that it was a year ago that the wall street journal did a poll, they gathered ten ceos and said what is the thing you most think heal reform should address to be successful in the long term and the universal answer was obesity. that is the first consolation. the second one which will be surprising to some people but is absolutely true, the substance

abuse mental health area. it is a huge issue for the working population. it is keeping people away from work. high-school stdents and elementary school students could tell you it is a major issue in people's educational decisions, it is a vast issue for society. we use to stick people in closets, mental health issues are an enormous productivity concern. that is something that comes through very clearly in this report, a related phenomenon. the third area, those of the first week to. the third one that comeout is

cancer. there are lots of estimates of the cause of early death. some of it is a slightly different flavor than the other things but it is clear the impact of cancer are very big. that area shows up as being particular lead important. that will be related to obesity related things, things we don't know very muchbout at all. that is where i conceptualize things in those areas. there is an issue about a report at the end, what would you do to address them? i think it is worth trying to match that up with what people are talking about in health care reform. one of the things about it is the need for more innovation in some areas. we know relatively little about how to control obesity medically or socially.

very big problem. we know not a lot about the onset of a lot omental health conditions and substance-abuse issues, very important things. in some areas we need a lot more research. in some areas we need to coordinate what we do better, we can treat hypertension for $0.10 a day to $2 a day with medication despite the fact we have been able to do this for 50 years, we successfully treat less than one in three people becausthe financial burden for some people, the difficulty of interacting with the medical system, partly because people forget, they don't understand what the doctor is telling them or when the doctor does tell them they fall off the wagon and a too embarrassed to admit it and go back. you hear from a lot of folks how health-care reform will kill innovation, that is total garbage, that is complete garbage because what it will do

is create the single biggest market in medical care that we have ever known, which is how do you help people did this stuff to manage their health that they know what to do and they know what they need to do. that is a likely outcome that will translate here and is something that if health reform works will he profound impact on us as a society. some of it wil be new innovation, some will be changes in quality. partly they are missing work, partly to have the medical care sqstem, the only aspect of your life you have to miss work to do. there is a whole part of i which is health reform to deal with this. the third thing i want to stress, i will keep my comments ltd.he smart employers have woken up to this, they're

starting to address it. they have thought about productivity as a rationale for doing health-carereform, turns out there are a numr of studies in the literature about the impact on abseneism and so on from investing in worker health. i have been going through that. what is surprising to me about a lot of it is almost uniformly, virtually every single study shows that employers save much more money than they put into these programs and the return on investment for a typical employer from investing in things like employee health is 2 or three to one. that is in addition to money that the good programs save through keeping you out of acute situations where you spend more on medic care. if an employer can to me now and said what should i do t lower my medical spending, i would not

say raise your co-pays orca at your service benefits, i would say figure out how to get your employees to do these preventive things because that is the way you can actually work with them and say lot of money. the smarter employers are catching on to that. but helen might be able to say a little bit more about that. this drive home a very important message and i will te you all about the trashy novels i read at some later point. >> thanks, dr. cutler. time to turn the podium over to helen darling, a leading voice in the employer community. >> i lofe david's optimism. giving me a chance to say some of the things i had hoped to say. i want to congratulate the authors who did this excellent work. it is a great summary o the idence and the kind of thing we always need somebody else to do for us so we have the data we

need to make the case that i think many of us understand intuitively. u get up in the morning and you know if you are hurting or don't feel good or something bad has happened, you are not going to be as successful that day in your job as you would like to be. we have heard example after example of that. the healthnd productivity of workers have, in fact, become almost the number one issue for corporate america and large employers in the non-profit sector. productivity of government employees, if you think about what the large employers in places like prisons and univerties and other places, they have a lot of low-wage, low interest -- indication employees, they have a lot of challenges, they have diarities inth have a lot of ch they have disparities in the

care they get. their product to the and health is quite low, those who have everything going for them still loss of problems of real-life -- lifetime. major corporations have come to understand this. even the federal government is getting the message and for those of you who live in d.c. you may have seen in the washington post, our police officers are now doing runs, they're going to lose thousands of pounds and things like that. to be honest, they are not the most fit group. recently, we live in an apartment and there was a fire, fear of a fire on the top floor, we had to go out of the building and the d.c. fire department came. i watched this man who looked like the most classic walking heart attack i have ever seen,

he was huge. he was going up with equipment thateighed as much as he did and he had to walk up the stairs and i was saying to everybody the man is not going to make it. i don't know about the fire. we have this problem across the board. what we know as a nation we are in serious trouble. i am not just talking about the deficit and the other things we have a very unhealthy population. it is estimated that 27% of the increase in health-care cost over a ten year period were directly due to obesity and obesity ane on top of everything else cost us $147 billion annually. that is just the extra costs related to obesity. one of the things we were recommended in terms of policy, we would like to see this farm package, every bit of federal money that is allocated in grants and things like that, would have to be accompanied, when you apply an obesity impact

plan. you would have to show what you are going to do with that money that would have a positive impact on reducing obesity. and all of the things that go withthat. we have a program called best employers and healthy lifestyles. we get 63 corporations for what they areoing. they are getting the message. i hope it is fast enough. the other thing that happened, we make progress on one front and then something else happens. i noticed the studies 1865, a huge number of 65-year-olds are not going to be retiring, they ll be working at least we 5 more years to make up for the financial loss and the inability to sell the house. we will have a work force that is five years older on average, and they of course will have the problems that even healthy people as you age, need a lot more testing, a lot more

support, to be healthy. we need a healthy and productive work force, we need a healthy and productive group of children which we don't have, we need a healthy and productive economy which we don't have, and our standard of living, your children, grandchildren a others are going to be directly affected by how healthynd productive we are, and we really do have to tnk of it as human capital. it sounds a little cold, don't mean it that way, but the most important input to our economy is we are an economy of knowledge workers, we don't do much manufacturing, we do small-scale manufacturing, mostly in things like medical devices, things like that. very sophisticated manufacturing. but we are a knowledge economy and the only way we are going to be successful in the world is if we build on our capabilities and we can't do that if we are not healthy and productive. ..

anxiety disorders, heart disease, there's a lot of disease out there. so i will end on that and thank you all again for doing the hard work for those of us who will happily use your research. >> well, thank you, helen, and i really want to thank all of our speakers this morning. i want to offer a special thanks to brian and greg of united

biosource corporation f their excellent study and before we open it up to questions i just wanted to try to put this study in context. we're trying desperately through this work to shine a light on a part of the debate that hasn't been focused on. it's not just about reducing costs say in the medicare program and we're spending our money more efficiently but unleashing this economic benefit to our society not only in the form of improved health but also the healt dividend that i spoke of earlier and if you step back from the events of the past few weeks, we also hope that this will focus the debate on ways in which we know we can improve the quality of care. i mean, frankly, we know how to take these steps and we hope we're making a contribution in providing momentum behind those changes. so with that, why don't i open the floor to questions. also ve, i believe, a telephone line open for

question why don't we take the in-person questions first. [inaudible] >> i'm not sure who to address this to but is a two-part question. what's the margin of error of productivity loss and how large of an investment on the man on moon to achieve the g.d.p. effects that are, you know, discussed in your report? >> i would think our margin of error is maybe on th order of 20% but that is, you know, in some sense a guesstimate. i mean, one of the problems that we face in this literature is that there's not consensus on methodology so one study as david had mentioned in cancer particularly they tend to report impact in death, premature death. mental health tends to be reported in terms of

absenteeism, presenteeism. we have some problems of consistency of measurement$ you know, but i think in order of magnitude, i think we're conservative because we did not look at second order effects where somebody who is suffering on the job from profound depression, the whole family is suffering with it. the kids, the wife or the husband so we didn't capture those kinds of facts. now, in terms of the man on the moon effort, the cdc has proposed a program to increase prevention effts across the america. it's a community-based program and theirudget for this is about $5 billion a year. >> do you consider the cdc the -- [inaudible] >> the cdc effort is primarily focused on prevention because that is cdc's mission. that's part of the picture.

it's not all of it. there are other effts in terms of direct treatment that would add to the cost. [inaudible] >> i don't think so. david? >> i was just going to note an often-cited fact that we spend about 2% of medical dollars on prevention despite the fact that three-quarters of medical spending is preventible and we're surely off by an order of magnitude in what share of medical spending should go to prevention. it should be closer to 20% than 2%. >> yeah, i'd just like to add, we don't necessarily have to spend a lot of new money to do some of these things. we deliver a lot of low-value care. we could deliver a lot more high-value care and that's actually one of the things that comparative effectiveness research is all about in spite

of the latest buhaha about misunderstanding and mischaracterization. basically, if we deliver to everyone, including the 40-plus million who d't have anything right now, high-value care, then we would have -- we would get to that triion dollar health dividend a lot faster. and we know how to do that now. >> one of the things i wan to point out in this discussion it's involving a premier projects many of them are upside down at least for the first three years. some of the hospitals in the premier projects of hqid, they're upside down on it. they got the 2 to 3% bonus but it cost them more to ha those improvements in place. you can say long term it will pay back but the preliminary data doesn't necessarily confirm that.

>> right. you want to answer that? i'll respond, too. >> you go ahead. >> okay. first of all, that's older data, the experiment goes back quite a bit. we just rolled out about -- soon to be $22 billion for health information technology in the country. there's been quite a big change in the number of hospitals and providers who have the capability to do things better faster, cheaper and that will be accelerated with this investment. so, you know, you may be correct. i actually haven't looked at it recently other than just the overall results. but we are in a totally different place rightow in what's going to be possible with health information technology. >> could i just add also, one caveat to that is the health information technology is not, as i understand it, geared to pick up productivity issues. and that's a huge issue with

trying to build a system that's based on evidence so that you have a feedback loop and a learning heahcare system to improve what you're trying to do. you have to have information, as greg was saying, that the literature really and the data system is not really there and there isn't really a major move to improve that that i know of. >> i was just referring to the premier demonstration because that was on quality improvement and saty. but agree with you. >> hi, my question is regarding -- in washington the common theme is skin in the game. my question is, what do you see the 10-year savings and would your association be willing to securitize a saving immediately and get commitments from all your members to guarantee that securitization? just the general figure of over 10-year savings, whether each individual members -- because we have a lot of overspending, a lot of inefficiencies within your membership group and would you be willing tout the money

on the table now for the savings that you would have in 10 year >> that's yours or maybe yours? [laughter] >> first of all, as people ask questions would you mind identifying yourself? f.t. deal reporter. for the financial times group. >> ah, i'm not entirely sure how to answer your question. you know, we've been engaged in the process, and we belie, you know, as you take these steps to reform the system, there will inarguably be savings attained. if you're asking, you know, whetr we would commit to those savings immediately, i would say that a lot of these changes are going to take time to be implemented, and we will work, obviously, to make sure that they do. but i think as the authors have alluded to, you know, there's still much work to be gained in

terms of the steps that need to be put if place to achve those savings. i don't know if anyone else -- >> stephanie kay am. miss darling you missed high and low value care. could you give us just a couple of examples. >> well, a prescription drug that avoids a heart attack that someone gets -- first of all sees a physician and actually gets a diagnos. either gets the medication or has it given to them and they'll take it and, you know, take each of those steps. i mean, some of those thing have huge value. appropriate use, medically appropriate to the individual patient, antidepressives. we talked about mental health disorders. i'm not a psychiatrist but my understanding is that those are

areas if you get t right treatment including in some cases some cognitive therapy and the right medication, depending on the condition, and you continue to take it and if you have the wrong dose that isn't working and you go back to the doctor, et cetera, et cetera, that you can actually live a healthy and productive life. so -- i mean, there's dozens of those examples. >> and then just one other thing. it looks like respirary illnesses in the packet that you gave us says it constitutes the most common acute illnesses but then it looks like in terms of cost, the cost is very low. can you just kind of put that into perspective for us in terms of the disease burden? >> well, i think that's appropriate as we're now thinking about the flu season approaching. kids going back to school, that one of the great successes of medical thnology is our ability to deal with acute conditions, you know, primarily through antibiotics so that while common they tend to be in

most cases short and have mild defects. and then you left o alzheimer's and one other disease. why did you leave those two out? >> yeah. well, tre are many conditions that do have devastating impact but ty are predominantly do not affect the working age population so alzheimer's is very much age-related. >> just -- can i just give you a scale of some of t numbers here. in a typical year, the flu will cost americans in the tens of billions of dollars, $20, $40, billion in lost productivity. those are people who are not showing up at work or even worse, showing up at work and infecting their coworkers. those are employers either not having things done or hiring temporary workers to fill in you talk about sort of the shortfalls in the economy and so then, we've got -- every time you see $20 billion lying on the

street, you should do something to pick up the money. and that's fundamentally what this report is saying and what it's abouts saying before you start asking the question about should someone's grandmoth get something or another, whyon't you find the easy $20 billion and do that first? >> it's called low-hanging fruit. and just to go back to the alzheimer's disease question that you posed to greg, we were only looking at the working age population. that was the point of a particular study that we did. but there are a lot of second-order effects certainly with alzheimer's disease in the working-age population who are caring for the alzheimer's disease afflicted people that impact on their productivity in terms of the care they give also the depression and the anxiety and all of -- all of that which

visits on them o there's a lot of things that we were not able or did not include in this report. so there's a lot of underreporting of what we attempted to do. >> al millikin am media. do any o you see an unnecessary rival oppositional approach between the pharmaceuticalal indust and medical doctors versus those in the nutritional, supplemental, natural and alternative healthcare businesses in their approaches to disease? >> they don't deal with the same things, basically. well, the biggest difference in those two areas are reimbursement and from where we sit. i mean, for the most part, employers particularly don't reimbue for that second group.

and people spend billions of dollars i might add but it's their own money so it's their privilege. >> does anyone think if there was support that that might help fighting disease? >> support in what way? >> well, perhaps reimbursement -- i mean, like even just in my own personal experience, my medical doctor has been dismissive of approaches that, you know, have been helpful for my own situation, you know, dealing with cholesterol, blood pressure, you know, things that i know are potentially, you know, very dangerous from a disease and health viewpoint. >> well, i mean, i agree with helen's point that structurally that's either not here in the system nor will be. probably more to the point i would think is that physicians tend to not get reimbursed for

counseling you to lose weight and to get more exercise. i mean, there's a lot of that kind of change within wt we consider to be the healthcare system that is way underreimbursed as well. >> there's a scary fact along the lines of what you said which is that a very large share of people who seek out alternative and complementary medicine do not tell their physician about it becse they're afraid their physician will lecture them about it. and as a result, they wind up in two different paths, which they're not getting anticipate benefits of but worse they're often adverse interactions one way or the other. so it really winds up being a horrible system. ere have been periodic attempts particularly through the iom institute of medicine and other areas to try and set alternative and complementary medicine on a path that's akin

to more traditional pharmaceuticals and therapeutics by doing the kinds of rigorous-controlled studies that would let you know on average, do they work and particular kind of patients and do they work and how do they intersect with other kinds of things that people are doing? my sense this may be a couple of years out of date. my sense is we still haven't done a lot of those so that it's still very much a process of flng blind when a patient is thinking about them. that's a very bad situation to be in for patients where they don't know what to do. they're very confused. they're afraid to tell someone what they're doing and we can't give them a lot of very good advice about the right way to do things is. it's an example of the whole area of chronic disease and how we have not dealt with that systemically. you could never imagine emergency medicine happening the same way. where one doctor did something and he didn't tell someone else that you were doing. you could never imagine that whereas we let this go on a

the time with chronic disease and it's quite symptomatic of where we are. >> mark mccarte with medical advice daily @gain. when it comes to large scale social behavioral change, it kind of strikes me as being similar to losing weight. the first few pounds come off real easily but the farther your ambition takes you the tougher it gets. have you tried to sort of calculate how -- what percentage of americans will respond to these efforts to make inroads on these behavioral things and where you're liable to hit a point where there's no real return on the effort? >> well, we have some experience in the employer community on that. and what we found is that money works. that people -- you can get their

attention and they will take steps, whether it's lose weight and they can actually keep it off. there's a wonderful study that was published, i think, in the "new england journal of medicine" involving ge where they paid workers over $7 handicap -- $700 and one year they got over $700 to get them to quit smoking. and they not only quit smoking and as you know the one year is the me. if you c take off -- i'm a former smoker so i know about this. you know, if you can stay off for a whole year, there's a very high probability of success. and they did. the numbers were just stunning, and they estimated, speaking good old cost-effectiveness, it was over $700 per person and, of course, the program ct a little bit but they estimated that they saved over $3,000 in year one. and you could just go on and on. so you can pay people and get their attention. one of the things that we have

happenin in the employer community is discount off their contribution for doing certain things, like continuing not to smoke or either losing weight or staying active in a program at's attempting to lose weight and, you know, has things like walking and things like that. [inaudible] >> i'm sorry. >> i'm talking about the degree of efficacy. if you have 100 smokers -- sorry. the question isn't whether it's effective or not. the question is how effective. if you have 100 smokers in the ge program, how many quit smoking and how many continued? that's sort of what i'm after. >> i don't have the number in my head. it's significant. i can look it up for you, though. >> we ve sucsses and faures. we gave you some of the failures associated with obety and taking medications. e biggest success has been the long-term reduction in smoking in the united states. where smoking rates have fallen in half since the 1960s.

the vast bulk of which is people quitting smoking. i'm glad to hear you've quit smoking. and they did it partly because of financi reasons and partly because that just became what people did. >> it became socially unacceptable. >> and there were all sorts of reasons why. i don't think there's any single formula that we know of now but i sort of put it this way. we don't know of a single formula for treating cancer now. but we spend seven number of billion of dollars trying to find one or trying to find multiple strategies. we don't knowf a single formula to get people take some medications but we ought to spend some amount looking into it. what we do is a pittance which reflects the fact that there hasn't been a way to earn anything by being in that space and when i was talking about

reform creating opportunities, that's really what i was referring to is creating opportunities where someone has an interest in knowing the answer to that. learning how to do it so that we can then apply that nationally in the way that we apply all sorts of other medical treatments. and i think we're quite ripe for finding lots me answers very soon. >> and just one last point along these lines is the very last point we try to make in our paper was suggesting investments in this -- on the order of putting a man on the moon. it sounds somewhat silly except that's essentially the kind of order it's going to take to change behavior and change some of the thingwe're talking about, we think. >> stephanie kagan, wmau. i just want to understand the independence of the report since many of these things have to do

with detection and treatment and advamed is a diagnostics and the statistics that you put out. >> yeah, let them puthat out. we pride ourselves on conducting our studies according to peer-reviewed standards and we do intend to submit the report for publication. i think our methodology is well documented in the report itself. and certainly any aspect of healthcare reform and health policy, you can pick out a pmrtion of it and say this is particular interest of treatment and advamed is people who invest in medical technology and so we

certainly do address the benefits of treatment. we also speak very much to prevention, which in the case of obesity, for example, is behavioral and does not involve devices. we pointed out that substance abuse is one of the most devastating issues, substance abuse and mental health in terms of oductivity. and here the treatme is primarily pharmaceutical rather than largely devices here. we tried to be guided first of all by what are the conditions that most affect the working-age population and then given those conditions, you know, what is the impact and what are the effective treatments. there are no magic bullets. devices and diagnostics have a very important role. i think everybody would agree,

even steve, that part of good practice is to effectively use our technology and not erybody needs to have a device, not everybody needs to have a test here. >> let them just say -- i'll give you a scientific opinion which is there's nothing fishy about this report at all. [inaudible] >> that's right. there's a more technical one. but every -- in looking at the specific conditions, everything that ought to be cited is cited. they've correctly done the analysis so there's -- i have not a doubt. >> thank you. >> i'm not sure anybody will be able t answer this but i was wondering what kind of role health insurers are playing any role in this or playing a greater role in couraging their members to playing a greater role or incentive measures.

>> i'm happy to answe that virtually large employers use health plans to administer. they play claims directly so they are what you call self-insured but it's adnistered and they buy the services like care management, disease management, things like that. they are playi a growing role. they offer a lot of programs, especially, now. i think if you go back really to sort of the '70s and the '80s, the role of insurance companies aside from just literally playing claims, they began getting into managed care and there they were trying to literally manage the care. what i think they come to realize just as large employers -- all employers have is really isn't about managing care. it's about keeping people from needing the care. so if you really want to control costs, you have to stop people from being sick or injured or --

it's really like the safety model in manufacturing. if you run a big factory in this country or probably any country but especially this country, then you want erybody to be safe. you want to do everything you can to keep people from being harmed. there's the obvious reasons the worker's hurt. it cost money and it's against the law in many instances to have these things happen and so employers focus on trying to prevent injuries and illnesses. and i think that that's what insurance companies have come to understand that they, too -- if they're going to avoid paying claims, they don't do a paicularly good job -- not because they don't try but because it can't be done with ying to say control hospital prices which last year the g.d.p. of our country went down three-quarters in a row and hospitals increased their prices which were already overpriced

7%. so, you know, what's that about? i think insurance companies just like employers have figured -- and the government, that you've got to get people to be healthy if you're going to control costs, even if you had no other reason to do it, like improve productivity of the country. >> maybe one or two other questions. >> i'm from inside health policy. i was wondering if you could talk a little bit about what's in the legislation now that you want to make sure stays in there? you know, when you talked abo cbo not being able to score it and the fear that it might maybe lead it to be taken out of the legislation? also, if the's anything that you think should be included in legislation that isn't, just, you know, broadly the policy implications. >> sure. i'm happy to.

the comments i was making - if you look at the process, there are certain elements of reform that have broad bipartisan support, whether it's better management of chronic disease, whether it's reorienting the incentives in the system to pay for quality of service provided raer than volume of service provided, the investments in prevention and wellness that we've been talking about here toda those are all core elements of reform that we would like to see move forward and they enjoy broad bipartisan support. so i don't think it's a qstion of, you know, what's missing per se. i think we want to make sure that those elements, you know, continue to be the focus of reform because we know that, you know, it's not just about reducing costs in the system in the traditional sense through direct cost reduction but by making these changes we think there'huge economic gains. any other comments?

>> al millikin fro am media again. thus far in the healthcare debate, there's an accusation that medical tests are being overdone and abused. do you and your associates have any -- you know, do you feel threatened at all about that? do you think there's validity in this? >> that's yours. [laughter] >> well, as was mentioned earlier, you know, we fully believe that the main goal of healthcare refor ought to be to get the right care to the right patient at the right time. and if you look at the problems that plague our healthcare system whether it's paper-based tractions or the crushing costs of disease or poor coordination of care or frankly a shortage of

providers, it's going to be more technology, you know, appropriately used that is going to be the solution for many of the problems that plague our system. but, obviously, no one is here to defend inappropriate utilization of technology. >> helen had it exactly right, which is if we took everything we did now, we gave the people who needed the stuff but were not getting at those things and we took the people who didn't need the things and didn't do them, we would have a much healthier population and we would spend much less than we do now. so, in fact, healthcare savings and higher and improved health go together. they're not substitutes. >> it is, in fact, just last week new england journal of medicine -- i think it was the shaddic lecture on hypertension. i would urge you to read it. we're doing more than we've ever done in identifying and helping people get help for hypertension

but the gap in what we haven't done, the number of people -- i mean, it's shocking when you think of the number and mt of them are middle aged men who are walking around and they don't know they have hypertension. it hadn't been diagnosed and it hasn't been treated and they are not taking the steps and they are walking heart attacks or strokes and, you know, you want to just scream and say, you know, that person could end up in a nursing home in a wheelchair for the rest of his life. but if you detect it and get it treated, it's actually easy and inexpensive to treat. and it isn't happening and so there's that and those are the things we should be talking about in healthcare reform. and the delivery systems that will facilitate making tse things happen. and getting people care who don't have it now. >> i think we are going to wrap it up. i'd like to thank again all of our speakers again this morning and if you have follow-up question there's information

in your material on how to follow up and they'll be around a little bit this morning as well. so thank you again for coming very much. [applause] .. [inaudible conversations]

[inaudible conversations] naudible conversations] >> tonight, three docts fm virginia hospital at arlington, va. tell personal stories about training patients and offer their views on health care legislation currently before congress. you'll hear from dr. stephanie.

>> the charge is anywhere from 1800 to $2,000. the payment is usually medicare reimbursement for a mastectomy is between $650, and $750. >> and issues surrounding patient care. >> patients have a tendency when they have a system -- symptom to goo the internet and ry to figure out what is wrong with them. without a medical background and grounding and experience we have, they always get it wrong and usually think they have some horrible disease. if theres anything, i would say, pients should not be trng to make their diagnoses on the internet. >> join us tonight and watch all three doctors from virginia hospital center at virginia university to share their stories about treating patients and their views on health care legislation. it begins at 8:00 p.m. eastern on c-span. >> tonight, texas republican

john culbertskn shows how members of congress use technology to stay in touch with their constituents. on the communicators on c-span2. >> next, a conference on the future of the russian military and how the obama administration should proceed toward a new foreign policy. during this panel analysts examine russia's efforts to restructure its defense and discuss the nation's military doctrine. from the hudson institute, it is an hour and a half.

>>ood morning. i would like to welcome everybody to hudson. my name is richard white, director of the center for political knowledge and analysis at hudson and longtime studenp of the russian military. i want to begin by thanking you so much for coming. we are truly amazed at the turnout in late august. we have a record number of people here for the hudson event, partly a tribute to our speakers, partly attribute to the person holding the conference in honor of, partly because the topics are very important, russian defense reform, perception of international security trends, russian views on national security and visions of a future war among other topics. i would request everybody now please turn off or turn to silence any of your communicationevices you might

have. we are very pleased at c-span and other t networks for covering the event, make things as easy as possible for our c-span viewers. we want to eliminate as much as possible distracting noises. just to review the procedures for today's conference, we will have four separate panels, and they will be short breaks in between, about ten minutes long, we will break for an hour at lunch at 12:30 a 1:30, with the panels will run will be the speakers for theanel will first deliver their presentations, then allow for the commentator or the speakers to ask questions of themselves and we will be glad to conduct audience discussion and commentary. we will have people with microphones and will come to you, please wait for the microphone to come so it will be picked up by the tv recording

and identify yourself for the courtesy of the speaker if you are able to do so. i will introduce people in the order, when they give their presentation for each panel. i want to begin by saying it is my great pleasure to introduce senator wimbush, senior vice president of hudson. people put today's events and the proper context. [applause] >> tha you very much, riahard. this is indeed an impresse audience, i am sure this is going to be an impressive occasion. today's events are a tribute to remarkable individual, mary c. fitzgerald, a hudson exit for 20 years, good friend and colleague. i am particularly grateful to richard weitz and by olfriend

and colleague, ste blank, for putting this event together and making it possible. let me say a word about mary. from 1989 to 2009, mary fitzgerald served as a research fellow in saw no russian military affairs at the hudson institute. she was fluent in russian and analyzed russian and chinese military writings for the department of defense, organizational structures and defense imperatives. sheerved as a consultant to the white house office of science and technology policy, the defense science board, the u.s./china economic security review commission, the emt

commission, and many others. onion on soviet military doctrine that few in the west could excess, mary was one of the first to discover the critical soviet concept of the revolution in military affairs, or the r m a as we kn it today. of fus on the new high-tech way of war it emerging, mary soon became a favoribecame a fa marshall, one of the world's preeminent military strategists. he worked to ensure that mary's discoveries and subsequent search obtained the broadest possible audience among intellectuals in the united states and western europe.

the pioneering impact of mary's work can be seen today, the concept of the bar and a, in many facets, transform the american defense strategy. with strong emphasis on network centric warfare, precision strike, dominant battle space awareness, became a central u.s. defense doctrine, shaping the contours of how our military understands and pursues a future understanding of the way warfare cod take place. highlighting the critical importance of the r m a was just one of mary's significant contributions to national security. her interviews with former and current russian military officers uncovered much that would otherwise have been missed by western analysts. her examination of the impact of new technologies and how national defence is understood,

drawing on her earlaer work in the car and a along with an analys of the impact of strategy, leading to breakthroughs in electronic and space warfare. later, mary was one of the first in the west to uncover the people's republic of china's focus on what has been termed the space theater for global warfare. years before china stunned the world in january of 2007 with a very public display of its anti satellit capabilities, she warned of this danger. at the time of her death, she was well into her latest research, broadly titlechinese and russian asymmetrical

strategiesor space dominance and as usual her insights were unique. mary fitzgerald completed cutting edge studies for the department of defense which included russian views on the electronic and information warfare, the impact on russian military afirs, russia/china convergence and divergence on twenty-first century warfare and many other salient seminal studies. shea contributed to many books and was the author of three particularly important ones, the first being soviet views in 1987, the second, the changing soviet doctrine of nuclear warfare in 1989, and the third, the new revolution in russian military affairs in 1994. shea contributed a pivotal

chapter to the hudson's 2005, china's greatly forward high technology and military powein the next half century. that chapter was entitle china's evolve in military juggernaut. she published just about every place that was important, the strategic review and comparative strategy and defense analysis and the international defense review, the naval war college review, airpower journal, the air force magazine, the armed forces journal, defense news, the wall street journal, the christian science monitor and many more. from 1994 to 1995 se served as adjunct professor at the air command of staff college where sh left extensively on russian aerospace theory and practice. in 2007 she submitted testimony

on china's military strategy for space to the u.s./china economic security review commission. but what made mary unique was her workmanlike focus on analyzing military trends. she was a pioneer, as one of the first female analysts in her field. those she was always modest about her work, her discoveries both shaped u.s. policies and launch the careers of numerous other analysts, many in this room today, and many other areas of inquiry. others, with far less knowledge, no language skills, or any real expertise, mig have sought the limelight, but mary never did. when the chinese conducted their auspicious anti satellite test

in january of 2007, time magazine tracked down mary, who should be a talking head on every show but she deferred. she lets analysts speak for her. she did get one major public recognition in 1993 after the gulf war. she was awarded a civilian medal by the chief of army intelligence for unique contributions to understanding russia's reaction to operation desert storm. mary fitzgerald broaden our understanding of significant national security challenges and she helped america prepare for the warfare of the twenty-first century. many of us knew mary for her deep devotion to her family d

friends, her immense compassion, and her extraordiary, we the, sharp sense of humor. my colleague at hudson, can weinstein, said it best in his debut to mary. as american citizens, he said, we owe her a debt of gratitude. contributions will be remembered for decades to come by t changes she brought about through her work. i want to thank you on behalf of hudson and our florida trustees for joining us in honoring mary with this auspicious conference. and we know that the resul are going to be exciting and provocative, and we know that mary, modest as she was, would heartily approve.

thank you very much. [applause] >> thank you so much for those terrific words. the first panelist will be steven blank, who will speak about russian military doctrine. dr. blank served as regional security expert athe u.s. army r college of strategic studies institute 1989. he has written many books, articles, conference papers, some ohis latest works include editor of imperial decline, soviet military in the future and nationality. steve played an instrumental role in helping us organize today's conference by helping diffent spkers, he will be helping produce and added a volume of the conference paper for today which will be

available on strategic studies institute web se for downloading. he has been eellent mentor in the field of many ynger scholars including myself. >> thank you, richard. i have to say, because i work for the army, my presentation today does noteflect the views of the army, the defense department or the u.s. government. this is my views alone. another roker a -- number of other people with the government. i will be talking about the new national security strategy, the russian government published on may 12th. this is an extremely self confident document. i say quite falsely that it says russia has mastered the economic and political crisis in the past and is on its way to further development. if you look at this document

carefully, if you look at the debate that goes into this document, what you see instead, a growing feeling of anxiety, immense political struggle within the russian military politicaelite, and an unresoed struggle at that, has its roots in russian history. those of you have gone back and studied russian history know that there was a perennial conflict in russian security policy between those people who think the governmentnd policy ought to happen primarily defense oriented or military oriented, respected, whereas those responsible for the economic development of the country invariably say we can't afford it and they are constantly sayg security policy must be tailored to what russia can really afford. this debate goes back to the nineteenth century. it is still the case now. in this concept we find it.

this strategy was supposed to come out in 2004. first call for a new national security strategy to replace the one published in 2002. this was supposed come out in 2004 but by 2005 prominent officials started saying we don't have the means or resources to right the strategy or defense doctrine. at the end of 2007 the department of defense officl actually said russia doesn't have the resourcec to make a doctor and even though they said it was coming at it. i don't know what changed in the 18 months after that but they got the resources to do so. this was the fact that there was a tremendously and resolve political struggle that held up publication until now. the struggle comes down between what i just described, a group of people taking the defense oriented, military oriented point of view and others argue on behalf of a policy, that is

more based on the economic realities of the situation as they perceive it. this concept have a defse oriented or militarize political science -- securitized concept that is more and more subject are labeled subject of national security. for example possibility of avian flu or the propagation of russian in sanity, has become a national church or a matter of national security to invoke a german political science, securitized, they have become an issue that has been reserved not for public debate but for the governmental elite to supervise this society and we know that is a very long standing tradition in russia. as a result, the people who have that kind of military and securitization have postulated in this document and in the

debate going through 2004 to 2009, loan conferencing threat perception of russia. russia is being threatened on all fronts by the west. what are tse threats? nato enlargement, the concentration of troop movements, increase military forces around russian cis, the evidence is rather shaky but this will not be fair people from sayinwe are confronting a greater military threat. as part of this process, the second fret is encroachment by the west upon the cis. russia believes it is advanced -- internal to its sphere of influence from western, particularly american encroachment. third, there is a tendency in the world, expressed by the u.s. invasion of iraq, for the

unilateral use of force without going through the united nations. this is a threat to russia because what they are saying is the united states ul decide to use force against russia or russian interests or our eyalli without anybody stopping it. furthermore they see a development not just of nuclear proliferation, though that threat varies with various people, a growing tendency on the part of the u.s. to think of nuclear weapons as instruments of war. we look at russian nuclear -- the russian think of nuclear-weapons in the same terms, fighting weapons. as a matter of fact, they're going to carry tactical nuclear weapons on cruise missiles in submarines. the doctor in in 2000 talk about

the possibility of first strike using nuclear weapons if russia's 5 interests are at risk. furthermore, they see a growing resort of war as policy around the world, these wars are coming close to russia. we are the main prayer of this threat. by no means last or leased, russia sees itself as being threatened by a comprehensive information strategy on the part of the west. and information -- not just simply taking down cybernetworks but an attempt to use information technology to undermine the structure of society and government, and unleash the society from within making it vulnerable to political penetration. the military or general staff is essentially calling for something that looks rather soviet. there isn attempt to bring back elements of the

mobilization system that categorize the soviet union. general staff point of view having to administer defense, the deputy commander in chief in peace as well as in war, having the capability to mobilize. they talked about the use of the military not just against foreign threats but domestic threats with information and political warfare. vladimir putin bought this threat assessment by 2006 even though it had been stipulating since 2004. by 2006/2007, he accepts almost point by point every single one of these threats. however e problem the general staff mentioned is the government refuses to respond to these threats. national-security strategy is a document that not only assesses

the threat but more importantly calls for response on the part ofhe government. russia simply can't afford that kind of policy, leading us to ruin as well, cause as russia's isolation, no one to rely on in the world, and as a position of conflict of erybody and his neighbor and russia therefore must pursue an overall defense policy that is primarily based first of all in and enhancing s economic capabilit and for the picy must be that capability, they must not exceed russia's capability to act in the world. therare consequences of this debate. the security strategy we see on the oneand, the threat assessment was bought by the government. the government talks about the fact that the security strategy, the likelihood of the next decade or so is primarily connected with the scrame for energy and will probably take place in areas around russia's strategic perimeter, the arctic,

the middle east, central asia. this presupposes the commants in certain quarters from the west, that this will lead to armed conflict among states, since energy is russia's main foreign policy weapon on the basis of economic prosperity, the west is after its energy and this will lead to war. the kind of wars they're talking about are not described in any detail, they should be described in the upcoming defense doctrine, we need to talk about the fact that the russian military is being reformed so that the army, so -- to some degree the air force, the helicopter force, would dominate the c.i.s. in the event of any kind of conflict. what they expect, with the general staff