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tv   Capital News Today  CSPAN  December 7, 2009 11:00pm-2:00am EST

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>> would be impossible to make the argument with a straight face i think. >> a question from the senate colleague from south dakota les year. we heard the majority leader, senator reid come to the floor just a few minutes ago and talk about how this bill is going to get premiums under control, keep the cost of people who have insurance keep their premiums under control. i saw a chart from the center from south dakota yesterday that said 90% of americans those who have insurance now if we did nothing and did not pass this
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bill the premiums would be lower than if we did pass this bill. passing this bill is going to raise premiums in spite of the fact the president of the united states promised while campaigning he would lower cost of premiums for american families by $2,500 so i would ask my colleague from south dakota isn't it true if this bill passes americans wanting, they've been promised the premiums would be reduced aren't they doomed to disappointment? >> the senator from wyoming is correct and this is where the real world in this bill comes into play because what we were told and promises were made of course many promises were made through the course of the campaign most of which will never be realized with this legislation there was also a promise made taxes wouldn't go up people making less than to hundred $50,000 a year. not payroll taxes on income taxes, any kind of tax and in fact we now know that 30% of the people who make under $200,000 a
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year are going to see their taxes go up under this legislation. so, promises are made during a campaign season tend not to necessarily be adhered to when it comes time to legislate and follow-through and i think that is clearly the case here but with regard to the senator from wyoming's question, the purpose of health care reform at least as i understand and for the most part the people of south dakota that i represent understand it is to lower-cost because of brigety complaints the thing you hear the most and you go back and the senator from georgia is here, william and, south dakota the figure most frequently from people in the states is do something about cost health care. we have these year-over-year double-digit increases or increases that are twice the rate of inflation and we are dealing with the small businesses are dealing with it more and more people, families are struggling with high-cost health care. nobody argues that. obviously we all basically accept the premise health care costs have been going up and health care reform ought to be
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focused directly trying to get costs under control. the irony in this is that after cutting half a trillion dollars of medicare in the first ten years and if you going to be implemented time period it is about $1 trillion half a trillion dollars of tax increase is what happens with premiums. well according to the congressional budget office 90% of americans would be the same or worse off. in other words 90 prison of americans would see no improvement in their health insurance premiums. in fact if you buy a small group market, the large group market your premiums from your premiums go up by about 6% a year. year-over-year infected family for let's put it in perspective american family can understand and that is if you are a family of four and this is according to the congressional budget office, if you are a family of four being $14,900 for insurance this year and getting insurance and a large market because you work for a large employer in 2016 your insurance cost is going to
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be over $20,000 a year. in other words your insurance is going to go up from a little under 14,000 a little for $20,000 a year in that time period. so, what american in their right mind is going to say that's reform? i think most americans are going to say what are you doing? spending too and a half trillion dollars, raising my taxes and cutting by parents or grandparents medicare benefits for what? so that my premiums can stay the same or go up? if you by your insurance in the individual marketplace your insurance premiums according again to the congressional budget office are going to go out anywhere from ten to 13% a year. so you get medicare cuts, tax increases and for 90% of americans use the the same or are worse off in other words your insurance premiums are not going to be impacted. you achieved the status quo or worse yet for insurance premiums will go up ten to 13% of your body of the individual market. that is according to the
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congressional budget office. and so i would say to my friend from wyoming the piping you make is exactly right. we are doing all of this and the exercise of to be reducing cost. clearly that is not the case with this legislation. >> let me address the question to the friend from wyoming who is a medical doctor and outstanding senator. you know, we are being asked to believe from the folks on the other side and with the american people are struggling with and having a hard time believing is they are saying that even though they are cutting medicare by a total of 450 billion plus over this ten year period that medicare is actually the solvency of medicare is going to be extended. the expected the american people to believe that somehow when the fact of the matter is we've noeth from the information we received this spring from the bipartisan medicare commission
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unless something is done medicare is going to become insolvent in the year 2017. pure and simple. and what we are doing here is not taking the savings that they are proposing and why we don't agree with them, but irrespective of that, irrespective of the savings they are seeing are going to be achieved instead of applauding the fact we are going to use that to grow the size of government, reimbursement payments to physicians to the medicare program and now we are looking at about 23% reduction and payments to physicians as reimbursement under medicare if we don't take action next year when you put all of this together the american people are saying you have got to be kidding me. hauer and the world are you going to extend the life of medicare by cutting it by almost $500 billion? >> there's no way you can save medicare when you cut that kind of money out of it.
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and how when they cut physician payment by 23% are we going to have physicians going to a number of small communities in south dakota in georgia and wyoming where we have many people who depend on medicare for their health care. i worry about access to care and your colleague senator isaacson yesterday talked about home health care and how for pennies on the dollars you can help people provide a lifeline for people homebound. keeps them out of the house will come out of the nursing homes. but instead the democratic lead senate yesterday voted to cut $42 billion out of home health care which people in small communities and the rural natures of the state depend upon so there is no way this program can stay solvent and it is hard for me to fathom and clearly hard for the people of why me to fathom how with all of this budget trickery it is printed work for people who need to go
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to a doctor to see a doctor or have a home health care provider in many rural communities to be we have town hall meetings and when i go to the town hall meetings people say don't cut my medicare, don't raise my taxes and don't make things worse for me than they are now. >> the senator of course is one of the only to physicians in the united states senate this experience and depth and knows what it's like to serve and provide health care services to people in areas like wyoming, south dakota and some places of georgia. but i think what is interesting, too and the senator from georgia was here as light and the senator from leaving wasn't at the time but in 2005 now we have a debate about medicare the senator from new hampshire proposed cutting $10 billion in medicare. taking $10 billion over a five-year pro quo or 2 billion a year and pay for it by income testing the part be benefit
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pilat, the premiums paid, those in the higher income categories would have paid a higher premium for the party drug benefit than would those in lower income categories. you would have fought the apocalyptic pronouncements and predictions around here about that was coming to do to medicare, $2 billion a year from 10 billion from $2 billion a year and you heard the other deaths might describe it as cruel, disaster of monumental proportions, that was some of the terminology used around here up the time. that was for $10 billion over five years and that basically was to see people who have higher incomes, the warren buffett of the world ought to pay more for their prescription drug benefits under medicare than those in lower income categories and people went nuts on the other side they went nuts about that. and here we are talking about cutting 465 billion over a ten year period, 1 trillion of for ten years when it is fully
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implemented and it seems to me, mr. president, and i would say to my colleagues the oversight is going to have a lot of explaining to do to the american people about why $10 million in reductions plus in morrill, cool and disaster of monumental proportions but cutting half a trillion dollars out of home health care and nursing homes and hospitals and everything else somehow to pay for it is entirely new entitlement program, $2.5 trillion expansion somehow makes sense. >> i appreciate the comments from my colleagues and i think we are hearing all around the country we do need a kind of health care reform. we need to get costs under control. we need to have a patient centered reform, not government centered, not insurance centered reform, we need to not cut medicare, not raise taxes, we need to not make things worse for the american people and mr. president, i would just say from what i have seen of this bill and worked my way all the way through this bill makes
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things worse for the american people, not better. this is not the right prescription for health care in america and with that, mr. president, yield the floor. >> mr. president, i would like to take a few moments to discuss the amendment the senator from new hampshire, senator gregg offered yesterday. the ed gray amendment has been billed as protecting medicare. that is the new fashion on the other side of the ogle to say that the bill cuts medicare. frankly that's a misleading statement at best and it is an accurate basically. in reality the gregg amendment is a killer amendment to prevent health care reform from taking effect. that is the purpose of the amendment. stop health care from taking effect. it has more details but he can give the flavor of it from
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excerpts. let me quote from the amendment. the first subsection is entitled, quote, ban on new spending taking effect, and of quote. you really don't have to go much further to get an idea but the amendment is about. just focus on that statement in the amendment. a ban on new spending taking effect. let me quote further from the first subsection. quote, the secretary of treasury and secretary of health and human services are prohibited from implementing provisions of an amendment made by sections 1401, 1402, 2001, and 2101. and of quote putting it what are those sections? one of those sections the gregg amendment would take effect. section 1401 is refundable tax credit provided premium assistance for coverage. those are the tax credits the tax reductions that help people buy health insurance, the
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amendment says it can't help people buy health insurance. you cannot have those tax credits. the second section of the amendment, section 1402, what's that? 1402 is the reduced cost sharing for individuals. that's the part that would make the co-pays out of pocket expenses affordable. the gregg amendment says can't have reduced cost sharing for individuals, got to keep those co-payments in effect and out of pocket expenses too high. speed amendment prevents expenditures that would help people with those co-payments and out of pocket expenses. the third section that the amendment would stop this section 2001. 2001 is a section that provides cade coverage for the income populations. that is the one that finds expand medicaid coverage to 143% of poverty. senator gregg says can't have those medicare favorites come can't help poor people with health care, private.
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the secretory prohibited from helping, making those payments to medicaid if that amendment is adopted. >> the fourth section the amendment would stop this section 2101. section 21a1 is a section that provides additional funding for the children's health insurance program. can you believe that? a senator gets up on the floor of the united states senate and wants to stop funding to the children's health insurance program. that's the section would provide one of the sections in the gregg amendment. so if you don't like tax credits that is tax reductions help people buy health insurance. if you don't like making health insurance affordable, if you don't like health care for the lowest income americans, if you don't like health care for kids, then the gregg amendment is for you. now folks on the other side of the aisle have spent a whole lot of time this year, all i hear from them talking about medicare. they make it sound like they want to help medicare. and in fact they are hurting
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medicare. a lot of folks on this side of the aisle said they want to help medicare. let me take a few moments to set the record straight how the medicare trust fund works. that might help them understand frankly why the bill before us, the reid bill helps medicare. contrary to the protests on the other side. the medicare trust fund provides hospital insurance for seniors and americans who are disabled. working americans pay into the trust fund and pay their payroll taxes. and when a senior has to go to the hospital or let's say nursing home there are lots of areas where seniors get help. spending to help pay for the hospitalization comes out of the trust fund. but surely from nursing homes come out of medicaid but some of the payments to the nursing homes also comes out of a trust fund that's medicare like home health care etc. when payroll tax revenues are
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greater than payments for hospitalizations the assets in the medicare trust fund grow. that's good. on the other hand, when spending for hospital care is greater than payroll tax revenues and interest payments on the trust fund assets, then assets of medicare trust fund diminished. that is not good. the actuary for medicare, this is the person charged with determining the health of the medicare trust fund. the actuary for medicare with hhs tells us if we don't do anything of the legislation is not passed them by about 2017 the medicare trust fund assets will be exhausted. that's clear. that's a definite. that is the fact and i emphasize the word fact because i'm just being honest, mr. president. i've got to be honest objecting this. when i knew the senator on the other side of the all talk about medicare they are not looking for facts. it's one thing to say something
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and engage in all of this rhetoric but it is not backed by facts is a bit irresponsible. i ask them to look at the fact and the fact is if the medicare trust fund life of it will be extended under this legislation for five years according to the actuary and asked one senator privately after the floor said medicare trust fund is not going to be extended, i asked him privately how can that be true? pieces what actuary portion. it's not senator sitting right here. its other senator and that senator said i don't believe it. it's a fact. the actuary says that's the result of the legislation before us. namely that the solvency the trust fund will last five more years. that is a fact. that is the act where the report says. so, we could either raise more people texas and continued solvency of the trust fund so
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seniors get benefits or we can reduce spending out of the trust fund. increase money in and decrease the money coming out. i will see again the medicare act where it tells us the health care reform will extend the life of medicare trust fund by five years or put another way if we do not act health care reform will hurt medicare's long-term solvency. the payments used for seniors. now let me cite a few concrete examples of how that works. health care reform would discourage hospital readmissions for example. that's waste. here's what the other side doesn't quite understand i think. because you don't hear them talking about. the goal is to extend the life of the trust fund basically by cutting out waste. not hurting seniors but cutting out waste and cutting back on over payments in some areas where some providers are
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overpaid. and where seniors are helped, an example of ennis hospital readmissions if you could discourage hospital readmissions that's fewer dollars that are wasted out of the trust fund for seniors and it's better health care for seniors. we know the incentives for hospitals to have more readmissions because that is what makes money, every it meant it to the hospital. some hospitals frankly don't go out of their way to prevent readmissions because they know they can make more money that we also it is not good care to seniors. that is when a senior is discharged from a hospital you want to make sure there is a flow even of seamless effort of keeping health care for that patient whether it extended care or home health care, nursing home or what not and there is a physician involved and nurses involved and so on, so forth, so the patient is taking his or her
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medication and it is to make sure the patient is keeping it better all the time. we have heard many people talk about this, too often the patient is discharged -- care for that patient isn't as great in the sense of the physician of the hospital or the hospital is no longer involved and sometimes the physician, the doctors are not involved because the regular doctors are not involved very much when the patient is in the hospital. mauney view is it needs improvement. it is not perfect. anyway, we are saving on health -- seating dollars in the medicare trust fund by preventing excessive readmissions. if you're excessive that is wasteful and it doesn't help the patient so that is one way that we are saving and that helps extend the solvency of the medicare trust fund. that's one way. and there are others. let me cite a second one.
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health care reform discourages hospital acquired infections. i think in america unfortunately i don't know if it is a fact of life read somewhere and i haven't confirmed it the rate of infections in american hospitals is greater than it is for other industrialized countries. that is clearly a problem people die from infections in hospitals and it just seems to me the more we can encourage a few infections and when we is health care reform may be lower payments to hospitals that have to many infections. i know it's hard to do a judgment call that you got to do the best you can combat too will help the solvency of the trust fund and help care for patients. so that is one other way we are extending solvency of the trust fund. other people talk about i see my
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good friend from william on the floor, senter barrasso talk about health care. i am sure he wants to eliminate fraud in home health care. i'm sure he does. we all want to. so we cut back on areas where there is fraud. where is their fraud? there's fraud in out fliers. to many hospitals built, and especially sick patient it's an out liar. one county in florida built 60% about late payments in america even though the county had 1% of seniors in america. other examples like that. but general accountability office came with less and said we've got to do something about this. there's fraud in the home health care program. i don't single out home health care. i'm a big fan of home health care. they do really good work. but we want to take out the
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fraud. excessive payments is fraudulent. is that a good thing to do? doesn't that help extend solvency of the trust fund? is in that helping patients, not hurting them? that is what we are doing here. other examples like that. in fact, all folks came to us and said make some of these changes because it is much more efficient. we can get better care and the result is fewer dollars going to the home health care. we also added a provision for rural health care. america needs a little extra help, extra bonus health care. my point very simply is when senators stand up on the floor and said we are cutting medicare sometimes the easy work cutting benefits, sometimes they say we are hurting beneficiaries it is false. it is not true. it is true some cases we are taking a fraud out it is also true in some cases we are taking some excessive payments,
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excessive not by our judgment by that attack and other organizations experts that study this and say that it is excessive one senator of the four stood up and told me he agreed that payments to medicare advantage or excessive. it doesn't make sense to take out the excess, take out the race, the fraud and in order to extend the life of the solvency of the trust fund to help patients in the future. that's what this bill does. it doesn't, quote, hurt seniors by, quote, cutting medicare leaving the implication we are cutting medicare benefits. season the loud enough needy people start to wait. that is what the other side is engaging in. if you look at the facts, the actual facts the actuary says it does extend the life of solvency of the trust fund. the actual facts we're cutting out waste. industries say help us with this and that so we can be more efficient. that is what is going on here i have countless examples let me
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get a third one. this legislation would encourage hospitals and doctors to put together by bundling payments. doctors and hospitals work together guess what happens, mr. president, they are less likely to order duplicate tests, it's not all silo. they are working together. duplicate tests, payments based on fee-for-service, based today on volume, quantity it is in some cases wasteful. it's wasteful. all of us go to hospitals, doctors of this kind of wondering my gosh, something seems wasteful here. got to keep new tests and new this and knew that and the doctor didn't -- i was here previously got to start all over again, all this new stuff, images industries, the or just waste and we are trying to help cut out this waste and bundling payments as the finale going to help. the techniques, accountable care organizations, medical, concept,
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these can take a year or two or three, a gradual tickled but they do work and it's the model of care systems we talk about of which cut out waste and proof quality of the same time and that's going to help medicare. these integrated systems are also going to help extend the solvency of the trust fund and its improved quality care, not reduced but improved. the main point i'm making is these reforms will extend the life of the trust fund, and guess what, mr. president, the improved the quality-of-care. not decrease but improved. but we also added additional benefits under the for seniors the would not receive us legislation does not go into effect. >> now mr. president i want to talk about what this legislation does and doesn't do. because every claim that is being made is simply without foundation. this amendment is basically an amendment designed to try to get
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this bill. what it does is try to condition any kind of spending we might spend additionally and any tax reduction in the bill it conditions on a certification they are offset which we love to do and we do they want to offset without accounting changes in medicare. or social security. that is a gimmick. it's calculated to prevent us from taking the positive changes we make and using those changes and any effective way to do even more that is positive. let me be very specific about some of the more that is positive but i want to first -- let's go through each of the claims made by the other side. first they claim the medicare payroll taxes are reduced in this bill to pay for
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non-medicare benefits. they say that this bill raises the medicare payroll tax so that we pay ford on medicare benefits. just not true. it is true the payroll tax goes up for an individual with an income over $200,000 for a married couple with income over $250,000. but let's set the record straight. blight law, and nothing in this bill changes that law. all medicare payroll taxes are used to improve the solvency of the medicare program. this bill does not change that practice notwithstanding anything they try to say. and it certainly doesn't drivers medicare payroll taxes to another program. even the cms actuary has
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certified because the medicare provisions contained in this bill the solvency of the medicare part a hospital insurance trust fund will be improved by five years. so what they are saying with respect to that is simply not true. they also claim that medicare cuts are used to pay for coverage expansion. this statement actually ignores the benefits that seniors receive from this bill. and i think it also is important to remind people how the medicare financing system works. i just talked up the medicare solvency in the park a program. the part a program is paid through payroll tax to read the part b program and prescription drug program is paid through a combination of general revenue
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contributions and in raleigh premiums and they pay about 25% of the total program cost patriot premium and 75% paid by the general revenue. part de financing works exactly the same way. this bill reduces medicare spending by a total of 463 billion. doesn't reduce the benefits but it reduces those of the spending over the next ten years and you know what that does mr. president? that lowers the out-of-pocket premiums that beneficiaries pay for medicare physician services and prescription drug coverage is. so in effect a week, and this has already been certified by cbo. we lower the premiums for seniors triet that's the benefit. the opponents claim that the medicare cuts to providers are going to result in decreased
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access. it's interesting the very same people who brought us the so-called death panels that never existed are really at this again with respect to access. they want to scare you and say you're not going to get access to a doctor or to your medical care and they claim that medicare beneficiaries can be harmed by the bill, and yet even as they say that, the people who represent 40 million retired americans say no, no, that's not true. our people are protected. the american medical association says no, no that's not true. the folks with much care about are protected. this bill fully protect guaranteed medicare benefits for seniors. it will keep medicare from growing broke in seven years. it extends the life of the medicare trust fund. it reduces prescription drug costs for seniors. it ensures seniors can keep their own doctors next year by
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blocking 21% pay cut for physicians. it creates new prevention and wellness benefits and medicare. it keeps seniors in their own home and not in nursing homes. >> the senator's time is expired. >> can i get more time? >> i yield an additional five minutes to the center for massachusetts. >> mr. president, i thank the distinguished leader and the chair. so the opponents of health care reform are simply not telling you the program is about to be insolvent because private insurance companies and some of the providers are in fact using the money to basically get rich off the medicare dollar. we ought to be clear about the impact of these policies even with the medicare changes that we have made our yoke medicare beneficiaries here this. even with medicare changes in
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the bill, overall provider payments are still going to go up. they are not caught, they are going up. we are slim because simply slowing the rate of growth. and that is something everybody on the other side has said that they want to do. wall street analysts suggested many providers including hospitals are going to be winners. that is a quote common net winners under our bill the estimate hospital profitability will increase with reform because more and more hospital patients will have private insurance that they don't have today. and the hospitals today are out of pocket because they take care of these people but they don't have the insurance. so just as in massachusetts where the premiums went down and expenses for free care went down that's precisely what the impact will be here. so we have a choice, mr. president. we can do nothing which is basically what our colleagues
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have proposed. status quo means that the care is going to be broken approximately eight years. it means seniors are going to pay higher premiums and cost sharing due to wasteful overpayment to providers. millions of didn't fit to become eckert dollars a brand-new be wasted lining the pockets of insurance companies to keep people off indiscriminately or tell them they don't have the coverage when they finally get sick and need the coverage and the status quo means seniors are going to continue to pay for their prescription drugs. the fact is this is the time for responsible action. this bill strengthens the medicare program. it reduces premium cost for seniors. it restores medicare financial integrity. it provides -- with ford vice medicare and protects medicare benefits for america's seniors. let me point to another thing they keep saying. they keep saying that this bill
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cuts billions of dollars for medicare of vantage programs. hurting 511 million seniors enrolled in the programs today. well mr. president that is exactly what they said. this bill cuts medicare advantage and hurts those millions of seniors. wrong. not true. scare tactic, same procedure trying to distort and provide your. nothing could be further from the truth. this bill cuts down on overpayments, not benefits. what tax payer in america should willingly pay an additional amount for service more than the service is worth and more than we pay in the regular program? >> with the senator yield for a questioned? >> if we can yield on your time at the and i would be happy to do that but i want to start making points. overpayments -- it's the overpayments to the insurers that actually threaten
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medicare's future and that's what increases the cost for seniors. and 2009 medpac, the commission that advises on care estimates medicare's current pay approximately 12 billion more for beneficiaries enrolled in private medicare advantage plans than if they were in the traditional medicare. these are overpayments according to medpac, and according to folks in the medical profession. and they exist because private insurance under the medicare advantage are overpaid by about 14% on average. i might add coincidently in 2008 the senator from arizona allows the nominee for a president one of the top aides, mr. douglas said i think in an article in usa today, quote medicare and finished plants can compete on a level playing field.
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the changes in this bill, me speaking now the changes in this bill will help reduce these overpayments and they bring us closer to that level playing field that was suggested last year. my friends on the other side of the aisle say that reducing the government subsidies to private medical plans is going to increase the cost for seniors. again this statement is fiction. the overpayments, private insurance companies received under the current law to deliver medicare benefits have increased the cost for seniors today. so mr. president i would ask -- the in fact result in a 90-dollar increase to seniors to pay for the difference. so i would ask unanimous consent the full text be placed in the record and not in full, and i hope as we go forward here that it is the truth and fact that will prevail, not fiction we keep hearing to scare seniors. >> without objection. >> mr. president. >> the senator from wyoming. >> i would also ask unanimous consent that an article
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immediately following the speech be placed in the record called the coming this is a disaster by douglas, the same congressional bushel officer director that he was referring to that goes into a number of these points i will probably do leader apply want to get this point because i want to relinquish time as the senator from oklahoma might want. >> i thank the center. the question i was going to ask -- >> the senator made unanimous consent request. >> the question i was when ask the distinguished senator from massachusetts is how many medicare patients has he ever paid for? how many medicare advantage -- how many medicare patient as he cared for? how many times has he been in the trough experiencing the heavy hand of government as we try to care for people on medicare? the answer to that question is zero because he is not a physician. he relies on the american
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medical association, the american medical association that today represents less than 10% of the active practice and doctors in this country. he relies on aarp who has 40 million membership but is the fifth largest revenue receiver from supplemental policies. that is who he relies on. the fact is as he doesn't have the experience of being in the trough of caring for patients. let me tell you what's been to happen to medicare advantage patients. the censure would not yield i have no intention of yielding to him. >> i was ready to deal on your time. >> the center would not healed by will continue my top. >> medicare advantage patience there's no question i've agreed with the chairman of the finance committee the competitive bidding needs to happen. but there's one thing that happened on the way to the bank but there's going to be decrease in benefits, not only decrease in what we pay for their spring
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to be decreasing benefits. and where will that impact the most importantly felch? notte the ruben areas. it's not when to be felt in the urban areas. it's going to be felt in several areas throughout this country that's where it is wicked be felt. it's going to be felt out there where there is a marginal hospital that is using the other benefits to help maintain the flow of that hospital. so there is no question that if you're one of the 11 million or with the exception of those that have feels caught in this bill foreshore the 90,000 from oklahoma are going to feel an impact from this cut. nobody's as a carrot and it just perfect. it's not. it's far from it but there's another aspect of medicare advantage that helps those on the floor economic ladder.
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with medicare is vantage they don't have to buy supplemental policy. because all of the things they need are covered. 94% of americans on medicare purchase a supplemental that are not on medicare advantage. they purchase a supplemental policy. why do they do that? why do they spend three or $400 a month to buy supplemental policy? because basic medicare that we have properly set will not be cut doesn't cover the basic needs of the senior and their health care. so consequently they pay into medicare trust fund their whole life, they by medicare part b and then they buy a supplemental policy. and it just so happens when of the largest sellers of the policies happens to be somebody that is endorsing this bill. if there isn't a conflict of interest and don't know what is.
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.. to operate in these new exchanges the bill would create across the nation.
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it would also forbid the public option from covering most abortions altogether. the only abortions the public option could cover related to rape. >> there seems to behold up in getting senator nelson's amendment to the floor. >> democratic leaders want to get rid of it next week. democratic leaders did want to dispense with that earlier on in this debate. senator hatch objected to that. he said anti-abortion ninjas groups did not have sufficient chance to review the language of the amendment and sign off on it so they have done that now it is ready to go. >> can you name democrats who may vote for this amendment? >> there are two of them i believe, senator nelson and senator bob casey. i think possibly byron dorgan of north dakota and maybe can't conrad of north dakota but i'm not sure about them. >> hobaugh republicans that my vote against it? the most of them. the only to that i think what
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our lumpiest nolan susan collins. they said they liked the language in the bill as it is. >> what are the possible implications and then i will ask the same questions about a failing. >> it is likely that democrats will have senator nelson vote on the bill. if i can just go ahead and answer your other question, if it does not pessin to nelson said he will not support the bill unless some sort of more restrictive abortion language is added to it. >> with more health care debate possible this weekend are you getting any sense of the mood of senators as they continue working on this bill? >> we have been staking out these meetings they have been having on the public option almost every night and when the more liberal senators come out of these meetings that it always seemed to be in a good mood and they say things are moving well. senator chuck schumer of new york was the third ranking democrat in the senate says he thinks things are moving along well but that we talked to moderates and they are not so sure. they don't think they are that close to a deal on the major
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issues most importantly the public option. >> how was it looking for getting it done by christmas? >> i would say we have heard that senator reid is trying to pull together what he calls a final package for the bill. he is doing that now and his spokesman told us yesterday that they hoped to, they hoped to start filing cloture petition is. these are procedural moves to end debate on the bill. they hope to start filing those by the end of the week. >> alex minus with congressional quarterly. we thank you. >> earlier a group of republican spoke with reporters about their concerns with the son of health care bill. the debate continues this week on amendments on various issues including abortion. this is 20 minutes. >> good morning everyone or good afternoon as the case may be. thank you for joining us today. i thought we would focus today on all the promises of that have
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been made and broken with respect to the health care reform bill that is on the floor of the united states senate. things that the president has said, things that the congressional democrats and seven want to accomplish and in the great tradition of our physician tom coburn i thought we would have and are x of broken promises but i want to start with the promise that no tax increases would occur for the middle class. you will know during the course of a campaign in his recently as august president obama said that he wouldn't raise taxes. he would not raise income taxes. he would not raise payroll taxes. he would not raise taxes of any kind. on people making less than $250,000 a year. we all know the joint tax committee has said no of the people who make less than two and a thousand dollars a year, 39% would see a tax increase in if you allow for premium subsidies you still have 24% of those making less than $200,000
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a year who would see a tax increase which applies to 39.9 million americans, so that no tax increase box i think you can say is a promise made and a promise broken. he also said there would be lower health care costs and of course that is a promise that was made throughout the course of the campaign and has been a recurring theme among the president and his administration over health care costs. wilson according to congressional budget office that for most americans, you are going to see at best your premium increases go up like they have been at twice the rate of inflation, up to the foreseeable future and the number the cbo has been using in we have been using its 2016. if you think 90% of americans are going to see their insurance premiums either stay the same at best rick worst go up. if you are in the individual marker plus according to cbo your insurance premiums are going to go up ten to 13%. if you buy in the small group market or in a large crib market
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your going to see your premiums continue to go up at little under 6% up to 2016 so much so that if you are a family of four and you were getting your insurance right now and the large group market in paying $13,900 a year for your health insurance today under this plan in the year 2016 which again is the baseline year that is used you are going to be paying over $20,000 a year so the or health care costs, i don't think so. again another promise made, another promise broken. we also know cbo has come on said the overall health care costs will increase by $160 billion in this plan so this notion that somehow of course the promise made that it would then the cost curve down just isn't true. health care costs according to the cbo are going to go up by $160 billion so another promise made and another promise broken.
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keeping existing insurance. in the debate last week we actually talked about this issue of what was going to happen to people who were on medicare advantage. there are 11 million americans to receive medicare advantage and obviously if you cut $118 billion out of medicare advantage that is going to impact the benefits for an awful lot of americans, at least 11 million americans in their lots of other americans and i think senator coburn will get into this were not able to keep what they have. this why don't that you'll be able to keep you had completely got shredded last week in the debate over the medicare cuts and i might add so much so that even senator casey from pennsylvania went so far is to say that medicare and vintage cuts were not going to be able to see if you like what you have eking keep it in that basic commitment to a lot of us around here have may would be called into question so you have democrats now saying this notion that somehow you can keep what you have is going to be
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sustained and it is not. another promise made, another promise broken. no, no cuts to medicare. who are we kidding? they talk about this isn't going to impact medicare. you talk about foreign and $65 billion in the first ten years when it is fully implemented, about a trillion dollars in medicare cuts and we all nowhere they come from. i just mention 118 billion out of medicare and 135 billion out of hospitals, 42 billion out of home health agencies and we have the debate about the johanns amendment yesterday and even 8 billion out of hoskiss care so medicare is going to experience big cuts under this proposal and that again is going to be something the president in his state of the union speech earlier talked about and talked about on the campaign trail that there weren't going to be any medicare cuts. another promise made, another promise broken. the open and transparent
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process, the promise that was made when we do health care reform we are going to let the american public in and all these meetings are going to be televised on c-span and again this was written with three people, basically senator dodd, senator baucus and senator reed and members of the administration behind closed doors. nobody had access to that. none of the republicans and certainly not the american public because these deliberations occurred behind-- behind closed doors. the last thing i will mention in this one i get a credit for because with all the medicare cuts we can actually argue that they do reduce the deficit but remember that is in the first ten years. cbs said in the second ten years there's too much ambiguity to determine whether not they actually do reduce the deficit and if you take out the fact that they didn't put in anything to address the physician fee and they included revenues from some of the programs like the ponzi
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scheme and the class act which has been described as a ponzi scheme, not just by our side but by the democrats, that their whole argument that this is deficit-neutral would be completely out of balance too and the dean of the washington press corps has said that this bill is a budget buster so i think you could argue it will not add to the deficit also is a promise made and if not broken today will certainly be broken when we get into the out-years and we can actually look at the impacts of this in the long term and with that i will hand it over to dr. coburn and then senator chambliss. >> i want to talk a little bit about, if you like the plan you have today can keep it. reverends summer web site very soon will be a letter from the democratic insurance commissioner of oklahoma says this bill is a disaster for oklahoma. not only will it raise insurance premiums, it will decrease the numbers of people available but
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even more fort lee the state employees in oklahoma will be under the tax for having to reach of a plan. by the time 2013 rolls around, so every state employee in oklahoma is going to pay a tax on their health care policy. they are not going to be able to keep it. if you have an fsa your not going to be of to keep it. so the very fact is if you really like what you have got today, your employer likes with you have got to date in you like what you have got today you can't keep it. i have had to other caveat. there is a grandfather clause in the bill but if you change one significant word in the health-insurance contract for your employees the grandfather clause goes away and then you come under the rules and regulations of the bureaucracies of the federal government. finally let me make one other point which we didn't have on this that it would reduce the fraud and waste and abuse so on september 9, president obama
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said the only thing my plan would eliminate is the hundreds of billions of dollars in waste and fraud as well as unwarranted subsidies that go to insurance companies. there is 4-newton $30 billion in this bill that is going to go into insurance subsidies, that will go out to insurance subsidies to help people in exchange. they are going to be buying in exchange for the same insurance companies that they are demeaning. of more importantly there are only $2 billion of the elimination of fraud. thompson reuters put out a study that said 125 to $175 billion in fraud and health care. ifrs said it is $100 billion in medicare and medicaid and it is an hhs's spraw permeance rook to $90 billion this year. there's nothing to address that. that is some place we could really cut and in delve the future of medicare that is not available.
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saxby. >> i want to address just three very quick items, where the president has made statements and made commitments that he is simply not keeping. first a want to take off on what tom just alluded to with respect to him having said that you like your plan you can keep it. that remark was made by the president on july 21 of this year. basically he said and i quote, if you like your current plan you would be able to keep it. every repeat that. if you like a plan he will be allowed to keep it. senator casey came not just last week as senator thune has said and i quote came in saying we are not one to be able to say if you like what you have eking keep it in that basic commitment that a lot of us around here have made will be called into question and it is for one very simple reason. if you are on medicare advantage and their 176,000 medicare beneficiaries on medicare
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advantage in my state, if this bill is signed under law they will not be able to keep what they have come so there's just no question but what the president can't keep that promise and does not intend to keep the promise. secondly he said on the ninth of september of this year that he will protect medicare, so don't pay any attention to those scary stories about how your benefits will be cut, especially since some of the same folks spreading these tall tales have supported the budget that would essentially turn medicare into a privatized voucher program. i am not going to delineate all of the cuts in medicare. we have been talking about that on the floor for the last several days and i won't repeat what we said but folks, they are going to pay for this bill, they have got to cut medicare. there's just no other way around it and lastly, i want to say on the 15th of june of this year,
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the president talked about medical liability reform, stating i want to work with the ama so we can scale back the excess of defensive medicine that we enforce the current system and shift to a system where we are providing better care, simply rather than more treatment. so this is going to be a priority for me and i simply ask the question, where is there one shred from medical liability reform in the bill that harry reid has brought to the floor? it is just not there. and, if we are ever going to get this cost curve that senator cut the mentioned headed in the right direction, we have got to have preventive health care measures in there. we have got to have the ability to cross-state lines with policies that we have also got to have some semblance of tort reform and it is simply not
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there. the president has just made an awful lot of statements over the last several weeks and months that he simply is not keeping in this legislation. >> questions? >> senators, as you know, it has been pretty much a party division on this bill but the abortion amendment that senators nelson and senator hatch are planning to offer is something on both sides. are you working with the appropriate bodies in colleagues to pass the idea on the abortion issue and the idea that that would make even more difficult for this final bill to get through? >> well, i will let my colleagues, it too but i think most of us, at least the three of us in a lot of us on the republican side will support that amendment and i think the question is whether not we can get 60, which it think is very much in doubt. i would hope that we could get
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to 50. i think there has been a convergence of thought in the congress in the past that among both republicans and democrats irrespective of how you come down on this issue the federal funds shouldn't be used to finance abortions and that is what the stupack language in the house did what i think the nelson and hatch language will attempt to do here in the senate. i certainly hope that it passes. i am enough of a realist and talking to both democrats and republicans to believe it is going to be hard. >> i which is make common. they want to get the vote out and let everybody cover themselves and my suspicion is when we see a manager's amendment the stupack language will be in there. and they are going to allow a cover vote. that is why they want to hurry up with this vote to allow the cover boats of the body can state their position and say i could not control the managers. >> so you think the managers and a stupak glenn which will not be
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in there? >> no, i said it will be. >> will there be an amendment on the public option? >> i have the revised amendment that puts members of congress, step in his directive to the administrative staff on the public option. let me tell you what i want to do that. the public option is going to have rationed care. is going to be another medicaid program in the best way to make sure that we don't ration care to those on the lowest end of the chain is to put the executive and members of congress and their staffs in that and i guarantee you it will be an adequate policy. that is why we should do it. >> democrats are switching to the public option to something like what members of congress have now? >> the patient's choice acts as everybody in this country should get what members of congress have. it is amazing they are coming this late in the day to think the rest of the people in the country ought to have the same
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options as federal employees. [inaudible] i am not going to support a public option. at that want to create the incentive to do that, i am all for that but to say he will enroll in this and we will take away the freedom from somebody to make their own choices about their own health care i will support. >> the majority leader on the senate floor today rejected the issue of race and suggested a slowdown, start over strategy with those who oppose the civil-rights act and women suffrage. any response? >> let me just say it has been kind of interesting to see the reaction of leiter read in so many of the democrats as we have been out on the floor debating this bill. they are so desperate that it is unbelievable. m4 senator reed to go out this morning and make such an
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outlandish statements like he made just is another indication of the desperation that the democrats are showing and the pressure of which they are feeling. folks tend to crack under pressure and i don't know whether that is an indication of what is going on with respect to him, but you know as i look behind me here come the three of us all voted for the civil rights bill so i'm not sure where he is coming from with respect to trying to inject race in here, other than to say it is a pretty desperate act. >> i would make a comment. i don't think there is one member of the senate that does not recognize the significant problems we have in health care. and i don't think you would find one that doesn't recognize that. the question is what do you do about it? because we have been shut out of the process, because we don't agree with the government center program rather than a
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patient-centered program, we are castigated as people who don't care about other people. i think it is beneath the dignity of the majority leader. i think it is beneath the dignity of the senate to make any type of the outlandish claim similar to what was made on this floor this morning and i personally am insulted by the majority leader. >> it is it to say it was inflammatory, irresponsible. >> hedges line to go back to the question of whether not their negotiations should be on c-span as veterans of the senate process. was that ever realistically-- and could you possibly engage in tough negotiations? >> well, he was a member of the senate when he made the commitments of the obviously is well acquainted with the ways of the senate but i think the point was, he was trying to, i think,
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suggest that somehow his administration was going to be characterized by the old ways of doing things in washington and whether not c-span was allowed into the room is probably beside the point although he did make that commitment, but the fact that he has, but they have made deals with literally every special-interest group out there, that they wrote this thing behind closed doors without any republican input is in complete contradiction in a complete violation of all these promises and commitments made about transparency. if anything this process smacks of old school, old-style washington deal making and that is why it is completely a promise made in a promise broken. >> i would add one thing to that. i think the president when he came to talk to the joint session of congress should have said two things he did not say. number one i'd been busy with other things and i have not led well on health care.
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i think we ought to start over and i think we ought to get the sixth year sedney fibers in the middle and that means republicans, independents and democrats and we have to grab the best deal for this country. not a partisan bill, not the government send the bill but take the ideas and let him lead on that and what we did is we did the opposite thing. i think that has hurt our country and that is why i think this is such a divisive process. this bill was pretty much an pathetical to everything i know about medicine as well as what i know about the future likelihood of our country to be able to survive this bill. >> let me say the argument to that is then it was transparent. we did have the c-span cameras with the help committee and we did have the c-span cameras in the finance committee that i think senator reed posen explanation to the american people who walk this to proceedings unfolded. the reasons why the changes have
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been made in those bills, there are earmarks in this bill that is on the floor now. vie were those commitments made in the american people are owed an explanation of why those were made in that kind of transparency certainly is not there. >> anybody else. kenny that-- thank you guys very much. [inaudible conversations]
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>> the commander of u.s. forces in afghanistan, generals danley mcchrystal and u.s. ambassador to afghanistan, karl eikenberry will testify at two hearings tomorrow on afghanistan strategy. in the morning it will be the
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house armed services committee. that is live on c-span3 at 9:30 a.m. eastern and also live on c-span3 their testimony before the senate armed services committee at 1:30 p.m. eastern. both hearings are also on line at c-span.org. later in the week it will take questions from members of the house and senate foreign relations committees. >> now another in a series of hearings on the president's new afghanistan strategy part of the witnesses are defense secretary robert gates, joint chiefs of staff chairman mike mullen and secretary of state hillary clinton. john kerry of massachusetts years this hearing. is about three hours. >> the hearing will come to
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order. secretary clinton, secretary gates, and admiral mullen, we welcome you here today. thank you very much for joining us and we appreciate your coming to share more details about the president's plan and for consulting and partnering with congress on the decision obviously of enormous consequences for our soldiers, our security in their country. this is a decision that the president of the united states has made but ultimately the all of us share responsibility for its consequences. given the complexities of our challenge in the seriousness of the sacrifices the head and the absence of strategy over much of the last 80 years, i believe the president exercised importantly leadership by taking the time he needed to make the right decision even as political pressure mounted in different directions. his words in your testimony showed that the administration
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has confronted tough realities, carefully weighed all of the options and the right that a comprehensive consider a path forward. i believe that the president appropriately narrowed the mission in afghanistan when he presented to the american people is not an open-ended nation-building exercise or a nationwide counterinsurgency campaign nor should it be. the prison was right to frame our commitment to afghanistan in the context of all of our national priorities for the drawdown in iraq through virgin challenges at home. he was correct to consider our mission there in terms of our enduring interest. over the last days i've heard a number of people say we are in afghanistan today because that is the place from which we were attacked. frankly, eight years later that is simply not good enough. we have largely expelled al qaeda from afghanistan. today it is the presence of al
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qaeda's in afghanistan, its direct ties to win support from the taliban in afghanistan and the perils of an unstable nuclear arms pakistan the drive our mission. what happens in pakistan, particularly near the afghan border, will in my judgment do more to determine the outcome in afghanistan than any increase in troops or shift in strategy. congress has provided $7.5 billion in nonmilitary aid over the next five years to help address the crucial pakistani mission of the president's plan. that is the beginning but i believe and i think the committee shares the belief that there is more that we can and must do with the pakistanis, all of which can alleviate the pressure of afghanistan, indeed even determine the outcome in afghanistan. i believe it is important for the pakistanis to understand that our commitment to them into the region is long term, even as
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troops are reduced in afghanistan. in fact, the conditions that permit a reduction in american troops in afghanistan are a benefit to pakistan. the president was correct in defining success in terms of our ability to empower and transfer responsibilities to afghans as rapidly as possible. while simultaneously achieving sufficient level of stability to ensure that we leave behind in afghanistan that is not controlled by al qaeda of or the taliban. as i have said before, to ejective family that is asked to send a husband, weitz on our daughter into harm's way, the deployment of a single additional soldier makes all the difference but it public debate reduces it to a symbol headline read the number of troops, does the solly the service. what will matter most on the ground in afghanistan is not the number of troops took what they
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will do and how they are integrated into a broader civilian and military strategy. i returned from afghanistan and pakistan in october was serious concerns that even if additional troops are able to clear the enemy and hold the area, even in limited areas where we will operate unless we are able to build and transfer leadership to local afghans, unless the governance and development pieces are in place we risked squandering the gains time and time again. right now are military will tell us that in many places that tripartite capacity is not there. there are three principal conditions that i still believe must guide the tasking of additional troops. first, are there enough liable afghan police forces to partner with american troops and eventually take over responsibility for security? the president has recognized the critical importance of speeding
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up training and to date with strobel to do so on the skill required in a look forward to hearing your plans today to increase the training capacity and quickly moved afghan security forces into the center to fight. second are their local afghan leaders with whom we can partner? we have to be able to identify and cooperate with provincial leaders to commend the a story to help our services and restore afghans' faith in their own government. third is the civilian side ready to follow swiftly with a that brings tangible benefits to the local population? the president has outlined a surge in personnel which will be crucial to locking in any of our military gains and bring stability to the afghanistan and i know secretary clinton you have been working on that task and we look forward to exploring it with you today. i would hope that justice the exit strategy is based on the conditions on the ground, so of our strategy for an deescalation
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based on conditions on the ground. i continue to believe that assonant urgence security need we should not send american troops into clear places unless we are confident we have the afghan partners and resources in place to bilmus victories and transfer both secured and governmental functions to the afghan leaders. i still remain concerned that additional troops will tempt us beyond the narrow a focus mission and the 30,000 troops rushing into afghanistan i believe we will be challenged to have a civilian in governance capacity in place quickly enough to transfer their sacrifice and to lasting gains but that the conversations with the president vice president in recent days in the president's speech had been assured that the administration recognizes the need to meet these conditions. how we answer these challenges will go a long way toward determining our overall prospects for success in were all eager to hear in detail how we can do better than we have done on each of these components
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everyone understands that president karzai's efforts will be critical to the outcome and we all understand are the ultimate goal is to empower and transfer responsibility to the afghans. jun i think we learned in iraq that when our policy is to be in another country with troops for as our hosts are very good at taking as long as the one. the president is correct to set a target and it will help create a sense of urgency for the afghans and gave the thorned nitza in their soil and send the message well america will remain committed to the afghan people we aren't interested in a permanent occupation. we can all agree that the next 18 months are crucial to reversing the momentum in laying the groundwork for a stable of enista and what were the police
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and army complete greater role in serving their citizens and his government focus is squarely on reclaiming legitimacy with the afghan people and where we have intelligence in place to engage in the counterterrorism missions that for years ahead we will need to be able to engage in. we should all recognize that americans, all of us, fundamentally share of this challenge. the senate voted unanimously to go to war in afghanistan. it should humble all of us that today there's simply no easy options. we have no choice but to grapple with complexities, reach the conclusion that best serves the american people and work in partnership with other branches of government and that is how democracy fights a war. the president's speech offered a vision of the path forward with a great many questions remaining including house simply beyond adding more resources to the u.s. and afghan civilian
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strategy will prove, what balance we will strike between securing population centers and venturing into the afghan countryside, how we intend to finance this increased commitment and crucially how we intend to improve our partnership with pakistan. we look forward to the conversation this morning. senator lugar. >> mr. chairman i join in welcoming secretary clinton, secretary gates and admiral mullen. we appreciate very much that you love come to the formulations committee today. the presence of palfrey view underscores the success in afghanistan depends on both military and civilian programs. we must in the civil military approach with the interlocking elements of the new lynaugh strategy. as we consider our course and afghanistan would evaluate options according to how well they contribute to the united states national security. the purpose of committing tens of thousands of troops, billions
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of additional dollars to iraq and afghanistan must be to enhance united states security and the vital national interest in the region. this may seem to be an obvious point, but during long wars, specific tactical objections can become in some cells. disconnected from the broader strategic concept or encountering of finite resources. pursuing al qaeda or the taliban and in proving governance and economic opportunity in afghanistan are important, but when our country commits the level of force is contemplated by the president to a sustained war, the objective must be absolutely fundamental, the united states security. this is especially true at a time when our armed forces are restrained by many years of high deployment rates, our capacity for new government debt is limited and our nation is not
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fully emerged from the severe recession. the president made the case on tuesday that what happens in afghanistan can directly impact the safety of americans. i believe that most americans accept this point based on the reality that the 9/11 attacks were conceived in afghanistan and that the taliban forces who protected al qaeda are likely to become more resurging if we leave. but much more discussion is warranted on whether the afghanistan mission is so central to our core national security that it necessitates a huge spending increases and the deployment of a large portion of our finite combat capabilities. ann's since we have to ask whether the cost of this deployment are justified and our overall national security context and whether we are mistakenly concentrating our forces defied a terrorist enemy
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in a specific location. even as the global terrorist threat is becoming increasingly diffuse. terrorist cells that are associated with or sympathetic to al qaeda exists in numerous countries, in africa and the middle east. terrorist attacks were perpetrated in europe by homegrown cells. killing taliban fighters and training afghani soldiers and policemen are unlikely to substantially diminish these broader terrorist threats. moreover the results of even the most skillful civil and military campaign in afghanistan are likely to be imperfect in the long run. i do not doubt that the application of additional again hymn allied forces will result in a military setback for the taliban. during this time, it is hoped that. can be made in building afghani
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security forces but over the long run we should recognize the problems stemming from tribalism, corrupt governance and lack of economic opportunity in the country of afghanistan are almost certain to persist, the company's efforts to ensure the central government can effectively govern and resist the taliban when allied troops are withdrawn. even if the president's plan achieves the very best stabilization scenario, allowing for you with withdrawals on schedules he contemplates we may be responsible for most of the afghanistan defense and police budgets in definitely in our budget. perhaps most importantly it is not clear how an expanded military effort in afghanistan addresses the problem of taliban and al qaeda's safe havens across the border in pakistan. it these safe havens persist,
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any strategy in afghanistan will be substantially in complete. specifically, will pakistan work with us to eliminate the leadership of osama bin laden, and other major al qaeda officials? as hearings in our committee have underscored, the potential global impact of the instability and a nuclear arm pakistan doors anything that is likely to happen in afghanistan. the future direction of governance in pakistan will have consequences for non-proliferation efforts, global economic stability, a relationship with india and china, the security of both the mill least and south asian regions among other major issues. the president does not dwell on pakistan in his speech on
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tuesday evening. perhaps because sensitivity in the country to american influences and intentions are extremely delicate but the president and his team must justify their plan not only on the basis of how what will affect afghanistan but also on how it will impact promoting a much stronger alliance with pakistan that embraces vital common objectives. having made these observations i want to recognize the presidents has been confronted with extremely difficult choices in afghanistan and pakistan. he and his team have worked through the problem carefully and deliberately to reach their conclusions. there are no options available that are guaranteed to succeed and every conceivable chorus from complete withdrawal to maintaining the status quo to a plan outlined by the president to an unrestrained and unlimited
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counterinsurgency campaign has its own set of risks and costs for the united states. the president deserves credit for accepting ownership of this difficult problem as we go forward and for his clear efforts that he expressed in his speech on tuesday night. congress and the american people now must evaluate whether this course kaput has a reasonable chance to succeed. and its success can be defined, and with the objectives outlined are worth the expenditure of american and afghan lives and treasure. in this situation the advocacy of the president and his national security team must be broadminded and thorough as his policy review appeared to be. within months the president is likely to ask congress for additional funds relating to afghanistan. in the meantime the administration must be prepared to answer many difficult questions about his strategy as
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the american people study the potential consequences of the president's decision. once again i tank or distinguished witnesses for their leadership, a very substantial leadership and i look forward to hearing their testimony today. >> thank you mr. chairman. >> let me just say senator dodd may have to leave during the testimony because csg chair the bernanke hearings, confirmation hearing today so we expect that maybe the reason he has to go. >> i could have brought him here and had a joint hearing between the federal reserve chairman. >> maybe he could have told us out to pay for this. madam secretary thank you for being here and if he would follow secretary stayton admiral mullen we look forward to your testimony in if you want to summarize we can by your testimony in the record. >> thank you very much gemming kerry and ranking member lugar and all the members of this
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committee. it is an honor for me to be here to testify before you and also to continue the dialogue, both the chairman and ranking members statements as would be expected, were extraordinarily thoughtful, raised a lot of the hard questions we are grappling with campeau's the challenges that we have to meet, both the administration and the congress together and i want to thank the committee for the constructive role that it has played in helping us to address the difficult issues raised in the region of the world that we are focused on today. when president obama addressed the cadets at west point, he set forth both the rationale and the difficult choices that his policy represents. at the end of a very long and
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thoughtful process that consisted of ten meetings with the president and his national security team and probably three times that many among the rest of us without the president, the president concluded that among a range of very difficult decisions, this is the best way to protect our nation now and in the future. extremists who have taken root in the border area of pakistan and afghanistan have attacked us before. they have attacked our allies. they are now attempting to if not overthrow the pakistani government and take back enough control if not the entire country of afghanistan. we believe that if we allow afghanistan to become a failed state, if we allow extremists to have the same safe havens that
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they used before 2001, they will have a greater capacity to regroup and attack again and also to continue to provide the leadership, the operational and logistical support that they currently provide to global extremism. we believe they could drag in the entire region into chaos that camerino that based on the report from our military and civilian leadership, the situation in afghanistan is serious and worsening. no, i know we don't want to go back in history and anchor our decision totally on what happens on september 11, 2001. but i think it does have to be part of the national debate. the damage done with those attacks against our economic and military power centers was also
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an attack on my constituents because at that time i have the honor of serving as the senator from new york. i witnessed the tragic consequences to the lives of thousands of innocent families, the damage done to the economy and to the damage to our sense of security so i feel a personal responsibility to help protect our nation from suds violence and i entered into the very intense consultations we have been engaged in, with that as my overriding goal but without any preconceived notion of exactly the best way to meet that goal. the case for action against al qaeda and its allies has always been clear, that the united states's course of action over the last 80 years has not. the thought of another war eric scared our focus and while our attention was focused elsewhere, the taliban gained momentum in
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afghanistan and extremist threat brand pakistan. a country as you know well with 175 million people, a nuclear arsenal and more than its share of challenges so it is against this backdrop that the president called for this careful, thorough review of our strategy. our objectives are clear. it will work with the afghan and pakistani governments to eliminate safe havens for those plotting against us, our allies and our interest. we will work to find reliable partners in the region to help the stabilized, which we think is fundamental to our national security. we will develop a long-term sustainable relationship with afghanistan and pakistan so that we do not repeat the mistakes of the past, primarily our abandonment of their region. the duration of our military presence will be limited by our civilian commitment us continue even as our troops begin coming home.
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now accomplishing this mission and insuring the safety of the american people is not easy. it does mean sending more civilians, troops and assistance to afghanistan and signage signal expanding our civilian efforts in pakistan which we have begun to do in of the chairman and ranking member of this committee. we will be asking the young men and women who not only serve in the military but are part of our civilian service team to be taking great risks and facing extraordinary sacrifices. i want to assure the committee that we will do everything we can to ensure that their sacrifices make our nation safer. the situation in afghanistan and pakistan is serious but it is not in my view as negative as frequently portrayed in the public. the beginning of president karzai's second term as opening a window of opportunity. we obviously have real concerns
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about the influence of the corrupt officials and the afghan government in we will redouble our efforts to pursue them but in his inauguration speech last month eyewitness president karzai call for new compact with the international community. he pledged to combat corruption, improved governance and deliver. his words were long in coming but they were certainly welcome and now they must be matched with action. the afghan people, the united states and-- we will help by working with their afghan partners to strengthen institutions at every level. the president has outlined timeframe for transition to afghan responsibility for klesse said in his speech the additional american and international troops will allow us to a accelerate are handing over responsibility to afghan forces as we begin to transfer our forces out of afghanistan in july of 2011. just as we have done in iraq was
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to get this transition responsively taking into account conditions on the ground. this is not a cliff. this is a transition. the timeframe for the transition provides a sense of urgency in working with the afghan government but it should be clear to everyone that unlike the past united states and their allies will have an enduring commitment to afghanistan, a result in this fight reflected in the thematic troops since the president took office and significance of the commitment that will continue long after our combat forces began to leave. our civilian effort is already bearing fruit. civilian experts and advisers are helping to craft policy inside government ministries. we are engaged in the process of certifying those ministries we feel confident providing money and we will not provided to the cannot certify them. when the marines went into this in july we had civilians on the ground with them to coordinate
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assistance the very next day. as our operations progressed our coordination his growing even stronger. we are on the track to triple the number of civilian positions in afghanistan to 974 by early next year. when we started there were 320. they had six month rotations. are checking of their duty roster showed a lot of them spent more than 30 to 60 days inside of afghanistan even though they had been assigned there. we have totally revamped how we are providing civilian assistance and we believe we are beginning to make a difference. each of the civilians leverage the only an average ten partners from locally employed staff and experts with u.s. funded ngo's but what we are finding most interesting is the level of expertise within the united states military. when you put an agricultural expert in vetted in a battalion along with the commanding
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officer of that battalion, they go looking for soldiers with the ridging informing experience. we have a real force multiplier and when i was in kabul two weeks ago meeting with their sentinel teams, those were the stories i was told in the military who are responsible for the clearing and the face of our military operations told me repeatedly how important this civilian presence was. as one said to me i'm happy to supply whatever support the valuable civilian needs and we need more of them. not only do we believe we have the right people to achieve our objectives, we believe we have a sound strategy. we will begin delivering economic assistance in bolstering the agricultural sector, the traditional core of the afghan economy. number my former colleagues have talked with me in the last month about the importance of agriculture and how they tried
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three years to help create jobs to reduce the funding that the taliban received from the poppy cultivation, in effect by moving them from poppies to pomegranates. we have taken that advice seriously. we also must support and that can lead efforts to open the door to those who are willing to renounce the qaeda, abandoned violence. we understand some of those who fight with the insurgency do not do so out of ideology, theology or conviction but frankly due to coercion and money. >> averaged taliban fighter as our information received two to three times the monthly salary that the average soldier or police officer. our regional diplomacy complements this political approach by seeking to mitigate external interference in afghanistan in working to shift the calculus of neighboring countries and that of course leads me to pakistan, a strong
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stable democratic pakistan must be a key partner for the united states and an ally in the fight against violent extremism. we have seen progress of this past years that people increasingly come to the view that we share a common enemy. i've heard that repeatedly during my recent visit that we have a long way to go. we will significantly expand, support and develop the potential pakistan in his people, demonstrating in long term commitment for the u.s. than three days in pakistan last month and most commonly i heard over and over again, you left this before, will you do it again? you walked away, you left us holding the problem you helped to create. we want to send a clear message as the kerry lugar berman legislation does, that we intend to be committed over the long term. we will not be facing these challenges alone. we have 42 other troop contributing countries, our nato
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allies have made significant contributions at this hearing. i will leave for brussels to begin the process of securing additional love and commitment. ambassador holbert is started their consulting with allies. we have had a very encouraging response in the conversations we have had thus far and we are looking beyond to build the strongest brought us possible coalition. japan just announced a 5 billion-dollar commitment to afghanistan. we think other governments are beginning to recognize this is a common link against a common enemy so let me conclude right began. we face a range of difficult choices but the president's plan represents the best way we know to protect our nation today and in the future. the task be face is as complexes in the national security challenge in our lifetimes. we will not succeed if people view this effort as the responsibility of a single party, a single agency within
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our government or a single country. we'll it to our troops and their civilians who will these these dangers to come together as americans and come together with our allies and the international partners to help accomplish this mission. i look forward as always to continuing to work with you to achieve that goal. thank you. >> thank you madam secretary. secretary gates. >> members of a committee i would like to provide an overview of the strategic thinking in the context behind the president's decisions. in particular the maxes amman al qaeda, the taliban, pakistan and afghanistan and their objectives and how the president's strategy aims to accomplish them. as the president for stated in march and we emphasize to deny the cool of the united states in afghanistan and pakistan is to disrupt, dismantle and defeat the al qaeda and its extremist allies. and to prevent its return to
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both countries. the international military effort will stabilize afghanistan to achieve this overarching goal. defeating al qaeda are mutually reinforcing missions. they cannot be untethered from one another as much as we might wish that to be the case. while al qaeda is under great pressure now independent on the taliban and other extremists groups for sustainment, the success of the taliban would vastly strengthen this message to the muslim world, that violent extremists are on the winning side of history. put simply the taliban and al qaeda have become symbiotic, each from the pathology of the other. leaders have stated this explicitly and repeatedly. the lesson of the afghan taliban revival or al qaeda is the time and will are on their side, that with the western defeat they could regain their strength in achieving a major

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