that's what folks want to talk about, and yet we have an incredible moral failing in this country. and i appreciate your comment, and i think i wish that we could -- and i know, you know, under the present and people working for him, in the heart of a do care about covering people. it's not they don't. it's just they know there is no political penny to be made by talking about it. . .

there have been studies, that's what sells the drugs, if it is a better look. [laughter] >> going on, i am an economist -- economics student and also a premed student. i don't go to clubs, i don't play at xbox, i read economics. [laughter] today the federal reserve had one flow of funds and which all forms of credits in the economy were contracting except for federal and state so i think we have a massive debt problem already and as you said the you're talking a lot how we're going to decrease the deficit through this, but then and this

also comes up, many of you may not notice but last month we broke a record. the last month saw the record budget deficits for a single month in the federal government history. we had $107 billion in revenue, we spent $320 billion. of the $320 billion, 164 billion which transfer payments or an entitlement payments. that means that we only covered 32 percent of expenditures covered even if we got rid of all the entitlements we have now and all the transfer payments we couldn't afford our government. so what i'm trying to say to you is this is about ethics and is it ethical to pass a bill like this in a time when we are broke? i feel like you said people don't want to talk about the morals and i don't want to talk about other things in the truth is our country doesn't want to face reality. we are broke, credit grew, exponentially at a rate much

faster than gdp and we now have to face that. that's the economic problem we face. our health care system is a problem but it's a very small area of the adel problem our economy has and i just want to hear what you think of that looking at the health care in the broader nature of our economy. >> those are good points. first of all, europe socialized medicine so systems predate world war ii and some not rebuilding their economy. that's true that many of them predate world war i as well. germany started in 1848 so it wasn't rebuilding the economy. but i think -- >> [inaudible] >> that's true. more generally i think your point about can we afford it, let me emphasize first the use in the group here -- >> [inaudible] >> let me finish please.

let's be clear because you are young and you have to worry about this stuff. the u.s. government, if we look at all the promises our government has made, versus the taxing plan to collect and project that as far as we can, huge uncertainties but to our best job, then the u.s. government is $100 trillion in deficit. in other words, we've got a huge problem in almost all that is health care. in so the statement you made is definitely wrong, that health care is a small part. it's the whole problem, the long run fiscal problems facing our nation are all about health care. so what can we do about that? we have to start worrying about cost control and that's what this bill does. we shouldn't have a new entitlement unless it's paid for. it is paid for it and try to reduce the deficit. so what's frustrating to me is that people say we shouldn't do this because we're in deficit, well this reduces it. you can say definitely you think our government is to interest of

the but that's a legitimate argument and this would make her government bargeman but that's a separate point and that is when obama said it in the blair house think he said we can have philosophical disagreements about the role of government and how big government should be, we can disagree on this bill helps reduce our long-term fiscal problems. and by reducing the deficit which is the whole story, your entire futures are all about the growth of health care cost. i'm talking about health care costs now, is not an issue now. it's an issue over the next century. regardless of how much it is, at some point we can spend anymore and it's really not -- this person's earlier comments about how we should value live and spend, the issue is not how much the economy is. i think in a society we can afford that. the issue is the government that if 40 percent of the economy is

health care taxes have to be a ton higher and we are not willing to do that. so the issue is not with our budget constraint families, the problem is the government is badly broken. unless we take the steps to address that whenever the steps to reduce the deficit and try to control health care costs and this does both so that's why i think of anything your ports are important but this bill covers that. you have to go to the mike. >> vc we haven't hit the budget constraint for families but this began with people not paying their mortgages so we have had the budget constraint and my understanding is private sectors to gdp is currently 300% and i don't know the exact number for which interest payments are currently taken out of income for people but i know it's rather high. and i personally want universal coverage, i've taught my professors quite frequently. my problem is i don't know, i just don't think this bill

really addresses are a problem which is that we need to come to reality that we think we are wealthier than we are. >> i am not saying times are tough now. >> we levy's remarks on health care to go live now again to the house rules committee, meeting today drafting rules for debate on health care legislation this weekend in the house. live coverage on c-span2. >> i believe i friends mr. cardoza asked me to yield to him and i will at this time. >> thank-you. as we reconvene here, i want to say the following: i have sat here and out like to be able to make this whole statement in support of your position. i sat here and listen to mr. barton talk about how this process has been used in the

past and he's right it has been used in the past. as i count, nearly 200 times we have used this process in the past. i don't think mr. barton boats were things that are unconstitutional, i don't think the other members here who have voted that way or mr. boehner wore ourselves have voted for anything illegal, but having said all of that i don't believe it smart for us to pass a bill this momentous with 18 to rule. i think it's perfectly legal, i think it's perfectly appropriate because we have done it before and under the articles of the constitution makes its own internal rules. however, i don't support to us doing it and i will not vote for a rule that deems as we have been talking about.

now, the rule doesn't say the word team, it says the conference report would be adopted, the senate bill would be adopted, but i don't think that's the way we ought to go and so i wanted to make the announcement in the committee right now in this process that i don't support that and won't support a rule that does it that way. but i will tell you that everything that mr. for your has said about this process is absolutely accurate in my mind, i believe him to have -- it is correctly and i think it would stand the constitutional test but i just some believe that's the way we should so i am incurring in the fact that i don't think we should pass in this manner and we should take three separate votes. i think we should take the rowboats, we should take a vote on reconciliation and then i think we should take a vote adopting this bill. >> i think my friend in reclaiming my time. i think he makes a very

important statement especially at this time in the process. i don't know -- i don't know how the supreme court will rule if the senate bill is deemed past. i don't know. i know in the constitution the fact that each house is specifies is responsible for its own rules and obviously that's true but it also specifies certainly the supreme court made clear in the line item veto case that exact language has been adopted, so i think the majority if it proceeds by deeming the senate bill passed puts at risk is legislation. mr. dreier. >> thank-you, i'd like to

clarify and this gentleman statement and that is this has actually been done six times, not 200 times. there have been instances where amendments have been taken but on only six occasions has this been done and i think it's important for the record to note that and no one knows exactly what the determination a court would make on this is as the gentleman from miami has said it correctly. but amendments have been taken but not basically an entire bill like this. >> i agree and the supreme court has not ruled. none of those moments of those instances has this become an issue that has been actually decided upon by the supreme court. i think this time it ultimately will if the majority deems the senate bill passed it will reach that stage in the judicial process, but anyway i thank you come i think all of those who have come to testify for your

courtesy and i thank you mr. chairman and i yield back. >> i think the gentleman and i want to reiterate what was said for the record before, at least one of those times most of the people on republicans cyber in this room loaded that way. i know you don't like the process except when you vote for its, but i think what's at stake is more than of the process of the rules but more about process people have to go through when i try to get insurance. tens of millions can't get insurance and i think that's what this is about. mr. hastings from florida. >> thank you mr. chairman. our chairlady is to be complimented for her patients and that is for patients especially with all of us. two members of our distinguished

panel, one that is in here now commented that the rules committee is a different committee in regard to time and that's very true. i will try not to take a lot of time but i think it's important that we try to put in context some of the discussion that has been ongoing. this is pretty widely known. i came here with some really -- celebrity of having gone through a process interestingly enough all the way to the united states supreme court on three different occasions that we were fond of saying and our legal team that the hastings case is made pavlov. but i'm 47 years a lawyer, 13 of those years was spent as a judge. i have interpreted the united states constitution rather recently and i hear my colleagues, i respect all of you

for your differences and your ideological devices but the lack of the matter is most of you talk about the constitution as it you really do understand the dynamics. let me go immediately to the case that dealt with the line item veto. that was clinton immerses new york and it doesn't have a single solitary application in this situation that is before us. had that case was ruled to be unconstitutional because of let the president to amend federal law without congressional action. in this instance i would urge my colleagues to understand that the house will vote to on the senate bill and therefore all of the rhetoric that you can employ, all of the reasoning that you can come forward with will not change the process. i do wish to go back and ask my

friend, my good friend from california abbey is the round, i will take the prerogative especially now that he has left the room on pointing out that just recently he made the statement that this is unprecedented and outrageous. well, evidently he didn't remember the 104 and 109th congress as mr. mcgovern and i were here with mrs. slaughter and ms. matsui and we labored those eight years under the mr. dreier ruling tutelage and giving him credit for having extraordinary capabilities when it comes to this process. but let me tell you what he said on a given day and one of those converses. he said that the self executing rules often used and often

misunderstood. that is from mr. dreier. often used and often misunderstood. additionally, he made the proclamation that occasionally and i am quoting him a self executing world may also provide for the adoption of other unrelated measures or action such as adopting another simple resolution, bill, a joint resolution or conference report. in essence what we have here is a conference report without members of the house and the senate sitting down together. but now let's see what the constitution says and get it on the record clearly so that we have no problem. article one section five of the united states constitution says that each house may determine the rules of and is proceedings. now, article one section seven says, every bill which shall have passed the house of

representatives and the senate's shall be for a become a law, be presented to the united states president and it goes on to talk about a veto power which are not necessarily relevant in this case. what is relevant is whether you look at it from the standpoint of just one little aspect our numbers, it is not unprecedented in for us to undertake this particular process. and what you need to know is that the senate bill should pass the house and go to the president for his signature before the senate acts on reconciliation and basically that's what we have done here. we say that when the process is concluded and it has not been yet i might add it coming it will guarantee that the senate bill cannot pass without the improvement. now that's where we are. admittedly, we leave out to the

tender mercies of the other party and the great hope is there will be some understanding that they will be able to proceed in the manner as signified. in that respect, house democrats still have to trust them and ask for transparency the rule presumably will make clear that the vote on the reconciliation package is, in fact, also a vote on the underlying senate bill. that's in accordance with the constitution. a single bill will have passed both houses. i don't know that that helps, but i do know as my colleague from california said that often these rules are used and often misunderstood and therefore i hope that we would stop all the rhetoric and get to the business

of what's ratan. in the fact of the matter is a lot of our fellow americans are hurting and they don't have a affordable health care. and for the life of me i cannot understand why we all shouldn't be within a share in order to help the least of us. the i wished that i had been there when thomas edison made the remark that i think applies here. there are no rules around here, we are trying to accomplish something and therefore when the deals go down all of this talk about rules, we make them up as we go along and i am now 18 years a significant amount of time in this committee and the leadership of the republican who had no time even when they claim all they did for the

prescription drugs they left that big old doughnut hole in and they never talk about the fact they didn't pay for it while they're here now becoming fiscal conservatives. one of the brightest minds in this country is paul ryan for whom i have great respect. i think all is onto something that is beneficial for us at some time but then i want to clear up one more thing. and that is this business about partisanship. it's as if you were not all in mr. miller's education and labor committee hearing or that you're not in the commerce committee or that you are not in the ways and means committee or the budget committee. all of those committees have had a umpteen hearings on this matter and many republican measures were passed on a voice vote without the american people that you all so want to talk about understanding were passed on voice votes and some were

voted on that our republican measures that are included in this substantive legislation that went to the senate that we are now going to concurred in and require on the reconciliation that they make improvements along the lines of much of the criticism that you have offered. i think what used to be understood is they're probably very little that we could possibly do or the senate's, if the senate republicans did not have anything to do with health care and that none of their measures are involved in this process. that is wrong, they have a lot to do. but every time a we do whatever is that the republicans want, they still vote against the bill and then they wind up voting even in committee against the measure after they have gone what they wanted the in the provision in committee. so when we get to the floor,

please american public understand the that the republicans have been involved here and let's give presidents obama some credits. never in history of this country has anybody in by the republicans and democrats that was president of the u.s. to the white house to sit down and virtually all day conference and have a discussion about this matter and some of you were in a that room. on rank-and-file so i wasn't there and i guess that was the good thing. i want to end with this, we quoted martin luther king about a lot of things but out ask you all to understand the number of people whose homes have been foreclosed on, the number of children that are going to be help with this measure immediately that have pre-existing conditions, i ask you to think about the person that as we speak has lost his or her jobs and does not have insurance. all of these things will not be

limited overnight and none of them could possibly be remedied by the federal government here that i tried to put the rest the notion of the federal government takeover. federal government runs the center for disease control, the national institutes of health, social security, medicare, medicaid, the pentagon, all of those are government run programs and i don't know too many people in here who didn't have any mom, a sister, brother, cousin, father that did not rely at some point in his or her lifetime on some of those matters. of the federal government. martin luther king said, of life's most persistent and urgent question is what are you doing for others? today and tomorrow and i believe history will record and that

democrats did something, democrats did something for the least of us in our society and it was the right thing to do and i ask my colleagues whose side are you going to be on? be on the side of the insurance companies? be on the side of the american public? thank you. >> thank you. mr. sessions of texas. >> thank you mr. chairman, we have an opportunity well on this committee to offer our own opinions and i think it's a misnomer for anyone to say that this is about insurance. what this bill is about is about how the government will play out the health care system to all of americans and i have several questions i'd like to go through. the first observation i'd like to make is that sitting on this panel sometimes i'm not have problems but i don't think it's

been straight forward and when we talk about the bill. sometimes we talk about what might be the senate bill and sometimes the house bill and remix those up about what's in the bill and what's actually going to be voted on. so the first question i'd like to ask you to view as you choose to because i think it's a huge issue for this body that we should have despised us knowing what's in it or not i think that debate should take place about the gatorade, the cornhuskers kickback, the louisiana purchase. the reason why i say this is because that will be something that will be in this bill that will be voted on that will provide a specific state or area with something that no one else gets. and i believe that that is not only horrible legislation, i believe in some ways it has been

amounted to a pay off that i do not think is correct. so i think this body at some point ought to have a discussion about that. mr. barton, do you have an opinion? >> i did offer amendments on behalf of myself and congressman johnson of the ways and means committee to have a vote to strike those so we have specific amendments for each of those special deals pending before the committee. >> mr. sessions, the special treatment for nebraska is in the senate bill, it is removed by the reconciliation bill. the special treatment for florida under medicare advantages in the senate bill and is removed by the reconciliation bill. i would disagree with the characterization of the louisiana purchase in the following way. the louisiana provision says that any jurisdiction that suffers disasters as defined in that section qualifies for

higher medicaid reimbursement rates, it's not limited solely to louisiana. now, i hope and pray that louisianans the only state that does it because we don't have that kind of calamity also ran the country but if god forbid we did the medicaid reimbursement wouldn't be eligible to other states as well. >> can i comment on what he said? they say they've eliminated the nebraska provision. they haven't, they kept it to given to every other state in the nation and so for the first four years of the program every person who comes onto medicaid who hasn't already been on medicaid is 100 percent pay for the the federal government. beginning in 2014 that some city phases out so what you're going to see is i think many states like, arizona, already has are going to begin to draw medicaid coverage for their citizens and we're going to make what used to be in there to% 50%

federal-state program, 100 percent federal program for people below 133% in this case a party. >> if i may i think this is a better chance to avoid that what my friend just said. the criticism of the nebraska bill provision which i think is extremely well founded was a terrible idea and that's why we're taking it out of the bill is that only nebraska gets the benefit of a bargain. with the reconciliation bill says is because we are insuring new people under medicaid these are people families making 27 or $20,000 a. individuals making less than that we don't have insurance, the federal government is picking up 100 percent of that cost for every state for the outset and then eventually scaling back to 90%. the criticism of the nebraska provision was a benefit in nebraska and the way that not everyone else got the benefit of. if that's not the case and i think is quite accurate to say

the provision is out of the bill. >> it's interesting, this is one person's observation that this was done to get folks to pass the bill and yet essentially very straight up what we're trying to do is avoid a conference for both bodies have to get together to come to an agreement. >> with the gentleman yield? you mention conference and part of the problem is your counterparts in the senate won't allow us to go to conference. they are obstructing the regular order so the deal is -- >> reclaiming my time, my observations are this is no different than a lot of other bills with a part of a process in the process when we are doing is we are doing what i considered to be a banana republic type of work around rather than going straight after what this is. >> mr. sessions, there is a special tax deal for unions in

the plan. the tax quote on quote cadillac or high and plans beginning in 2018 and for everybody in america that will be if their plan is a family has a value of $27,500 or individual it would be $10,200, but what this bill does says if you're in individual or a family in the union you don't pay taxes until 27,500 so there's a special tax provision that applies to union only and there's also -- >> i understand it that is in the record. >> i have several other points. >> you are talking about both. >> the reconciliation bill. this is not in the senate bill so they changed that. there also is a special provision for levee, montana or regardless of age everyone qualifies for medicare. for everybody else in the country you have to become a senior in order to qualify for

medicare. the reconciliation -- >> why would you think that? >> it is a special provision for the citizens of that state. ..

most government subsidies to banks would be eliminated for student loans but the bank of north dakota will continue to receive federal assistance for the student loan program or banks of the country won't be able to do that so there's a number of special provisions that we are aware of that still remain in this legislation. >> mr. sessions would you yield? >> i would like to respond to my friend, david camp's points. the reconciliation bill which will be the final product does not distinguish in any way between union and non-union workers. the excise tax applies to union and non-union workers. it is clear the senate makes the distinction but it's corrected by the reconciliation bill which is why we want to do it. with respect to the issue about connecticut's hospital, 12 states are eligible for that funding. it would be rewarded on a competitive basis. that is in the reconciliation

bill but it's not an earmarks. the gentleman mentioned north dakota in the student loan program. there was an understanding that state higher education guaranty agencies needed to be afforded the chance to continue to do the excellent work they do for students. so the public authorities throughout the country were given that opportunity. because the north dakota banks serve the same function in north dakota and it is functionally the same as that agency. was given the same treatment that new jersey's agency would be or california's agency and so forth and in the manager's amendment, excuse me, yes, the manager's amendment, so the notion that there is special treatment coming back to that under the excise tax for collective bargaining workers is not accurate. islamic i would like to ask the gentleman if he can provide a copy of the manager's amendment.

>> mr. sessions? i can answer that question. i can point that out if to yield to me. >> i'm looking at the bill, h.r. 4872. let me refer to to page 82 and 83, page 82 is where the subtitle begins provisions related to revenue. section 1401, high-cost plan excise tax. there you will see the reference, and essentially lines six and down through about 23 you will see the language that relates to the excise tax on the benefits. i believe that is already on the web site. >> you are in a reference to the manager's amendment. i would like to ask the gentlemen -- i'm sorry, ms. grangers have we been provided this manager's amendment it? >> we are waiting still which as

i understand i have a note here it will be here shortly. >> let me if i might mr. sessions to clarify the point on the manager's amendment. i think i utraquist as the chair of the committee that language be struck in the manager's amendment and i assume that will be included but i haven't seen the manager's amendment. >> i appreciate that. i think my point might be that there is conversation at the table among people who are here to give testimony and evidently you are able to give testimony about the bill and speak about it to the rules committee and the rules committee doesn't have a copy of that, you don't have -- i assume our members mr. barton, mr. rye and how members don't have a copy of this package which is not a double secret. this happens on a regular basis where there is a manager's amendment with the gentleman is able to offer an excellent explanation and we haven't been given that platitude.

>> you're going to forecast, great. >> the gentleman did ask for time. >> i just wanted to point out i know you said before these were special deals that were in order to obtain members' votes -- i think that's -- it may have been true when the bill passed the senate. i'm not been to argue that but what i would like to stress is i think what my colleagues like to point out is we were very careful when putting the reconciliation package together to review those and the only cases now where a state for example we see in our tennessee that you mentioned is getting some different treatment i would oppose special treatment is because it's justified in terms of a good government analysis, not because we are trying to obtain someone's vote as in the case of nebraska. so with the case of louisiana other ones like nebraska were eliminated. louisiana was not because you

had hurricane katrina and it was justified under the circumstances because the loss of medicaid funds and would apply to anyone else who falls into that category in the case of the disaster. and you also mentioned tennessee and it's true that in the bill you have tennessee and hawaii are the only two states because they don't have an allotment of the federal medicaid disproportionate share or dish funds they are getting some additional help but that's because they have no funds under dish and they needed to pay for their safety net hospitals that they have so what i would try to say to you is there may be circumstances where one state is treated differently but it's not in an effort to obtain votes which may have been the case on the senate side. it's an effort to correct that and do it based on a good government analysis of every case and i think that's a fair way to look at it rather than, you know, say this state is different in this respect it's

not because we are trying to get anybody's vote. >> so in other words the good government bill probably will not ever become wall and the bad government if we were to turn around the bill -- >> i'm seeing that these reconciliation amendments -- >> the good government bill becomes law we once you pass the reconciliation amendments, yes and eliminates -- eliminates some of the problems that you're citing that were based on someone got a special deal because they wanted it. >> that would then probably become law. i would like to go, and i mentioned i had three things i wanted to talk about. i would like to go to the next subject if i could and probably mr. runyon perhaps he would recognize this and i will make this available to the clerk said that each and every one of the panelists can have a copy here but there is been a discussion -- unsury, on the panel but if

others need a copy i would be glad to make them available. but there is talk about the lifecycle or extension of the lifecycle on medicare that the gentleman mr. waxman's the success began solvency. >> the gentleman has related about how great this samet bill ase i assume we are talking about related to the solvency. does mr. ryan have a comment? i know these are probably -- >> this spreadsheet is a coverage spread sheet but that's not the medicare numbers. but if you look at the letter i got from the cdu yesterday which i inserted in the record earlier this morning, page four, let me just quote for you to congressional budget office rolling so to speak on whether or not the medicare cuts in this the extent solvency. in effect, and i'm quoting here

in effect the majority of these trust fund savings under h.r. 3590 and reconciliation proposal would be used to pay for other spending and therefore would not enhance the ability of the government to pay for future medicare benefits. but pretty much makes the point right there which is you can't count money twice. either you're taking $523 billion out of medicare providers and what ever you are doing and it's going toward solvency or you are using it to create this new entitlement program. not both, it is 1 dollar comes into the government and it goes one way or the other, it doesn't go to ways to reverse a $523 billion are coming out of the medicare program to fund the new entitlement and the cbo certified it as recently as yesterday. >> can i respond to that? i would like to respond to that in a very general way and it's my philosopher the whole way we

are doing today and tomorrow. you said we can't count things twice. you talk about cbo. i did you can count things many times for the following reason. the cbo takes no consideration from the overall impact of this bill from a preventive perspective. in other words, all i believe and there are many commentators out there beyond the cbo that say because what we are doing in this bill, covering everyone, filling the doughnut hole, letting people get primary care, the amount of savings to the government in the system over the long term are going to be trillions and trillions of dollars beyond what the cbo estimates because people who don't get their drugs now because the meat the bill not whole problem or people that don't have insurance and don't go to a doctor on a regular basis or people that don't get preventive care because of a co-payment because we remember we eliminate co-payments for preventive care. all of those things are going to mean people get to see a doctor,

get their drugs, get the medication on a regular basis and over the life of this program you are going to save millions of dollars to medicare, medicaid, federal government, to the system as a whole. so i understand when you're trying to say you can't count twice. i think you can count this two, three, four times because of the impact to the system and the amount of money we are going to save and cbo will never score that. >> so i would just say to the gentleman who i don't know if he was up here when we went through the stimulus bill but i asked the question to the gentleman mr. rangel what kind of things would happen and he told me mr. sessions with the matter of months you will see millions and millions of jobs created in this country. i hope you are better at kissing

that they mr. rangel because he came without anything to support that theory. i would like to go to as part of that than the uninsured. we have heard about how everybody talks about everybody is going to be injured. we heard mrs. slaughter mengin 95%. it looks like a round 2014 all the 31 million people uninsured and about 23 million uninsured in 2019. can anybody accurately discuss who those people are? >> this coverage question about those eligible, essentially it would be people eligible to enroll but who do not. >> it was on the sheet of paper i passed out. >> first of all i'm assuming

your question excludes the undocumented because as you know they are not covered by the bill. >> i would say as best i could tell you i was looking at this sheet of paper. i don't know -- >> here is what my understanding is. akaka citizens undocumented people each of them is not all will do good vantage of that opportunity just like there is universal free public education but also in truancy. this is the cbo best guess as the number of people who have the opportunity to enroll but. the fact of the matter is under this bill banning the senate bill and reconciliation bill every person who is either a citizen or a legal resident of the united states will have the opportunity to obtain health insurance 100%.

>> mr. sessions if i may. the point you're trying to make is while this is claiming to be universal coverage you will have a population the size of texas floating through the country on the injured even after spending trillions of dollars, subsidies, taxes, mandates, government bureaucracy and that will still try to get emergency room costs, health care costs, still be the payment shifting and major burden on the united states and however you tend to describe it clearly what we saw in massachusetts when they sought universal coverage was a higher premium cost, higher government spending already after two and a half years they started to ration care at certain hospitals and certain population groups just in two and a half years bissell the results of that answer that is the concern they are not only not covering all americans clearly but they are also driving those costs up for those who have health care. >> rationing care, where does

that happen? >> we already began four months ago limiting payments to certain hospitals within massachusetts and cutting benefits. >> -- is not perfect but the goal to insure -- >> does massachusetts have the highest health care premiums in america today? >> i don't think so. >> it does. has already begun cutting payments to -- >> while we are paying -- what we are paying for health insurance -- people paid their own health insurance in massachusetts are paying for health insurance and those in texas -- let me finish my sentence please. we in massachusetts have attempted universal coverage. everybody should have health care. people are paying for health care in massachusetts but we are also paying for people in texas, people who may be able to afford insurance who choose not to get it who get sick and good to the hospital and that is all

uncompensated care and we pay for it. one of the ways to control health care cost is to make sure people have coverage. one of the reasons that it's difficult for us to be able to control health care cost as much as we would like is we are paying for people in your state who don't have coverage. seabeck so you're saying -- so you still have the highest health care premiums in america. there is cost shifting from the government to the private pay and then finally has health care spending been reduced to massachusetts as the result of the plan? >> the plan is working. it's not perfect but we that it works if everybody else in this country every other state come in your state has one of the highest uninsured populations -- >> i would be embarrassed if i had the highest health care premiums, too. the answer is yes they do have the highest premiums. we will see the same. [inaudible conversations] >> there is a lot of plans that

could be made here. a the only thing i would see is when given an opportunity the people of massachusetts, i think they voted overwhelmingly across the state to elect a person who would come to washington to oppose that great plan that might be same or similar. >> of the gentleman will yield the senator voted -- >> mr. sessions, mr. brown voted for the massachusetts health care plan. >> to not replicate anything. >> what the gentleman yield? >> i would yield to the gentleman from north carolina. >> i want to just add a point about what my colleague mr. sessions is saying that there is an article in the "boston globe" on wednesday, quote stage treasurer timothy hill of massachusetts saying if president obama and the democrats repeat the mistake of the health insurance reform in massachusetts on a national level they will threaten to wipe

out the american economy within four years. then he goes on to say that it's time for the president and democratic leadership to go back to the drawing board and come up with a new plan that doesn't threaten to bankrupt the country. so i think there are people who share the same concern, mr. sessions, who lived in massachusetts and served in public office. >> with the gentlelady yield? >> it's not my time. >> i want to say i think the majority of people in massachusetts would not want to repeal the health insurance system that we've put in place. i also point out that same health insurance system was voted in favor of bye senator brown. the other thing in terms of cost our costs have risen more slowly than any other state in this country. if we can get a comprehensive plan in place it will save us from paying for the people in

your state can afford insurance who choose not to get it and when they get sick we end of having to pay for it. >> when you're talking about the people in massachusetts pay for texans who choose not to have coverage because we have higher rates of uninsured -- >> when talking about is when people go into a hospital without insurance, it costs money. it is uncompensated care to read and the uncompensated care whether it is in texas or anywhere else, someone pays for it. who pays for it? we pay for it in the form of federal taxes. we pay for it because we don't pay for goes on the debt and we pay for on the interest of the debt. so the uncompensated care in this country is one of the reasons we see the deficit's going out of control. so we are paying for your state, mr. sessions, for being one of the worst states in the country -- >> we are reimbursing then why are so many people going through

bankruptcy of somebody paid the bill? >> [inaudible] >> but who did? >> they put on their credit card because they didn't have any insurance, they ran up their credit card and they are into bankruptcy, uncompensated care that is added to everybody's premium in this country. >> i believe that. >> that is why businesses are dropping insurance and people come to washington from large and small business and tell you the current system is broken and unsustainable. that is flat out the case. >> i'm going to reclaim my time. i'm going to tell you the way i look at this sheet of paper. the way i look at this sheet of paper is today there are 15 million people who are not covered and in 2019 there will be 23. so, if you subtract that out, we are looking at all of this stuff that we are doing to take care of half the people who are uninsured today. and we are talking about why did

the first three years i believe cbo bears this out, 5 million more jobs to pay for this, didn't probably which bill you go for mr. perlmutter, whether one or on the house side another, what i'm saying is 3 million will take your figure. 3 million people are going to lose their job to take care of 27 million people who then will be covered. and i think that is a horrible way to look at how you balance out this big effort and what we are trying to do. i was led to believe -- i appreciate -- >> 10 million uninsured at the end of the decade under your proposal. >> and i appreciate that help, mr. miller but the bottom line is we are talking about your to bills. and george to bills we've been selling out there we are going to take care of everybody. but what we are doing this for is about 27 million people, and

three more are going to have to lose their job and are going to put this huge system on top of everybody. >> would the gentleman yield? >> i would yield to the gentleman mr. pallone. >> i know you've got these figures in your mind about -- >> they are right here. >> i understand what i would point out, when you are going to cover all these people and they are going to have to -- they are going to primary care and are going to see a doctor, they are going to be a lot more health care professional jobs to take care of all of the primary care to deal with all of these people now health insurance and i want to respond with we yield to dr. fox because the bottom line is you suggested that we are headed towards bankruptcy or whatever. that is what is happening under the status quo. the status quo more and people are not we do have insurance. premiums are going up 20, 30%. the percentage of the gross national product is devoted to health care and keeps climbing. it's twice what it is in any other developed country. if we don't do me anything i

have no doubt we are going to be bankrupt but here we are proposing a very rational way of trying to corrupt the system and put a lot more people that would eventually be injured and give them insurance to try to control these increases and not have a 20 or 30% increase like we are seeing now and covering everybody. so i just don't understand. i don't mean to be disrespectful but it's almost like you say the status quo is acceptable and things are going to get better on their own. they are not, they're going to get worse. >> reclaiming my time -- >> you may not think this is a perfect solution, but it is so much better than the status quo. it's just so much better. >> i appreciate the gentleman but nobody is suggesting status quo. not one person here. i am simply saying i don't think that -- >> if mr. sessions would yield. >> [inaudible conversations]

>> i want people to stop talking over each other. it's always been polite appeared. this is the only committee as we know that goes on forever. [laughter] we would like very much -- we would appreciate very much if you would limit yourselves to some degree because we have a very long and heavy day ahead of us. but please, ask for and receive the ability to speak before you all start talking at once. mr. sessions. >> i agree. thank you. reclaiming my time. the last issue i wanted to get into is directly related to the physician reimbursement called sgr. and i am aware that we had a 21% cut that took place in march. i know that was about another 280 billion-dollar fixed is already in place. we are seeing a number of physicians that are deciding they will not take care of

medicare patients as a result of this. we now if you add the 21% and try to fix what ever we are told a might be, $523 billion instead of $280 billion. it is not in the bill would it is a cost to the system. and i am concerned that we are not right sizing this mr. hensarling, you've been through this in the budget committee. i would appreciate your take on that. >> i thank the gentleman for yielding. i listened carefully to the gentleman from new jersey and i'm glad he is concerned about the nation going bankrupt which makes me question why would you want to enact a policy that simply stamps on the accelerator towards bankruptcy. i know that earlier today many people on your side of the aisle are waiting around a congressional budget office letter talking about we're going to save money.

we are somehow going to reduce the deficit through these policies. cbo is made up of crete professionals but the only estimate or as we call it score was before them and guess what if you don't put before them the dak fix they don't score it. now already the speaker of the house has said there will be a doc fix physicians will not receive a 21% pay cut on medicare reimbursements. the speaker said the that on the record. so the ranking member of the budget committee mr. ryan of wisconsin asked the cbo okay the speaker said we are not going to have 21% pay cut and i will read from this letter i trust that it's already been entered into the record but it's a letter dated march 19th from the congressional budget office to the honorable paul ryan, and i will read the operative language.

quote, you ask the total budgetary impact of enacting the reconciliation proposal. the senate passed a health bill and the medicare physician payment reform act cbo estimates that an acting all three pieces of legislation would add, i emphasize the word had $59 billion to the budget deficits over the 2010, 2019 period. so i have my own a letter from the congressional budget office and frankly this is as the gentleman from texas knows is just one of the many budgetary gimmicks that are being used, and i sure people's hearts and minds are pure and clear but they are accounting would mcburney madoff blush. we are talking ten years of revenues matched against six years of program. every single decade is the democratic majority in tandem turning off this program?

for four years after this year than are you going to have you're 21, 22, 23% pay cut for doctors under the medicare system? for clamming medicare savings twice on your revenue side. you're claiming 520 billion in medicare cuts, 210 billion in medicare taxes, but this is double the counting. you can't have it both ways. either the money is used for the solvency of the medicare system where it is being used for your new entitlement. that brings us to the class act, the new in title mind that you are putting into this program. five years of premiums, $70 billion that he were taking out of your brand new entitlement to do is to reduce the cost of this. so are you going to pay it back? even the democratic head of the budget committee said, quote, this is a ponzi scheme. this is the democratic chairman

of the senate budget committee describe this scheme as a ponzi scheme. reeds on social security. $53 billion in new social security revenue to achieve the appearance of deficit cuts but they are not really there. are you saying that you're going to permanently take this money out of the social security trust fund and not replace it? i mean, that's going to reduce the deficit and on most to own up to the fact 21% of the medicare system to create a new entitlement yet you're not going to fund, yet again raise the social security fund a and not replace that revenue. again, it's just not realistic. and the doughnut hole. the doughnut hole doesn't get scored until the next decade. it is totally unrealistic. again, casting no aspersions on the congressional to office, but

the score was in front of them. i could go to the congressional budget office and say i want you to score the hensarling family health care plan and i want to assume i don't get sick the next ten years and we're putting our children up for adoption. can you give me a number? one assumption is false and the other assumption is totally unrealistic. so cbo will score was before them. now that the speaker said on the record there will be a doctor fix you can't count 21% pay cut, thus congressional budget office says that you are making the deficit worse and you are hastening of the road to bankruptcy. ..

>> the cbo looked at the full 20 years, and he said that the deficit will be reduced by between three tenths -- i put three tenths and five tens of gdp, about $1.2 trillion over the 20 years that that was what was before them. that's what they concluded. and you just can't say we believe them when we like what they say, and we don't believe them when we don't like what they say. that's what they said. >> are you suggesting then that in the number that you're

talking about, that the doc fix of -- >> no, sir. i did not say that. >> this goes back to my point, that we're looking at a system today that's got to be reformed. >> does the gentleman -- >> of course i support the doc fix. >> how would the gentleman would the gentleman pay-fors? >> let's just go to, i think you ought to pay for a. >> how? >> you know what? we could do that just fine and we will do it next year when we're in the majority can. you just watch out. >> will the gentleman from new jersey you'll? >> i sure will. >> i know it is $580 billion, or 523 billion, because we're taking it and spinning it somewhere else. it's a matter of priorities. and what we're essentially doing it for is this 25 or 26 million people, but still living 23 that are not served. and this is where it goes too.

the entire system, the entire system, rob, is -- >> would the gentleman yield? >> i will. i gave the gentleman time. i am saying to you, the entire system could collapse to cover 25 million people. and the entire system, everybody, could collapse if we really add it all into good. and the gentlemen does -- >> will the gentleman yield? >> i will yield to the joan. >> the gentleman says he supports the doctor fix. which is why the american medical association said very positive things about this bill. there's three ways to pay for the doctor fix. you can find spending, or you can adjust the bass line and pay for it that way which is what the present budget resolution does. which of those do you support? >> here's what i support. i support being honest and recognizing that maybe the ama says it's okay to take out the

21% but not one position i talked to is in favor of that. and that they will quit doing business for our senior citizens and we're not doing anything that i consider to be worthy to avoid that circumstance. and i'm simply saying, you know, you have to evaluate what's in front of you. my evaluation of what's in front of me is 19 it all out, netting it all out. we're not going to buy the doctors. we still have $523 billion that the gentlemen, mr. hensarling, by the way, madam chairman, i would like to ask unanimous consent, the letter he read be include in the transcript. >> without objection. >> we are going to not even put in $523 billion of cuts. >> would the gentleman yield one more time? >> and that is a bad proposition to lend 3 million more jobs to get to there. i would.

>> i just want to try this one more time. revenues, spending cuts or just the baseline, which do you support to pay for the doctor fix? >> i support that we should not expand the system, that we should have more people pay for this system. and, you know, there's. that republicans, the first 50 billion would come from toward reform. and i would take the first 50 of this from tort reform. and i think that we been onto -- >> was the other 230? >> well, it would be in there if we don't grow and do exactly what this bill -- >> will the gentleman yield? >> i will go to mr. pallone and then i will draw a conclusion and then i would be pleased. i appreciate. this has a lot everybody an opportunity to have full dialogue. >> would you yield? >> i'm going to be very brief.

i listen to what mr. hensarling said, and the bottom line is whatever you put before the cbo, in a particular bill that's what they're going to go on. and based on but we gave him about this bill that we're going to open with us tomorrow, they said that it reduces the deficit significantly. now, you know the republicans in the past when they did the doctor fix them they didn't pay for it that it wasn't paid for. there's no reason to believe it's going to be paid for. the iraq war wasn't paid for. so many other things were not paid for. i think it's very unfair, i don't know, they been that's not the correct word, but it's inaccurate or somehow unfair for either of you to come here today and say what about the doctor fix, or i can take what about the war, or what about this? the bottom line is, we're not voting on the doctor fix today. if we vote on then it has to be paid for or it will be deficit reduction. the same thing with the iraq war, the same thing with all these other things that being passed without attention to the deficit. the bottom line is this package

which we're asking you to rule on is a significant reduction in the deficit. and it is completely paid for. so i just think, you know, i've been trying to say from day one here that the cbo is a very artificial construct. there's no question it is. i consider today include you we're going to save trillions of dollars beyond what the cbo says, just because they don't have preventive care and the fact that so many people are going to be able to see a doctor and not end up in the emergency room. you can do whatever you want but the rules are we've got to use the cbo and this is what the cbo says that we're touting the fact it is a major deficit reduction, because within the confines that you and i and all of us agree on, this is a major savings for the federal government over the lifetime of the program. >> i appreciate that, mr. pallone. but you've argued both sides, but you're not including the whole costs. >> i said he when you're in a majority for 12 years, and i'm not being disrespectful. but the whole time you passed all these things on a didn't do

any tension to the deficit. >> we were running $200 billion deficits a month. >> it's clear that doctors fix is not going to be -- >> off the surplus. >> you know and i know what. >> i appreciate that. >> i just wanted to point out that we did offer a proposal on the floor during the debate on this health care bill that would update the doctor payments for four years at a 2% increase. it was fully paid for. so the concept that we've never tried to pay for the doctor fix is just absolutely wrong and i want to correct it. we did pay for the updates when we are in the majority. that was -- is absolutely wrong to say we didn't pay for updates in the doctor fix. cbo says that if you include the cost of doing that, the deficits going to go up and that's not even including the real cost of long-term care insurance. the real cost of the 10 billion that we know irs is going to have to have to enforce the provisions of this bill. so there's a lot that's not in

the cbo score, but we do have a letter from cbo saint if you just include that one thing, you increase the deficit. >> in other words, this new 16,000 employers in the irs that will take to come after this, they aren't included in this bill? >> no, that's not include. >> oh, my gosh. >> if you cut $500 billion from medicare, and you don't do the doctor fix, how are you going to keep physicians receiving medicare patients? you're not. you're not fixing -- you're not doing the doctor fix that you're cutting 500 billion from medicare. in fact, you are double counting as my friend hensarling mentioned. you're not going to keep them covering seniors, and that's a concern that really needs to be addressed. >> maybe that's how you pay for the built-in. mr. hensarling i know has been after me, and very polite and i appreciate my friend putting up with me. >> well, i well, i thank the gentleman for yielding one more time.

i would say to my friend from new jersey, this friend from new jersey, number one, the assumption you make on 20 years still include the double accounting on medicare. you're still claiming 520 billion in medicare cuts, 210 billion in new medicare taxes that you're using twice. wants for the solvency of the system, and the other to pay for this. and again, you can't have it both ways. the cms chief actuary has written quote in practice the improved hifi nancy cannot simultaneously used to finance other federal outlays, such as the coverage expansions. and to extend the trust fund despite the appearance of this result from the perspective accounting privileges that i would say to my other friend from new jersey, again, what you put before cbo, yes, they will score, but to go around and try to entice members to vote for this bill, when you have

assumptions that are simply not true, i just think is undeserving of the process of this house. i would also point out to this friend from new jersey, since i have several friends from new jersey, the congressional budget office, it says, itself says that in the out years -- [inaudible] [laughter] >> that in the out years, that their estimates become even more unreliable. and i think we know through history that the predecessor to the congressional budget office, when they were asked to score the 30 year cost of medicare, were off by a factor of somewhere between 801000%. so this new entitlement saves money, it will be the first entitlement in the history of mankind that actually produce to save money. and frankly, it just defies common sense and logic that you

going to bring in 30 million some odd new people into the health care system, half of which will be on medicaid and at the end of the day somehow you're going to end up saving money. you may have convinced yourself. it is clear you have not been this the american people. >> i'll be brief because we need to move on. i just want to codify something, mr. hensarling said. i do speak louder. how about now? i just wanted to comment on something mr. hensarling said because i think you can go without saying, we can have our numbers come we can have our charts. we can talk about rejections, but if we can have an arbiter of what is the most accurate, then we're nowhere. it's a food fight. and the reality is here, each of us, republican and democrat, have relied for more than 30 years on the congressional

budget office. whether they are always right on the number, or a little off, we rely on them because we know they are not partisan. we know they are not biased. we know they're independent. and if we can't trust them, then all bets off because there's no one we can trust. and so i was and they say to mr. hensarling. for mr. hensarling to say that the numbers are not real is to impute the reputation of the congressional budget office. >> i'm going to reclaim my time because i do believe mr. hensarling was saying that at all. >> he was saying it was not in the. >> mr. sessions, if i could clearly say this. let's understand that the congressional budget office isn't a child. when they go through and scrub all these gnomes, they make sure that they are not being hoodwinked by unix and shell games. so they came up with the snow was. not republicans, not democrats but we should be able to move forward and understand what the cbo is giving us. i thank the gentleman for yielding. >> i would like to be extended to additional minutes.

mr. hensarling for one of those minutes, please. >> i trusted you know. i do not trust the assumptions you gave cbo. >> mr. dreier? >> thank you very much, and let me just say that i think that what we have with this here again underscores a need for an open rule and a debate on house floor. i have listened to mr. pallone, and almost a daily basis i listen to mrs. slaughter, mr. mcgovern and mr. hastings. regulate point to the horrible things that we did as a justification for the action that is about to be taken, whether it is using this process, which would use with great regularly, whether it's all kinds of things. and i'd like to just share with our colleagues again, the fact that when they now majority came to majority, it was the process of campaigning, they did so in

large part attacking us on our record. and there was a document called a new direction for america. and this is what speaker pelosi ran on in a new direction for america. and i just like to share with our colleagues a couple of brief paragraphs from this item. the bills should come to the floor under a procedure that allows open, full and fair debate consisting of a full amendment process, that grants a minority a right to offer its alternatives, including a substitute. members should have at least 24 hours to examine bills in conference reports text prior to floor consideration. rules governing floor debate must be reported before 10 p.m. for a bill to be considered the following day. house, senate conference committees should hold regular meetings at least weekly of all conference committee members, all duly appointed conferees should be informed of the schedule of conference committee activities in a timely manner and given ample opportunity for input and debate as decisions

are made towards the bill language. and the fact is, i mean, we regularly hear that we did something that is being done now, which was harshly criticized. and the promise that was made in a new direction for america was, in fact, these things are being subverted now. i asked about the conference. mr. sessions, just yielded to me. and i do know that you will of course be able to point to something that we did eight years ago they didn't exactly comply with what was put forward here in a new direction for america by ms. pelosi. so i would just like as we look at what's taking place here at this moment, say that an open and free flowing debate on the floor of the united states house of representatives is with the american people deserve, and that's what we should be doing right now. >> i appreciate the gentleman. mr. chairman, thank you today and to the gentle woman, mrs. slaughter, for making sure that each of these memories

could be here today. they are taking a lot of their weekend to come up and provide testimony. i have found it very insightful. i do have friends from new jersey, a place i used to live and i enjoyed new jersey. but i think it's important that every time we do a major bill, that we have experts, people who understand the bills which has not been the case, or able to come here, answer questions that i know you're counting votes that i'm a noble. i yield back. [laughter] >> i was going to put you as undecided. >> i think this panel has been terrific. i just want to say one thing in response to my friend, mr. dreier, and that is we are faced with a competent process today because members of your party in the senate have said that they will filibuster the appointment of conferees. we go to conference. i mean, we can't get around it

that you need 60 votes. and they won't even allow us to have a vote, up or down on this pic and so you know, i wish things were different but i will tell you, you know, with respect, members of your party have made it very, very difficult by throwing roadblocks at every chance they get to try to prevent us from moving this forward. >> will the gentleman yield? >> i want an up or down vote. it is very, very difficult. i yield to the gentleman. >> if we've had the democrats in the senate four years blocking our proposals for associate health plans, for our proposal to bring about reform. they chose to do that and we could have played a bigger role in driving the cost on health insurance -- no, it's not payback at all. is simply recognizing that the idea of a 1.2, and it is a $1.2 trillion program that involves the federal government more heavily in health insurance

that has ever been a before is not the answer. that's what mbs of the senate are saying, we say the exact same thing. i thank my friend for yielding. >> i will yield to ms. matsui from california's. >> thank you very much. mr. chairman, i'm very pleased to be a. i know all of you are pleased to be here. and we should get some better cushions for your chair there. i should say this is an interesting time, and i have not been here for six, eight, 20, 30 years at all. but i am here now. and i am privileged to be here now, to participate, especially this great bill. i mean, teddy roosevelt i guess it started this process. so it's been republicans and democrats. and i don't know when teddy roosevelt was president, must have at least 100 is ago, but we have been through this where we all, as americans, felt that it was time time to provide for our

citizens, time to provide citizens. and we go uphill and downhill. we go up, we come down. we're doing this again. we are at this crest now. we can almost get there, almost get there. and we could just bring up the pass as much as we can't about you did this come you didn't do this and all of this pic i think we all agree that we've done things, right? but i must say, that i have to tell you, each one of us and our families have it personal stories. maybe, you know, i look around, and you know, when you get to talking with your colleagues on a personal basis, you know you've had challenges. you know that. and i must say that when you get down to that level and then you hear from their constituents, not the ones who are loud, not the ones banging on your doors, but the ones who come up to you later, the want to write little notes to you. people do right notes, you know.

the ones who called. and, you know, their stories are very similar to all of ours, too. and i think each one of us, despite the great health care we have, always know that there could be the next thing there. that could really wipe us out. that's over talking about here. we are talking about taking care of each other here. and that's really an american tradition that and i think it's time we move on it. now, i understand that this is a difficult comprehensive bill. it is. i sat in the energy and commerce committee hearings and subcommittee meetings and everything else, hours and hours and hours. and i think all of you did, too, and labor and ways and means and everywhere else. and in discussions, town halls, talking with your friends, we've done that. we discussed all of this. it's really time to do this now.

and i must say that i think each of us have the best intentions here. but we cannot just are pulling this thing apart, because we know why it's hard. it's a very complicated, comprehensive system that really does touch all americans. and want to ensure that all americans can be covered in some way. and we also our free market society, so we also realize that we have a plan already as far as our private insurance and how we do things. we haven't medicare that we have a few things you. but as far as putting it together we have not done that. so it's really time to do that. now, we can do all the good stuff and just say, let's just get rid of preexisting conditions. let's go ahead and just get rid of lifetime caps and all that. you can do that in isolation. we absolutely cannot do that in isolation. if we could, we could have, we

would have done that already. we get to the. so what we need to do is look at the whole picture. and i think i read in one of the articles that you look at health care like a three-legged stool. you know, if you just had one leg on it you could barely balanced, maybe for a while. you have to let judges to a certain a certain way. three legs, you are finally pretty much balanced out. and that's what we're talking about about this system. so i think it's important for us to look at the fact that this is something that the american public, and i for from the american public, too, most of them understand that the system we have cannot go on the way it's going. they are a little afraid. you can understand that. change is difficult. but we're trying to do this in the most reasonable way, with what they know are familiar with already. they can keep their doctor. many of my senior citizens, can i keep my doctor?

yes, you can keep your doctor. we understand how important is to have your doctor and we understand how important it is to have a coordinated care so you don't have to keep taking all these tests over and over again. we have address a lot of these things, and that is what it is a complicated system. so i think that it is something where we have looked at. we want to make sure it is affordable for all middle-class americans because they're being challenged the most. we know the insurance companies have been given their free ride. so we hold them a couple. and we want, you become have accessibility for those who don't have it right now. those are the principles that we built this upon. now, i can't see us pulling this thing apart right now. we have gotten this far. i know there are challenges ahead here. but anything this big is going to have been taken this long, and when we make policy and we tried to get it to the floor, we know it's not the most simple way at all, but this is not a

simple situation at all. this is almost the last thing we can do right now for all americans. we'd like to do it. now, and i'd like to see, probably mr. boone or mr. miller our mr. andrews, why it is so important to have the three legs of the competence of aspect of this bill. >> you know, i will try to be pretty because i know time is running out. you talked about the system and how the system be changed and how you set to so many of our subcommittee hearings. and i know that so much of the emphasis today is on the money. and i don't want to take away from the debt and the money and all that. but i think that what we're talking about here in so much of our hearings and energy and commerce was devoted to this, is that changing the way we do things. and, you know, i'm not trying to be critical, mr. hensarling, but just to talk about the people that are outside the system. were not covered.

the fact of the matter is there in the system. they're going to the emergency room. yore but they're getting the wrong kind of care at the wrong target everyone is in the system. everybody gets health care. nobody can be denied care if they go to in an emergency room or a clinic or whatever. but we're trying to change the way we do things. and there hasn't been that much attention to the fact that the whole way we deliver health care is going to be changed. not in the money or insurance so much, but the fact that it will be prevented. people will go to see a doctor on a regular basis but they book is the primary care, and different innovative ways of trying to look at care so that it's not just one doctor here and one doctor there, but the whole system, the concept of the medical home. they're so be things like this that change the way we deliver health care that will not only save a lot of money, as i've said many times today, but also make for better quality care. and that's what i think when you

say change the system, i think that's what president obama was talking about. not so much the dollars, but the fact that we need to do things differently. and visitors of the system very much a way from this. and looking at when you get sick, when you go to the emergency and back towards trying to prevent bad things are happening. spend that's what we have as a prevention in here, too. >> when people see this they will love it because it's such a change in a way we do things. >> we've heard almost universally across the house that people say they want to avoid discrimination based on preexisting conditions. it's hard to find members as he or she is not for that. in order to accomplish that and not spike premiums for insured people come you have to have a larger pool of people that are covered, eventually. you can transition into that, but eventually that's what you have to do. so then people say, why do you have the exchanges?

well, because when you're bringing in the larger pool of people and make the presenting condition work, you want of a competitive workplace unlike these is the marketplace is in this country, that gets the best deal for people. and then people say, well, why do you have to have the subsidies? to get people into this marketplace, if somebody is making 25, 35, $40,000 a year, you can have all the marketplace as you want but they can buy in without the subsidies. and people say what you have to have the spending restraint and the revenue? you can't have the subsidies without the revenue. so i would say to you, gentle lady, that is easy answer which is so glibly stated by people, let's just take care of the presenting condition problem. it doesn't fit together if you don't take the next step and the next step in the next that and make it work to the people in the country deserve more than a half-baked solution that won't work. and that's what this bill does that spent would the gentlewoman feel? >> i thank