>> thank you for being here. >> thank you mr. chairman. thank you for the patients. >> thank you mr. chairman and members. i have one amendment that has to do with comparative effectiveness. mr. chairman and members, i believe the american people have made it very clear that they do not support this health care proposal. among the many concerns they have faced one of the most serious is that a major expansion of the federal government's role in health care will inevitably lead to rationing. i would ask that the house has the opportunity to vote on my amendment members of congress can say whether they agree with the american people that the government should not be in the business of denying access to lifesaving medical treatments the senate bill contains a new initiative providing federal

funding for comparative effectiveness research. while this research can be beneficial by providing patients and doctors with better information about which drugs and treatments work best it can also become a tool for government bureaucrats to decide which treatments are, quote, cost effective and which ones the patient can get. nothing in this senate bill or the reconciliation bill would prevent cms from denying coverage based on comparative effectiveness research. the herger busoni brown amendment would prohibit cns from using comparative effectiveness research to make cost based coverage determinations. cms would still be permitted to make coverage decisions based on safety and effectiveness just

not cost. this language is taken from bipartisan legislation i introduced with delegate chris jansing and dr. tristani. we need only look at the u.k. national institute for clinical excellence to see the importance of this amendment. we use comparative effect of this research to decide whether the british health system will pay for treatment based on a formula that divides the cost of the treatment by the number of years a patient is expected to live for example nice felt that the first therapy of the kind to treat women for her2 positive breast cancer was too expensive. after public outcry, they decide to cover this drug for women with late stage breast cancer in

2002 nearly four years after it was approved in the united states. .. now we go to mr. franks. >> thank you mr. chairman.

we appreciate the opportunity. mr. chairman, i have one amendment of my own into that i offer on behalf of myself and dr. brown and congressman sam johnson. the first one mr. chairman would change the reconciliation bill cuts of another 66-point $1 billion for medicare advantage on top of the 136.2 billion already cut from this very successful program in the same path bill. this is a total of $202 billion for medicare advantage. of course in my district mr. chairman a loan, i have one of the higher numbers of senior citizens and 43% of all medicare beneficiaries in maricopa county which is 75% of my district have chosen to participate in medicare advantage plans and they do that for a couple of reasons. number one medicare advantage plans are privately administered and they have a lower percentage

of claims that are denied. they have lower out-of-pocket expenses and they give the enrollees a great deal more choice in flexibility. the reason of course that i am afraid that the cuts have been made is because it is sort of going in the opposite direction than this entire reconciliation bill. one of the things that is important i think to keep in mind is that medicare, the basic medicare system denies more claims than the average private health care insurance. but in medicare advantage because it is more privately administered ameliorates that to some degree so i am hoping that the committee will find some wisdom in passing or at least letting the amendment be passed or voted on and mr. chairman i guess i would just remind us all that the highway of history is littered with the wreckage of government to thought that they could somehow manage and

maintain productivity better than the markets, and that is our essential argument here, that the markets will work better if they are given the chance. with that i would like to move on to the other two amendments both having to do with abortion mandates. i know that this issue has been discussed the great deal but i would ultimately like to go on record as saying i truly believe in the years ahead that this bill, if that is passed, that this congress will be forced to completely overhaul it again, to change it dramatically because i believe costs, like has happened in tennessee and massachusetts, will force that reality as well as doctors leaving the system. i think we are just going to realize we are trying to repeal the laws of physics here and we will have to change it but there are some things that can't be changed after they are done in a significant way. i guess to paraphrase james agee, he said every child who was born no matter under what

circumstances and no matter what parents, the potentiality of the entire human race is born all over again. mr. chairman of the ostensible person of this-- purpose of this reconciliation bill is that it is done in compassion and i think that is just so hard for me to grasp, if you grant diplomatic immunity because the leadership of the majority has doggedly determined to include the increased taxpayer-funded killing of unborn children and i think nothing so completely destroys the notion that this bill is about compassion than the disenfranchisement of those who are helpless and have no voice in this debate. so i am hoping the committee will see the wisdom and also the moral impulse to see this at least voted on before we move forward with this, because in the final analysis, if we can't find the will or the courage to protect the innocent and our

efforts here, i feel like that we may never find the will or the courage to protect any kind of liberty for anyone and somehow we will allow ourselves to be dragged into the samaria and knight, where the predatory survival of the fittest prevails over humanity and i just think somehow all of the history that we have seen in the past when we have disenfranchised a certain group and changed our history and how we were sorry in retrospect, maybe that should be considered before we move forward here and i hope the committee would give the amendments a chance to be heard or go. >> thank you. any questions? >> thank you mr. chairman. mr. franks, i think that your mention of one of the things that i think is-- stirs up the most objections to the proposed bill is the fact that many of us

believe, and know and can point to the fact that this bill is going to fund abortions. and in fact it is going to force everybody who participates in one of these health care plans to pay into a fund that will pay for abortions. is that your understanding? >> it isn't i think more importantly, congresswoman foxx is that regardless of the debate that we may have over the different provisions in the bill, which i absolutely agree with you are incontrovertibly there, one way to wipe that debate out would be to pass an amendment like this that puts us back on the hide language that removes this as a point of contention. i am at a loss as to understand why that that can't at least be done because it certainly would be, do more to bring us together than anything else. is taking the lives of unborn

children is health care than it is later in the day than any of us remember. >> can i have a follow-up? >> can i just say one thing before you follow-up? i know this issue provokes deep passions in people but i have to tell you and we do give diplomatic immunity in this committee. people say a lot of different things but i have to take exception to the the way you characterized it. you may have different views on this issue but i don't think that is the right way to approach this issue or to characterize the leadership. >> mr. chairman i would stand completely corrected. >> i think that is, goes beyond the pale. dr. fox, you have a follow-up. >> thank you mr. chairman. we all realize this is a very emotional issue. it is particularly emotional for thus who are pro-life, and it is , it is of great concern that

the majority has refused to make sure that the stupak-pitts amendment or similar, hyde amendment language has not been placed in this bill. we know that is not in the senate bill. it is why our colleagues on both sides of the aisle have problems with this bill. and, it is our understanding it is why the majority is having some difficulty getting the votes for this bill. and, i just want to say that we don't want to inflame passions about this, but we do want to make it clear to the american people that a major objection to this bill-- i mean i object to it on many grounds, the government takeover of health hh care but the fact that we will force americans to pay for a let to the origins is something that

has never been done in this country, and it is something that leave very very much object to, and i think that has to be mentioned at some point in this hearing. >> thank you virchow. >> and that we would say that it not only goes down to, starts down a slippery slope, but it sets such a different tone in this country, and i have to say that i agree with mr. franks. if we call elective abortions health care, then we really are living in 1984, where the language is just turned around. >> thank you or go. >> mr. chairman if i might respond. >> the coalition of 59,000 nuns released a letter in support of this bill, and i think i would

stand with them more than i would stand with people who want to make. >> mr. hastings. >> mr. chairman, it has been mentioned by our colleague that she could point to in the bill where it does what she and mr. franks are saying, and i would like to-- it to be pointed out to me where it is in the bill. >> mr. chairman, i would like to insert for the record a letter from the national right to life relative to-- i am sorry. >> i'd early disagree. this has been hashed out over and over again between the principles that have that passionate concern, and i too express myself with those that

do have this concern. one thing i have learned over the course of the year is that you are not going to be able to legislate in this arena and i want to carry you all where i usually go when with this discussion comes up. but, i lived in the days when a woman did not have the right to choose, and women did some pretty tragic things under the circumstances of pregnancy. and i don't know how we can legislate anything here that is going to cause us to avoid that particular consequence, but i am in arrow disagreement that this legislation does that. i have great respect for mr. stupak and mr. franks, you

dr. fox on the other side, our colleague diana degette who has led the women and those of us men who have similar views then than today and somewhere along the line, we are never going to meet here on this issue. we can be as passionate on either side and we are not going to be able to resolve the problem of what happens when a woman is pregnant and makes a choice either under the you just of legality in the roe versus wade permits or if you were to eliminate roe versus wade, it isn't going to stop women from choosing, even though most of us would hope that no one chooses to have an abortion. nobody here is trying to mandate an abortion.

i don't believe this legislation does and i believe you all stand corrected. >> mr. hastings? thank you. i wasn't saying that this bill mandated abortions, and i agree with you. i don't think that anybody sanctions women wanting to have abortions or needing to have abortions in their minds. i believe that is the case. i don't question people's motives on that issue, but i do have references that i can give you are and where we this act does provide for funding for abortion. i will be glad to give you a copy of that and i will put a copy in the record also. i can site pages and sections for you. i don't think that you probably want me to spend the time to do

that this afternoon, but i will be able to give you that. and i will say again, my heart goes out to any woman who finds herself in a position where she is making a decision whether to have an abortion or not. believe me, my heart goes out to her. but, as i said, i believe that most americans do not want to pay into the federal government money that then will be used for abortion. >> reclaiming my time. there is nothing that requires them to do that, even under the most striking example of that, the nelson language on the other side. this to check business, which i am opposed to as well, gives a person the right if they want to , to buy insurance that will

cover their needs. and i just, for the life of me am having difficulty understanding how this legislation requires that? >> it is section 1303, page 2072 , requires every person in a qualified health plan that includes abortion coverage to pay an abortion surcharge to cover the cost of abortion on top of a separate payment to cover the cost of the remainder of the health plan. this forces everyone in a qualified health plan state exchange that does not opt out to pay for someone else's elective abortion, and the cost must be a minimum of $12 per year or more. steel where are you reading? what is that? i am talking about the bill. >> if i could mr. chairman, the reality is rather than having this debate, the amendment just

simply says that you can't do it, so if you are convinced that the bill has no problem, the stupak language has a lot of opportunities there. let me just say i don't intend to inflame the passions here of the group but the reality is we have been torn apart by a lot of other issues that have similar dynamics in this country and we did fight her way through that. >> ms. matsui. >> we do appreciate the view viewpoints here but i must say, there is no federal funding for abortions in this bill, no federal funding for abortions in this bill. and in the language of the senate, if you, you have to take a separate policy and pay for it yourself. there is no federal funding here. it just amazes me. we live under the hyde amendment. that is just the truth of it. that is what we do. >> madam chair and mr. chairman

if that were the case then certainly there should be no hesitancy to support this amendment or the stupak language that would remove all doubt in everyone's mind and remove some of the obstacles. let me just close here mr. chairman. i know that it is a difficult issue but for those of us that are aware of the reality of 4000 unborn children dying every day in the home of the free in the land of the brave, it is an issue that moves us so deeply that sometimes it strains the stability of even the most stable among us. >> mr. chairman, i would just like to say that the hyde amendment applies only to hhs funding. mrs. matsui does not apply. >> thank you very much. we are now going to hear from mr. dent and mr. paulson on the same amendment.

>> i have a separate amendment as well. >> alright, you are next. >> mr. chairman, thank you. i have two amendments and also the amendment mr. paulson and mr. lance and mr. gerlach. my first amendment deals with medical liability reform. i come from a crisis state where we have had medical liability crises for some time. i worked at the state level to try to correct that issue with some success but not as much as we have needed. but if we want to make sure people have access to positions we have to be able to make sure we can recruit them and retain them and that has been a real challenge for us. that his wife this reform, defensive medicine is a cost driver. we can all agree, people cannot have health care if they cannot see a physician or physicians are not available and they cannot afford insurance the one thing we must do is make sure we deal with this very serious issue and there are many estimates out there, as much as,

over $100 billion spent in defensive medicine costs in the united states. we have another cbo analysis that would say we could save upwards of $55 billion over 10 years if we were to enact meaningful liability reform. very specifically my amendment will do a number of things but it will stabilize compensation for injured patients, hold parties responsible for the degree of fault proportion to liability and ensures meritorious claims are swiftly resolved, encourage compliance with clinical practice guidelines and guarantees medical care is available to those who need it the most by providing protections to safety net buyers. also i won't get into the weeds of medical reform for periodic payments to share fair rules and certificates of merit, clinical practice guidelines and regulatory directives, nonpayment determinations but those are all part of the bill.

it is comprehensive. it is one area where we can actually save some money and i respectfully ask this amendment he considered by the committee and favorably if you could consider this on the floor of the house. unfortunately the liability issue is not then as much a discussion as i believe it needs to be so i ask for your consideration. the second amendment and then i would yield to mr. paulson. deals, presented by myself, mr. paulson gerlach and lance. essentially it will strike section 1405, the excise tax on medical device manufacturers. simply strike that tax and essentially the offset would be $20 billion from an obligated stimulus funds. this is a very big issue where i live. i have many people in my district who are employed in the device manufacturing business. this is a jobs issue. plain and simple. i have companies like olympus headquartered in my district,

probes and scopes, very concerned by this legislation. a small manufacturer that makes rapid hiv and aids diagnostic equipment that you find instantaneously. these are the types. finally a german company headquartered in my district. they are very concerned with their 2000 employees in effect they have gone so far as to refer to this as the death tax. that is how serious they are about this. and about how this will cost them $23 million, just as one company in bethlehem, pennsylvania. they say this tax is 100% cash flow. they will reduce employee spending. that means layoffs, fewer jobs. they will reduce spending on advanced research. they will reduce spending to pennsylvania vendors, reduce spending on capital equipment and forced to attempt to pass on as much of the tax as possible onto their customers.

effective tax rate would be raised to over 73%. the burden would increase by 77% so this is a very big deal. the bottom line is this is a tax on research and it will lead to people being out of work. the patients of america will suffer. this cost most assuredly will be passed on. if we are going to raise the price of a or raise the price of a wheelchair or a timed oppressor or whatever it is, a scope or a probe made by olympus this is going to be passed on. i'm extremely concerned about the implications to those who work in this field and in pennsylvania and in new jersey, we are very much impacted by this. we are rich in a biotech industry and this is so serious that again it has been referred to as the death tax and i would like to submit the document i received from the company on the impacts. >> thank you mr. chairman for

the opportunity to testify before the committee. along with mr. denton mr. gerlach and mr. lance. i serve as cochair of the house medical technology caucus, and i've really made becoming an active member of this caucus a top priority because i know how important radical technology is to my district, to my state, to my country. it really is an american success story. it truly is. this bill does contain the 20 billion-dollar tax on medical manufactures. the tax will hit many technologiescommon in modern medicine such as pacemakers and stance, mri scanners will now be levied against device manufacturers across the country and in my home state of minnesota. along with a negative impact on jobs,, medical innovation tax post i've are one of are one of the nation and reduce the number of lifesaving technologies that many of these device manufacturers are working so hard to develop these days. patients are going to end up paying more for fewer medical technologies over time and i think that is the exact opposite

of what we need. finally as is the case with nearly any tax that gets put on private issue the increased costs will ultimately be borne by those consumers that rely on it in this tax will make health care more expensive for a good segment of the population that ends up depending on these devices including wheelchairs. that is why i along with mr. lance, gerlach and paulson, if it replaces it with an obligated stimulus funds. the administration itself often talks about jobs being saved in our amendment would have a great impact certainly on the number of jobs and be saved by preventing this tax to be levied nationally 350,000 jobs are a part of the medical technology. in minnesota it is close to 20,000 jobs. in fact statistic show every medical technology job has been shown to generate an additional two jobs i creating the need for secondary positions such as technicians.

additionally each medical technology payroll dollar generates an additional $1.12 in payroll to account for the increased number of positions and skills required to fill those jobs. it is not just the larger companies we all are friendly with but almost every week by two are in my district these smaller companies that are fighting to create that lifesaving technology and i want to make sure they have the research and development tools to help modern medicine and not send these jobs overseas. so these medical technology companies will improve the quality of life as they do right now and save lives for consumers. it fosters fosters that innovative spirit i think that is so important that is kept minnesota and america at the forefront of medical innovation for decades and i thank you for allowing me the opportunity to testify. >> thank you out for being here. same subject? i just wanted to tank of these guys for coming and for your patience. any questions? mr. hastings.

>> like you gentlemen, i represent an area that is full up with medical device technology. as a matter of fact, it is kind of a secret in the sense that most people don't even know that all of that biotechnology is along i-95 when they are passing it on any given day, and the area that i am privileged to represent. my question is, is there an excise tax now and have we made some improvements from day one of this legislation to where we are as we are about to pass that? >> i can tell you that the tax, i am told that the tax, i understand the tax in the bill that will be considered tomorrow is that the rate of 2.9%.

>> 2.3%. >> that amendment will take it to 2.3 itself so the bill itself is 2.9 and this would take it to 2.3 although the exemption on a class 1 device, like bandages and other things would be eliminated. >> our class 1's are public, retail or individual? >> i think it would include things like bandages, band-aids and that sort of thing. essentially it lowers the rate and expands the basic devices. my understanding is it would come to somewhere around $20 billion over 10 years. the senate bill i think originally started off at $40 billion over 10 years. >> one thing is certain. you have made an impact with reference to this legislation and i am sure regardless of the ultimate outcome with reference

to the manager's amendment that you will have a continuing impact and certainly with members like myself. i may not be a part of that caucus. i believe betty sutton as an betty sutton and i are good friends and have raised the subject repeatedly over the course of the 15 month we have talked about this measure. dr. dan's, i want to ask you, you said, and i'm not trying to be picky here but a part of your recitation earlier, on the medical device measurer, but earlier was that if people don't have insurance, they wouldn't see a physician. i am using your words. >> maybe my language was not as clear as i wanted it to be but my point is, in my state we have a very difficult time recruiting younger physicians.

we have a hard time recruiting because the way our liability system has been set up for years. we also have a problem and retention in the fact is there is not as much access to health care, primary care in effect we have hospitals that don't deliver babies any more. >> you are not unique, and i hate to say, i don't do it much on this committee but i represent urban and rural hospitals and if you are talking about underserved, i can show you underserved. i am not making an argument that i'm suggesting to you and i think you would agree, if we didn't have insurance companies we would still need doctors and have the need for doctors. doctors are the pivotal physicians, the pivotal part of all this health insurance in my considered opinion and perhaps a little attention has been paid to portions of the legislation that does contemplate that need, and tries to do something about it by making some provisions.

but, in addition, if we didn't have government we would have doctors. you all aren't as old as me but when i grew up, we didn't have no medicare and medicaid and doctors were still there and doctors were still doing-- do you know what they did? they did the same thing i did as a lawyer. they represented people that had needs and that is what physicians do. all you need do is look at haiti to see the classic example of a significant number of physicians i reference a book to use too, mountains beyond mountains deals with a physicians work for years and his quarrels with his friend who had opted to make money. piaf did to perform service. now, i know just based on personal experience that on

liability, in and of itself, is a burden for physicians. but it is not the end they'll be all to the problems that we have in this nation with reference to health care. >> i would agree mr. hastings and i would also suggest you that representing pennsylvania, the city of philadelphia was referred to by lloyds of london as the most expensive work to write liability insurance. we had one year where the city of philadelphia more payoffs were made than in the entire state of california, just to put that 1.5 million versus 30 million people in california. >> i have, i don't no, i probably has as many physician friends that lawyer friends and i'm a lawyer but one of the things they quarrel about when we are together in social settings is the same subject. and i am convinced that the shrill lawyers in the shrill physicians would get together

and eliminate who i perceived as a large part of our problem, and that is the insurance companies, that have kept us in an up or for the 47 years that i have been a lawyer, then i think we could resolve the problem. >> i would say respectfully that in my state one of the problems is we didn't have insurance companies that would write medical liability claims. they just wouldn't do it. >> everybody keeps talking about selling insurance across state lines, and i don't disagree with that, but i live in florida where there are hurricanes. a lot of those companies just up and left after hurricane andrew, so state lines don't do anything but allow for cherry-picking when the deal goes down. insurance cup these are indeed business of debate. nobody can quarrel like that. that is what they do and through depressions, recessions and everything else, when the other people are going out of business

including the 1929 stock crash, insurance companies were like freddie krueger. they raised their hand it continued right along. i don't disagree with much of what you have said and will support the medical device aspect. you and i can talk all day long about it. >> in conclusion, the only.i will make him a liability, my state set up a fund, ran into trouble many years later and guess who got the bill when the claims went through the roof? the taxpayers are now paying. cigarette smokers in particular are paying for all of us now. 's be the best medical services are in philadelphia. >> it is wonderful. the best in the world. >> thank you very much. >> thank you madam chair. i will issue three words dreaded by any politician i will be brief. this amendment is a repeal of the independent medicare

advisory board. 19 members of this committee thank you for the opportunity to support my amendment which is extremely simple in its intent. i'm proposing we agree on a bipartisan basis to strike the independent medicare advisory board from the legislation and restore congressional authority over medicare policy. my republican colleagues and i have been talking for months now about how we believe the underlying legislation results in a government takeover of health care and will result in rationing of care. no provision of the bill makes this possibility more likely than this board. you see this commission is so intention will be to determine whether medicare spending more than its budget and if so, offer fixes to cut that by medicare spending that are fast tracked with little opportunity for congressional oversight. my colleagues have heard me tell about my experiences we have had in tennessee in a program called 10 care but for those of you who haven't let me be brief about this. 10 care with our state solution

to an ever expanding medicaid budget and was billed as the nation's first experiment with it try universal care. what happened was the program over overpromise benefits and made no effort to ensure that the capacity to deliver those services ever existed in the state in overtime are cost tripled from the initial projections. we had to ration care by closing enrollment in implementing limits on a number of physician visits allowed in one year. this year you can only see a doctor eight times no matter how may times you need to see them in the state will only pay a hospital $10,000 regardless of what your bill is. if anything is clear that the proposal is we haven't learned the lesson my state provided. this medicare commission is not going to be looking at how you improve patient care. is going to be looking at how you meet a budget and that harms patient care. not. in the past these commissions have looked to cut physician payments first and when they stopped services cut back on the

number procedures allow. reduce commissions like the medicare payment advisory commission made nonbinding recommendations. some congress adopts and others that doesn't buy at least the decisions are reviewed. now we are creating a system which all of these flawed recommendations will become law. i would like to read a couple of sentences from a letter i have about the board. and it is signed by 75 members. an executive branch medicare board would also effectively eliminate congress' ability to work with the center for medicaid and medicare services create and implement projects designed to evaluate new and advanced policies such as home care for the elderly, the patient-centered medical home, less invasive surgical procedures, evers between hospital and physicians and programs designed to eliminate fraud and abuse, national policies that would flow from such a board would ignore the significant differences in health care needs of the states and communities.

all of the providers in all states would be required to comply even if these policies were detrimental to the patients they serve. such a commission could not only threaten the ability of beneficiaries but of all americans to the access they need. that is very strong language but it is not my language. i ask for unanimous consent to enter into the record a letter offered by congressman neal from massachusetts and cosigned by 75 members of congress on a bipartisan basis including mr. mcgovern on this committee. it is clear to members on both sides of the aisle share my concern that this board threatens patient care, so why can't we agree to remove it on a bipartisan basis also? the american people deserve better than this proposal and i urge the committee to allow the consideration of this amendment on the house floor. i would like to have that submitted to the record. >> are there any questions? thank you. we appreciate you being here. mr. cassidy. >> thank you madam chair woman.

they i ask unanimous consent the statement from our colleague mr. walden be iluded in the record, just before we hear from mr. cassidy? >> i ask unanimous consent that the statement. [inaudible] >> without objection. >> thank you very much. my amendment addresses health savings accounts. health savings accounts, they work. a lower cost, they are patient-centered, they incentivize healthy spending. for example kaiser family foundation kind of a left of center thinking did a study and they found that a family of four the health savings account in the catastrophic policy on top, had costs 30% less than a family of four traditional insurance. they also found this family of four traditional with an hsa and

catastrophic policy just as frequently accessed preventive services as a family of four with a traditional insurance policy. now they also found that 27% of people, 27% of people who have an hsa with the catastrophic policy were previously uninsured. about 50% have family incomes of $50,000 or less so clearly by involving patients and their health care it lowers costs, expands access to high-quality care. it would be kind of a nice cornerstone for reform. that said, this bill does not explicitly exclude high deductible health plans but it does not specifically protect them either. frankly those people out there who we hear chanting trying to have their voices heard are afraid that there is mischief in this bill beyond what they can see there. so the fact that it leaves the door open if you will for removing access to the future i think is of concern. that said this amendment assures the 8 million that are currently

enrolled with a high deductible health plan an hsa will be allowed to keep their current plan by deeming those plans out of coverage. furthermore any standards adopted by the secretary, i will never again say deeming without smiling because it is become soaked totally different than we know. furthermore should not apply to high deductible health savings accounts if such standards would have the effect of disqualifying such plans for a meeting of the essential benefit package requirements. i think it also does one more thing. it just establishes that if americans are responsible, and most americans are, they have the freedom to decide what they will purchase with their dollars. health savings accounts which are basically a bank account, which if you don't spend rolls over and mr. hastings you will love it, insurance companies have no role other than to provide access to ppo pricing if you will. so the individual controls it, not the end of-- not the

insurance company, which is their power. it cuts out the administrative cost of insurance companies have been instead allows them a direct transaction between the consumer and the person providing the care. so again, i ask for this bill's approval. any questions? >> thank you very much madam chair. let me just say it is interesting that the last two witnesses we have as we prepared to close this hearing--. >> we have mrs. fox. >> the last two witnesses who said that they witness table and i assume ms. fox will stay here, and the idea you have come forward with this one that i have been proud to champion. introduced the first health savings account till 23 years ago. the other point that needs to be made is they are effective than the notion of expanding them is

what we should be focusing on. i appreciate the fact that the last two non-rules committee witnesses we had happened to be medical doctors and you are both making very thoughtful and interesting proposals that we should be considering and i thank you for that. >> i would say that speaking to a patient about hsa's he said a physician had written them a prescription for medicine. he says, this cost me $159 i have an hsa. he did not say 160, he said 159. the doctor said you have an hsa, tore it up and wrote them a generic over-the-counter for 20 bucks. the system saved them $139. when patients than their own money they lower costs and improve care. >> the only thing i want to say to you is the group outside, you indicated that they are trying to have their votes. i don't think they are trying. their voices are being heard.

i will tell you something else i don't think him i don't think very many of them have preexisting conditions with reference to their lung capacity. but in addition to that i don't think too many of them would be uninsured. otherwise they might meet themselves a little bit. >> if i may say there is a friend of mine who is a patient at home, who volunteered the scott brown campaign. she is uninsured and for herd is a question of freedom. she sees that her freedom is about to be usurped and i am so admiring of her. she would rather the principle of freedom be preserved. she would rather not trade her freedom for security. that's that there are some of those people out there who i think you'll find our uninsured. they just have a higher value. >> thank you very much. bill, i want to thank you for coming up here. a couple of points. first of all dr. john goodman who invented the medical savings account way back when, and i

served as his vice president for public policy at the center for national policy analysis. i also have-- i don't take the government insurance but do have an hsa that we try and manage our costs inside our family and it is my hope that hsa's will still survive despite as you said, don't know whether they would or not. but they are a great option for people. the best part about them, we could all argue, but i think is that they, it is pre-tax dollars where you are able to use your pre-tax dollars where if you don't work for a corporation or a member of a union, taxpayers generally do not have that opportunity. to receive that level playing field. so it is my hope we will find that hsa's will be amenable

under this boat we are going to make tomorrow. and i thank you for being here. i yield back. >> are there any further questions? thank you very much. >> thank you very much. >> thank you madam chair. i waited until last because i didn't want to inconvenience the other people who were offering amendments. there are several things that our constituents expressed to us. i want want broadness do anything to anything beyond my constituents, since there there are some sensitivity to that, but i hear all the time from people i talk to that they hate the fact that we don't read the bills. they particularly hate it when two bills that have no relevance to each other get put together

and get past because one bill can't get past on its own, and it gets attached to something called a must pass bill. i think spontaneously, my constituents hate that as much as anything and tell me that when they talk to me about it. so, my amendment is a fairly simple amendment. it would take out the part of the reconciliation bill that would do away with private loans , and i will give you some background on it. the direct loan program uses the federal government as a lender to provide capital for all loans as well as interest on subsidized loans. under the direct loan program the department of education serves as the lender and funds

come directly from the u.s. treasury. the direct loan program was created in 1993 and has captured only about 34% of the total market at its height, proving to be less efficient than the family education loan program. it was approximately 1700 institutions currently participating in the direct loan program, direct loans are made available $22 billion in student loans in 2009. the ffel program has been providing loans to students for more than 40 years with over 2000 lenders participating in the ffel program, serving approximately 4400 institutions, $70 billion in ffel loans have been available to students in 2009. the simple truth is that there are hidden costs with direct lending. in the direct loan program was created proponents believe taxpayers would ultimately save money if the federal government served as the lender to students

rather than going through private lenders who receive a subsidy to keep loan rights low for students. however over the years this has not been the case in the direct loan program has continuously lost money. numerous independent studies have concluded the direct loan program has not provided the promised savings and is actually paying out more in interest payments to the treasury than it has gotten back from borrowers. in addition, if the government takes in this program and does it all, and doesn't really allow for private business to issue these loans, then we are going to have to increase personnel costs, and these are not being considered in the cost of this bill. eighth 2004 gao report reevaluated the direct loan cash flow and found the program borrowed $137 billion from the treasury during fy1995 to 2003.

of this amount, $92 billion was outstanding as of september 20, 2003. in fy2003 with appropriations of $2.7 billion received, the total cash outlays of the direct loan program still exceeded the total inflows by $10.7 billion. h.r. 4072 includes a reconciliation provisions to alter federal student loan programs by eliminating the ffel program and shipping all student loans to a government-run and taxpayer financed system under the direct loan program. this provision known as the student aid and fiscal responsibility act, safra, kills jobs and greatly expands federal government controlled of the educational loan market by eliminating the ffel program. democrats will limit choices for parents and students seeking educational loans and decrease the quality of services historically provided by private lenders. moreover the provision i believe

has no place in this bill. i feel the same way my constituents do. we shouldn't be putting two bills together that are not related. that is why i have offered an amendment to strike the entire student aid fiscal responsibility act language from the amendment in h.r. 4872. just like in health care we need less government control and more personal freedom. i urge my colleagues to support my amendment. >> thank you this is foxx. are there any questions of ms. foxx? there are none. i see we have no further witnesses. that will close the hearing portion of h.r. 4872. reconciliation act of 2010. i thank you again for your patience, having been here for nearly 12 hours it seems like the thank you very much and the rules committee will be--. >> i have two articles i would

like to put into the record. >> without objection. t "wall street journal." >> thank you very much. we will be in recess subject to the call of the chair. [inaudible conversations] [inaudible conversations] [inaudible conversations]

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in their book, a day late and a dollar short high hopes and deferred dreams and obama's post-racial america to former bureau chief for "the washington post" examine the progress toward the goal of achieving a post-racial america. busboys and poets here in washington d.c. is the host of this hour and ten-minute event. >> by name is terry michael. and director of the washington center for politics and journalism, which is pleased to

co-sponsor this event tonight. i have the honor of having brought robert here to washington under the politics and journalism semester program. he was in the first inaugural class in the fall of 1989. we are now in our 22nd year with about 500 alumni, and robert actually represents all of our alumni and their operating board of directors. he joins judy woodruff, mike kerry and juan williams and a number of others who run, who i have to answer to, the board of directors of the center. robert came to our program from louisiana state university. he was a junior and he went back to school and edited the school paper, and then for a while he thought about getting a masters in business administration. at "the washington post" saved him from the fate of personal wealth by recruiting him as a reporter for the post and now he labors under