>> so where is this book available, and how are you doing here at cpac? >> we are giving away copies in order to get the grassroots word out. we are launching it here at the conference, and the book is available at whatwouldlincolnsay.com and amazon.com and when people buy the book 20% go to particular causes. >> what causes? >> we are going to support for the presidential nominee is for the republican party and targeting specific senate voting that we think is going and get a difference in the reelection. >> with other books have you written and what is your daily job? >> it is an interesting question because my wife and i were actually sales traders. that is what we do for a living and we decided to take a year off to get involved politically, and we thought what are our talents? what do we do? we train and speak and write. so we are taking this year off

to market this book to raise money and raise awareness. >> what would lincoln say is the name of the book. richard fenton is the author. ..

she's also a pastor said he had to heritage stab you find rita ricardo campbell award for her outstanding contribution to the analysis and the motion of a free society, particularly in her work on the asked shape debates. before joining harry t. she worked on the house side for representative representative jim demint as well as representatives do where you can also work in the senate earlier than that for senator jesse helme. please join me in welcoming my colleague commented nina poacher ringo. [applause] >> thank you two of you for being better than today. tuesday in a president obama. he mentioned his landmark legislative victory, the patient protection and affordable care and there's no wonder the americans continue to dislike a health care a lot more like it. it seems every day there's a new glitch or contradiction that services raising work out the

elaborate plan can actually work. further complicating matters for the administration is the decision by the supreme court to consider the law's constitutionality. but with a toothpick if b-bravo, it is still critically important that americans are reminded unless the supreme court strikes down the block in its entirety, there's still plenty to be concerned about. today we are going to hear from a distinguished panel of health care experts who will discuss why full repeal must remain a top priority and to help provide an alternative vision for what a response will health care reform proposal would look like. let me take a few minutes now to introduce them to you. first, sally pipes, president and ceo of the pacific research institute recently as the other two notable books that we have upfront on the health care loss. the truth about obamacare, published in 2010 in her newest book, the pipes play and come in

the top 10 ways to dismantle an replace upon. second we will hear from michael caine or come to senior fellow at the cato institute. an excellent review of the health care lot and bad medicine, a guide to the real cost and consequences of the new health care lot, newly updated and revised. finally, last but not least, we'll hear from grace marie turner, president of the galen institute following nachman of the health care lot alongside jim could print up with yet xm public policy center tom miller at the american enterprise institute and are truly thought moffatt at the heritage foundation for america. please welcome them to heritage today. we'll start off with sally.

>> thank you. i'm delighted to be here. with a historic vote to 2700 page patient protection and affordable care act was passed into law on march 23rd, 2010. how fast he yourself gone. it's almost the second anniversary. as nina mentioned, it was interesting to me that the state of the union, the president devoted only 44 words to health care reform. i think it has the two with the fact that only 53% of americans support repeal of this legislation. so i wrote my first book to promote it, care because the nancy pelosi said we have to pass the site to find out what time it, i thought i could write something into hundred 70 pages to stay within it. unfortunately it -- his roommate put. my new book, the pipes plan, top

10 ways to dismantle and replace upon the care is in response to the people criticizing the members of congress who support repeal. or you don't like the love for what is your plan? attaches to a 10-point plan giving members of congress and some ideas of what they should be for repeal and then replacing it, to have a positive agenda. i'd like to stay understand health recently to unraveling and onion. many layers and tearful moments. we all want to find affordable, accessible quality care for all americans. that is our goal. how do we achieve that goal? through two divisions, one which focuses on empowering doctors and patients, the other focus is on increasing the role of government in our health care through increased taxes, and mandates, subsidies and ultimately controls on insurance companies. rather obama gave 50 speeches on health care reform was passed and he started talking away

about health care reform that switched in august on nine to talk about health insurance reform. so, the president gave, as i said, 50 speeches, but also ultimately wants medicare for all. he really wants a single-payer canadian style health care system, which i grew up in in canada. so how do we achieve universal coverage and then the cost or down? the united states in 2010 spent 19.9% of gross demented product on health care. we demand the very best. americans are impatient and want everything right now. cannot that the country and from sprint 10.4% on health care in the global budget is set by government. of course canadians demand much more in health care so you get long waiting lists. the phrase where he worked until 1991 we started a publication called waiting your turn come a guide to hospital waiting list in canada last year the average

rating canada from a primary care doctor to treatment by a specialists with 19 weeks. that is almost five months and it is the longest time since the recording of wait time. so it is very, very important that obamacare be repealed and replaced with an agenda that brings about affordable, accessible quality care. the other point is that there's -- i believe the number of back tears are going to get out of the practice of medicine unless it is repealed. deloitte touche said 75% of that research said about obamacare and it will impact negatively on how they practice medicine. the other key point is that studies show 69% of the tourists feel that the best and brightest are not going to go into medicine and that is very discouraging for the future of our health. and my comments truth about upon

the kerry talk about a number of pillars about for team but we don't have time today. i'm going to talk about the replacing issues. the present abundant universal coverage into than the cost cost curve down. over the two main goals. we will not achieve universal coverage the cbo says the 29th team. .3 million americans will still be uninsured people at 16 to 18 million people to medicate them a program for low-income americans. if you look at the end of short number, 17 million are already eligible for medicaid and how to find out. the question is why can i believe it is because doctors get low reimbursement rates, lower treating medicaid patients on medicare in there for people turn up at emergency rooms because they can't care there. unbending the cost or down, the president wanted a bill that cost 900 billion over 10 years. he came in at 940 billion over 10 years. cbo says today is up to 1.5

trunnion and i believe as many of us here in this handle and the decade 2014 to 2020 for the cost of this legislation will be about $2.5 trillion, and maybe even more because the real cost writer is adding people medicaid, individual mandate, adding a 16,000 new irs agents, ending discrimination based on preexisting conditions and attending at the annual or lifetime caps are going to be huge cost or resent obama was politically astute and bringing in the cost writer after the 2012 election. the individual mandate i think is very -- is a very bad idea. the galen institute, benjamin rush society and patient care we are filing an amicus brief in the supreme court case on the individual mandate and it didn't have gone uncompensated cared and what that is going to do to the cost of care.

the corporal or three days of hearing starting march 26. we expect a decision at the end of june. the court considers a number of issues to individual mandate, it should severability, kansas state before it's too at the 1862 medicaid and of course the anti-injunction act. if this is a type, which i believe it is, how can -- can the government start counting attacks before it was actually introduced in 2014 if they won't build a cd impact until 2015 with people fire their tax return. but that is very committed very important issue in the unconstitutionality versus constitutionality. the real problem i see is that the court ruled that this mandate is constitutional, this will be the first time the federal government will have the power to tell us not oblivious to the health insurance in the

private market, but what will be the limit of the power? will we have to buy the car -- previous car? what will he be told we have to live on broccoli and have no meet? it is a very, very important case in the key to obamacare. many economists, may 77 clue to believe the legislation is not rebuilt and replaced and the president really wants a single-payer system, private insurers will be crowded out of the market because ultimately they will be a public option characters dirty talk about it in private insurers will not be able to compete showing private insurers already out of the market and insurance. so then we will all be left in a canadian style single-payer system where care is rationed. they face long reading the summary we lack of access in canada to the latest technology in treatment. where were the best doctors go? patients go? were we going to go? i believe the president, nancy

pelosi and harry reid have an ideological vision that government should be making decisions for us rather than ourselves making individuals about our lives are to be built and it's a very, very frightening scenario. on repeal come a few things could be done right now the 2.3% tax on medical devices in 2013 should be repealed or the independent payment advisory board should be repealed the number of democrats as well. so that's a very important part because that is going to control a lot of power seniors risk youth or medicare, health care under medicare and repealed the class act he or kathleen sebelius said we cannot make a class act, long-term care program sustainable because they're not moving forward at the gop will introduce a bill next week to repeal the class act and it is very, very important that it is repealed. i doubt that the senate will vote to repeal or whether the

president will veto. they did send a bill to end a 1099 reporting requirement, but i really hope the class that can be repealed. so how do we achieve universal coverage? these are the solutions in my book. i believe in 2012 we need a new congress, a new president and early in 2013 congress can repealed a patient protection and affordable care act and replace it with an agenda of the things i believe in. so what is the replaced agenda? first we need to empower.recent patients and we need to support health savings accounts. for that is one of the first. we need to change the federal tax code. the government got us into this mess in the first place during world war ii when price controls arantxa 60% of americans get health care through employer. we get it with pretax dollars. individuals abuse or shut up you have to buy health insurance with after-tax dollars. i would like to see them early on change the tax code so

individuals can get their health insurance with pretax dollars. i think people should buy their health insurance across state lines. why should a young man in new york and the state which has guaranteed issue community ratings have to spend $500 a month on health insurance when a young invincible like you today should buy the health insurance plan that suits his individual needs. we also need to get states to reduce the mandate, 2100 across the country. they are 20% to 50% to tincher. if i went to be sure protestation they should be able to get it. but why should mike tanner have to find insurance plan to subsidize what i want? if nina wants a health care plan to allow her to survive, all of this work on obamacare, she should be litigated, but i don't want to subsidize care. so getting the states to review

those mandates come in medical malpractice reform. i believe they should be a state issue, not a federal issue. the cost of medicine is about $210 billion a year according to price waterhouse coopers. we've seen in texas and 03 when they did not were reformed 16,008 doctors have gone back to texas. and it may have lacked gear, rick perry for governor of texas signed a law which luther paid, which is very, very important. the president said over and over again.thursday to many tests. they want to line their pockets at money. that is part is for the very reason that they are afraid of being sued. we also need to expand the access to health savings accounts. i believe the president doesn't like the savings accounts and doesn't want people to be in charge of health care, but that is where we see reduction in

premiums and particularly for younger people, each essay is the way to go. we need to deregulate the piece exchanges. a member states have returned the money and the number has got waivers. california was the first to take the money because everything that happens in california. we need to come as i say, support hsa's. we don't need government controlled state waste exchange is telling insurers what is going to be an essential benefit plan. we need to do medicare reform. we cannot continue entitlement programs, medicare, medicaid and social security as they have been going on. medicare will be bankrupt by 2024 for dummy changes. someone who set up in 1965 the average person live to age 65. today they live to age 80. so we need to raise the eligibility age. we need to mean septic. why should a person like warren buffett who of course pays less

tax than a secretary, why should someone like warren buffett deana government run program? that should be there for the seniors that really needed. surveys the eligibility age and vowed to arrive reduce premiums in medicare. then we can control costs. nancy pelosi said over and over if we do premiums, all of our seniors will be dying in the streets. seniors will be dying in the streets unless they make changes to the entitlement programs. and then medicaid we need to change the medicaid into block grants for the states and essays that this is an important part of the supreme court case on this power of the federal government to force state to expand the medicaid program. the question i ask him who do want to be in charge of their health care companies are more bureaucrat, government bureaucrat or to yourself? jenni williams, the premier of newfoundland part-time province that i went to the states of

miami to not sigh miami to mount sinai hospital to admit her surgery done because i couldn't get it in newfoundland and i was going to be on a long wait in ontario. he went to an off-site in a car paid out of pocket and had his surgery done. when he came back, they were furious because this is their signature issue. janie williams said, i headed down there because it is my hope, my heart and it's my choice. universal choice is the key to universal coverage. we are on the road to serfdom unless this legislation is repealed and replaced. repeal and replace that the only solution. as our dear friend p.j. or works as if you think health care is expensive now, just wait until it is free. thank you. hi mark

>> thank you all very much for coming out and thank you at the heritage foundation for having me here. for those of you stuck inside the beltway, first of all i am sorry, but i can't, you will now that the heritage foundation and the cato institute don't always see eye to eye when it comes to health care. in fact, it has to look us in a room together until we can come to some sort of terms. but one thing we absolutely agree on the net is that the patient protection act is an absolute disaster and needs to be repealed in its entirety. i will focus my remarks on one aspect of it and that is the cost. because even though the president only devoted 189 words of the state of the union address to the question at deficit and debt, i believe that that is truly the overriding issue of our time. after all, we are still barring

34 cents out of every dollar this country spends. we have a $15 trillion on the books that it does point and if you include the unfunded liability of social security and medicare are total exceeds $120 trillion. and not contacts, the cost of obamacare becomes crucial. and if you all remember of course there was a great moment just before obamacare past in which harry reid and nancy pelosi and the rest of the democratic leadership were nearly dislocating the shoulders because they are patting themselves on the back so hard because they said they'd cut the cost of the patient protection act down to $940 billion. it shows how long i've been stuck around washington because i remember when i had a $40 billion is a lot of money. now i realize it is the rounding error in the latest bailout.

but it really is a substantial amount of money. the problem is that the ink wasn't even dry on the bill before that night hundred 40 billion number recant to a rival. it seems, for example, if any if left out a few things. for example, there is the actual cost of implementing the bill with the congressional budget office estimates to be about 100 feet teen billion dollars. that is the cost of everything from hiring the new player irs agents to enforce the mandate to hiring people to oversee the exchange is to the insurance regulators, all of this will have a cost. but this is in washington ought to race but not appropriated funds and therefore doesn't have to be counted as the cost of the bill because it is not being spent yet. will be in the future, but they don't actually count it just yet. and then of course there was a little sleight-of-hand whereby

they assumed that medicare would be cut by 23% in order to help fund this. this was the notorious.fixed idea. in fairness i have to say to 23% cut is in current law, had been sentenced to death in wide and every year congress has the good days than not being particularly suicidal, they postponed that cut. but in order to get the cost onto 940 billion, it was assumed that in 2010, for the very first time that i would actually take place. and not to assume that anyone in washington is actually cynical, read the very first time that 26% would take place they introduced a separate bill to repeal the 23% cut. when asked about that, they said that solo separate bill.

okay, no cost and $50 billion, but that's over here. that's not part of our bill. you cannot count that as part of our cause. just think how much better your household budget would look if you could say your mortgage was a whole different cost and didn't have to count it. that's essentially what they were doing. so we didn't actually get the whole repeal of the 26% cut. we got the usual postponement of it already postponed twice and if you've been watching the dust off off the bill to cut the payroll tax, you know part of that is actually another year post element of the 23% cut. we can scratch that three and 50 billion savings as well. in addition to that, there is some double counting that went on in bookkeeping ways. the ways. the bill eisinger reduces medicare spending by $500 billion going forward in addition to the 23% cut that they think those days by reducing efficiencies by wiping

out the medicare advantage program and doing some things of that nature expect to save 500 billion. the use of 500 billion to extend the life of the medicare trust fund can simultaneously at the same 500 billion funds the cost of subsidies under obamacare. not even in washington to spend the same dollar twice is a problem. so maybe you cant of account data. they also count the social security tax is an fund subsidies under care. there is a number of these gimmicks built-in entities to cause these out and out all of the cost and together come you find the real cost of the bill is upwards of 2.5, $2.7 trillion the last $800 billion to the federal deficit over the first years of operation. now that probably understate the problem because since then we've learned a couple other teams. for example, included

$50 billion of revenue that came from a class act, the giant ponzi scheme that took the $50 billion competed out beyond the ten-year budget window so they could count the revenue but didn't have to count the pao. since it turns out the class act is not going to actually take place and be implemented or you can count the $50 billion in the worst insult i recollect it come to you that $50 billion in costs. finally if the cost of subsidies under the exchanges. when the bill is passed the estimated about 9 million americans would be put into these health care exchanges in the estate. the estimates now are in excess of 20 million americans will go in and even that probably underestimates because there will be an incentive on behalf of business to dump their employee into exchanges where it's cheaper because they didn't have to pay the two or $3000 penalty for not ensuring someone versus $7000 for paying for their insurance out of $10,000 for pain insurance.

the federal coverall subsidize them. you'd have to pay for the business and you're much better off simply paid the penalty of getting your workers out of there and you don't have all the hassle of having people come in and deal with the h.r. department plus you save the money. the more people to get dumped into the exchanges, the more subsidy the federal government will have to shell out. even if you go from the nine to 20 million americans, that will add $500 billion to the cost of this bill over and about 3 trillion or so that were dirty talking about. so we just keep piling more and more cost into this bill. we paid for with 600, $800 billion of taxes, $3 trillion in cost-plus if you notice there is a shortfall and that is the problem we've been dealing with on behalf of the whole federal government. frankly you could've summed up the entire state of the union address in two words. we are broke. we don't have a couple of

trillion dollars laying around to continue to pay for this very costly and wasteful and dangerous program. so i think if you leave aside all the bad impact on health care that we hear about the recent waiting times, we need to repeal simply the matter of fiscal sanity. thank you all very much. [applause] >> good afternoon, everyone. thank you for hosting us today in thank you particularly heritage for hosting this. 2012 is the year that counts. this is the year that's really going to determine not only the future of health care in america, but i really believe the future of our freedom because as the law stands, what on earth can congress not commandeer rest of the state to

do for the violation of constitutional principle. either we are going to turn our health set her into centralized system that is controlled by a few is bleeped policymakers that they are going to get to work fixing the very real problems that do exist in our health set their end putting in place policies that get the incentives right, that put doctors and patients in charge of medical decisions in a truly begin to reform medicare and medicaid, medicaid which i truly believe is the worst health care program in america and yet one that by the time this line is fully up and running but have 87 million people in this program. that is not an acceptable outcome and it still needs 23 million people uninsured. we got to fix this. when it makes its decision that

could range from throwing up a whole lot to letting the whole last stand for his son probably more likely complex range of decisions in between. i think probably the most optimistic and perhaps most realistic scenario is they declared the individual mandate of the constitution and set narrow frame. that is my hope it gets on wishful thinking but they leave the rest of standing. which is really going to be a big mess because people will -- people are really beginning to think that the press and then and all the time he talks that the fox and he just mentions 26 routes on parent's policies, insurance reforms, preventive care. they don't understand the massive complexity of this law. he never affords is the pulse of this chart.

but if the joint economic committee last year, trying to depict one third of this hall thought. 159 bureaucrats and commissions so the american people are necessarily can use about this law. the president when he and his secretary sebelius and others talk about this comment is just talk about the small provisions, not about the whole lotta and what is sweeping impact is going to be on the health care. the president really, we heard in a speech last night only 44 words is devoted to health care. the administration is adopting a strategy of silence after spending two years on most getting this out past. they stopped talking about it. not surprising because of the disney usually unpopular. the latest tracking poll just this morning from the kaiser family foundation said so it

remains as as ever that the majority of americans continue to impose an overwhelming majority object to the individual mandate. both because they believe it is an overreach of government power. but also because they think mandated insurance is too expensive already in a notice it is only going to get more than they are ready when the government is mandating that has to be about policy. the individual mandate is centerstage of course because of the march -- the upcoming supreme court arguments. but another finding from the kaiser points out this interesting and the majority, 55% believe parts of the health care that would be implemented even if the court strikes down down the individual mandate and three in 10 think the ruling against the mandate effectively will mean the end of the entire law.

so that really sort of feeds into the president trying to confuse things, to try to get people to think it is just the small 26 euros on their parent's policies. the preexisting condition pools, the free preventive care, eventually filling the dog on the medicare prescription drug benefit. after the 2010 elections, which really were a referendum on upon the care, the president was pretty belligerent and saying no, people really weren't -- it wasn't about obamacare. i just didn't explain it well enough. and insisted that allow only needed needed a bit of tweaking. but i think his democratic political advisers eventually got to him and say in his white house advisers eventually reached a really inescapable conclusion and i thought it was best put by democratic pollster

pat cavallo who said just after the election, the economy is important as it was, was not to defy that fracture in this election. it was health care. this health care that killed them, talking about the 63 democratic house members who lost their election. the american people found this to be a crime against democracy. they want it repealed and the issue will go on and on. with the american people wanted most from health reform was to get their costs down. so could there possibly be a more administrative law than the affordable care at? i think. mr. obama repeatedly has said during his campaign that health costs for the average family would go down by $2500 a year by the end of his first term.

the costs are rising faster than they have in a number of years. another kaiser family foundation survey found premiums for the average family policy increase by $1300 last year alone, three times faster than the year before. and this minimart mandates come from washington, the costs will continue to go higher and higher and gives him a bigger share of family budgets as well as employer pages. the $500 billion in new taxes, only some of which are in effect will certainly increase the cost of health insurance further. there is no most of pay for these bills but us. one way or another, whichever pocket they are taking it out of, we will pay the bill. a number of factors of course contribute to rising health care costs, that the mandate and that taxes in the regulations in this

to help are going to send costs soaring. the congressional budget office assumes that the average family policy will cost $20,000 a year by the time the law is fully up and running in 2016. and remember that policy is no longer going to be optional. it is mandatory for supreme court upholds this provision of the law. so $20,000 a year to purchase a health insurance policy that the government tells you you have to have. mckinsey and company assumes tens of millions of people is likely to just set it, i'm not buying this policy. the government has to sell new policy anyway. the government is a requiring tucson that policy anyway, so why should i buy a policy if i can buy what they need for the same premium i would have been

paid had i been by in a long period we see that in massachusetts with the individual mandate. so we may actually wind up with a worse problem of uninsured as americans follow the incentives. should i spend $695 for two and a son of man come over by a $20,000 health insurance policy? the same thing is true within employers as they begin to figure out the day can send their employees to the exchange and a laminate this causes simply pay the fine. former congressional budget office your policy can assumes 35 additional people wind up in the taxpayer subsidized exchanges and the results of the incentives to be dumped from their employer plans into exchanges and we can have a home of their conversation about exchanges. but they will be really very widely wind up in coverage that

will not collect different than medicate as today. at what we know is that medicaid pays doctors and hospitals so little and especially that they just can't afford to see patients come in very many medicaid patients in new york. some visit $7 for medicaid if they can't possibly pay their overhead for that. and yet, that is the program we expect people to go into. so the president wants us to think that it's just the small stuff, 26 euros, free preventive care. this whole synonymy is coming out of that it is if the president is being that did even if the individual mandate is start down, they're huge, huge consequences for our economy. i believe job creation will continue.

we always see cbs and alexandria where i live than they put in automatic checkout facility. but we reached out her going to vanish because employers simply cannot afford to pay the huge health insurance costs are even lower wage workers that they are replacing the type knowledge she come in the very jobs people need to get their foot on the ladder to get into the workforce that will be killed first by obamacare. imagine also when you have been lawyers and maybe tens of millions of americans deciding to violate the federal law as a matter of the family budget decision. what does that say about our civil society in america? what is that going to need for a country when tens of millions of

people and hundreds of thousands, maybe millions of businesses decide to violate federal law? i think that is really going to have a corrosive effect for our economy and for our ability to function as a civil society and this country. and one final thought. i was talking with a very wise member on the senate side, e-mailing back and forth over the weekend about the latest direct to from health and human services that catholic hospitals in catholic church is even catholic employers must provide preventive care that includes contraception, including drugs that produce abortion and sterilization as part of their health land. or they would be fined. and the president apparently called -- the president of the

u.s. council of catholic bishops before they announce that was made saying don't worry about it. were giving you a year to comply. and timothy dolan babysat after that, they're giving us a year to figure out how to violate our most fundamental conscience and principles? it's not going to work. so they put him at the very commit very difficult position of saying we are either going to violate federal law to pay the fine or pay later contract amended those are options solutions. that is an example i think of why it is not just the individual mandate before the supreme court. he is very unconstitutional. it's commandeering violating the 10th amendment and the first amendment as we said. but violation of religious

freedom. the mandate is upheld, but what if our constitution say about the ability of free citizens to govern ourselves, make her decision or whether or not the federal government is going to comment on the order our allies and confiscate their own personal property and tell us you have to spend $20,000 a year of your family budget, even if that is more than you pay for your mortgage or rent. in order to comply with federal law. that is why this law must not stand. if the court oppose it, that will be back at the ballot box in 2012 in the american people will have the final say on the spot. thank you all very much. that spin that wonderful.

i think all three of you for excellent remarks, reminding us again almost two years later the problems that we have this health care law. i just want to underscore another trend we see, which is this is just what we know today. there are still mounds and mounds of regulation and information that we will still have to wait to see. so i think that really underscores the danger of moving forward with this health care that because we even today are not clear as to what the final package will look like. we have time for questions, so please if you have a question producer hand and we'll bring your. one down here and one in the back. let's start down here. >> how to be possible to repeal this thing if you need 60 senators to do it in the most optimistic scenario?

>> has written a detailed post on this and not the hoover institution said that because much of the lot and involve spending, that you really own they will need 51 votes in the senate in order to repeal most of the major provisions michael particularly talks about. and you can't spend any money, then the rest of the earliest going to ask -- is going to crumble. so the maturity of the house remember that they passed a big piece of this to reconciliation in 2010 at order to get it through after scott brown was elected in massachusetts in the hot 59 votes in the senate. so a lot of it could be undone by the reconciliation and you might google key tennessee to look at this more detailed description of this. >> any other comments?

questions that bear. >> president obama has provisions of the health care a lot about the event in insurance on the coverage people bring to these conditions. he said he mentioned that insurance would be able to reach annually. >> the problems with debating the provision as it will be even worse than the current situation. the fact is it is expensive to insure people who are sick. i mean, the situation asleep been able to drive your car into a tree and then pick up the bonus they hate geico, now it's a good time for me to have that auto insurance. or wait until your arty sick and then become miniature. that's a very bad risk for insurers. now you can pass along and say insurers cantilever lace discriminate against you. what will they do?

off an awful lot of insurance offices on the 64 of a walk-up so that it's much harder for sick people to get a fair and come in and sign the paperwork, which they will do. the easiest thing is to just don't have -- should be.by cancer patients, for example, in your insurance plans come you don't sign up any oncologist in your network about truce. so basically if you've cancer you look at which your insurance policy to join them say what senate for the sun because i won't be able to get treated so have to go to this other one. so what shall start seeing is a rash from quality among insurers as they basically try to have a lot of health clubs that they'll be in verse two sign of healthy people and very few procedures to pay for people who are sick you do have her assertions come oncologist, people are sick. they change the nature of insurance run that increased the health healthy people.

but she wants to do is lower the cost of insurance for people young and healthy and moving the regulations and mandates and make it cheaper for people to sign-up for their young and healthy. and then allow them to stand up and throughout their lifetime if they get sick or the insurance companies built that in and it makes it a much more sensible market. >> but then, people introduce more regulation like insurance companies and their networks. >> sure, you can constantly chase the wheel so to speak good you can constantly try to cover the regulation, that people are always smarter and will find a way around it cannot just end up costing more and producing less care. >> i was just going to add under the affordable care active for $5 billion to help those people with preexisting conditions if they've been out of work without insurance for six months or

more. richard proctor said 5 billion will be gone by 2012. this is between 2011 and 2014. what is said the administration said 400,000 people would be moving in to the insurance in the high-risk pool were only 41 dozen people have actually signed up for the insurance in the state tires will come which makes one wonder how many people they really are with preexisting conditions. but even those of you have signed up on the five states have gone back same there's not enough money here for us to make the high-risk will work, so they asked for money from the fed. it shows the example that this will cause so much more than the administration and cbo has ever said. >> i should say also one of the reasons the states are spending more is because when the premiums were set at the legal level according to how the law was written, few people are buying the insurance because it is so expensive soup hs cut the

cost of the insurance of the insurance is less expensive and therefore they ran out of money even faster. so the government just as understand how to make her covert. washington does things through direct has since been enjoying my money and it's just not cannot work in one sixth of our economy. >> a question that area. >> isn't the insurance for $3000 this phrase universal lack of, what do you think the optional care is so you encourage the states -- [inaudible] and finally, rounding in massachusetts is totally

incorrect. adding a lack [inaudible] [inaudible] >> just real quick on the whole idea of universal coverage. i think it is a mistake that

focuses on the number of people with insurance as opposed to a healthier population. we tend to conflate the idea of help with health care with health insurance in the three things are entirely different. but the goal at the end if it is a healthier population. one way to do that is too health care seeing doctors and hospitals and so on. one way to pay for seeing doctors and hospitals and so when mr. health insurance but not the only way. in terms of your bang for your buck, this study repeatedly shows that buying insurance for someone is not the biggest bang for your buck in terms of health at the down and peered he might be much better off using that to expand access that there is a community health clinics or things of that nature or you might be better off putting their money in something that has nothing to do a scene adapted from what to do do with how promoting healthy lifestyles, getting people to eat better or work out more or things like that that is much better impact at the bottom end.

so we shouldn't necessarily judge the best of the health care plan that whether or not it gets a whole bunch people with coverage. having a piece of paper in your hand and saying this is health insurance isn't a guarantee that you'll see a doctor. everett has universal coverage. and simply seeing a doctor doesn't necessarily make you healthier if you can go out and stop exercising any too much adult father that his advice they won't do you any good. so the three should not be completed. >> i was just going to say the administration is saying 2.5 million kids are on their parents health care plan until the age of 26, so this is a huge success. the kaiser family foundation shows the average family premium master with $2000 up 9% the previous year was only a 3%. at the 2.5 million children up to the age of 26, how many of them had individual plans before were covered and decided it was

cheaper to leave that go join their parents plan. that is something you want to look into because there could be a lot of share from a type of insurance to another. >> i think we are fortunate enough to have former congressman john shadegg even though he is behind a pole so i can't see them, so i hope that you. [inaudible] [inaudible] i have two questions. one is, how could we make obamacare an important and critical issue in the 2012 election because i do think that the referendum in the 2010 election and second, should the congress, specifically the house

be repealing some of the features are outrageously expensive addictions in the senate so we can remind you what. but how about the policy is and how much damage it will do. >> what we most need is your continuing leadership. you would be leading the charge is to make sure it stays a key issue in 2012. fortunately, the house is actually going to be taken at the repeal of the class act, and long-term care provision that democratic numbers have caught a ponzi scheme of the first-order. they are going to be taken up next week. i believe they have the independent payment advisory board, rationing board and medicare up for debate. they are certainly going to be attention to the employer mandate and its focus on killing jobs. so i think that is right.

i think they need to continue to keep the focus on this blog and shine a light on it, one issue after another so the american people to understand that if it is so much more than those half a dozen things that presidents going to talk about and it really is this monstrously complex plot future leadership is getting us to understanding how we can reform how 35 and the right way has just crucially important and i'm glad you're continuing to be dealing with the heritage foundation to keep your voice down upon the domain. we need your wisdom. >> i would say part of the problem as let's face it, congress has the attention of them not. they promised the first vote they would take would be a repeal. they took and passed, died in the senate like everything has

been said well come with the folder replication. let's move on to beijing be another crucial issue. dating post office is whatever. and it didn't come out today. i was out of date they will find they have -- they were directed to come up with a replacement plan salad today do have a replacement plan they will announce sometime after these precourt rules on the legislation as a whole. so they don't seem to be in any rash to get out and do this. and i think it's pretty because the pressure has been off of the american people. people got cynical. we all want to repeal it. 52% in the latest full text let's repeal it as the bottom 15 in almost all of the polls say that they walk repeal. that hasn't changed but it still has not been any more popular no matter how many times it's been explained to people. but assuming everything fair-minded people are on call in congress and they aren't

asking for it to be repealed anymore and frankly congressman got a phone call tonight before. they move on. >> well, i think it's very import as radio shows. they've got to get the american people to engage. they were engaged in the election that we've got to get this back up. norman coleman, former senator from minnesota just yesterday who was an adviser to mitt romney said well, the gop is not going to repeal the spirit octobers is coming from? is an inadequate help romney's campaign. we've got to keep up the pressure for what it is so important because if mr. obama is reelected in 2012, he will continue to veto a repeal of those like what happens at the senate last year. it is just so very important that we do that because in canada in 1974 we still have a single-payer system.

by 2014, it will be impossible to get rid of the government program. you can never get rid of government programs in place. we've got to do it now. i want >> i want to underscore that is so important as a court case because of the topic of the news that today is the case gets closer that we also don't forget to put all their eggs in the basket will solve the problem. we must be vigilant that we can't just depend on the court. we have to depend on congress to do their job to do their job completely and fully in continuing to grow to full repeal. next question. >> my name is chris. i'd like to take my scalpel to this whole problem and i'd like to just cut it. first comment for everybody. the system could prospectively come into the impact is in or

try the declining reimbursement electronic medical records could have another colossally damaging effect on the system. mostly as shortages that most of you know there is now a very alarming shortage of oncologic drugs. and we see shortages of immunizations. vichy shortages in the system of nursing care and we see this every day in our lives. i question if there is a layering of them. i would have been if the following to place. an insurance company missing scranton pennsylvania and sells insurance without any mandates i'll? pennsylvania has 63 medex. these are the governor mandates a delegate type without. what happens then? is a very low cost insurance that is very high quality and very high coverage is actually

evades people an incredible way. what happens after that quick >> illegal under pennsylvania law. they would not receive a license to kill and therefore their entire business at tv would be illegal. >> of the law in pennsylvania where to play chords? it is essentially is the insurance commissioner to license and you're not allowed to sell insurance. >> if it goes into effect, will we have yet another two-tiered health health care system for the haves and the have-nots? ..

so the pharmaceutical companies have to go through so many hoops to get their drugs approved at some point they either have few drugs or they just can't do that anymore. health insurance receive them. i have a paper on the web site on the cause of the radical restructuring of health care that talks about insurance companies leaving still because they can no longer figure out how they can comply with all

rules and regulations and make up the market in health insurance, and doctors, 40% of doctors thinking of leaving practice when the law is in the effect of 2014 the infrastructure of the health system is declined come and get some people are going to be able to buy their way up and people will go to canada or offshore hospitals end up being freed. but the quality of health care in america will decline for everyone and people will not be able to -- if the drug is not created, there is no way you can get that job. >> i have a different perspective. i think the bill was going to be fine for the wall. it's going to be fine for speed and insurance. they spend $150 million, they should put the white house and met with president and came out with all sorts of agreements to spend money and campaigning for

the bill because they know that now every insurance plan in america has to cover their prescription drugs. there's going to be new expansions and medicare. they will have brand name drugs covered under the bill not whole going through the generics so they came out ahead. the drop the public auction and got a mandate people have to buy their product it's a $70 billion in year bailout. now the small and medium insurance companies can't comply and will go out of business but that is great for the insurance companies who will control the last little bit of the market. they lobbied in favor of the bill because the thing that's the end of the doctors are going to get special treatment under this and put in and things like that so i think this is a great bill for business and it's just the little guys that are going to get stuff done in terms of all of this petraeus and again

this amazing the american medical association only represents about 17% doctors is the man on the street thinks the ama represents every single doctor. my worry as i said in my talk is that private insurers will be crowded out and a lot say to me we are just going to do our private practice and we will be fine but if you look at canada when they took over and the provinces and the federal government took over the health care system the outlawed any private medicine, any private payment so i think we have to be very aware that this could be m ultimate consequence of the affordable care acted that isn't repealed and replaced. private medicine can be of law and we will be in the medicare for all system. >> better get the frequent fliers miles right. >> is this popular as i believe it is, too why is it the three top contenders are each in their own way for some form of

obamacare and apart from this question or practically what can we do as voters come november in the presidential election? >> last night new gingrich said he wanted to make the moon of the 51st state so i'm thinking of moving there. [laughter] you know, it really boggles my mind coming and we talk about why are we not doing more to repeal it, the leading presidential candidates in the republican side right now supported an individual mandate that the federal level and at the state level. they both support exchanges. they both support a lot of the insurance regulation going on in the community rating and a guaranteed issue provisions there's really not much of a dime's worth of difference. they both supported the prescription drug benefit

extension 17 trillion-dollar medicare part d both of them were in favor of that. so it is hard to draw a contrast and it's going to be much more important at the congressional level over the congressional intent candidates and where they stand on this because they are all giving lip service to the repeal. i don't see either of them leading the fight if it comes all of congress, so that's where the fight is going to have to be. >> that's right. congress will have to wait on this and if the bill shows up on the president's desk to repeal as much as they can for the reconciliation necessary in the senate all you need is the presidential assignment because i think that it's -- mitt romney says he will repeal and the first thing he wants to do but then he says well, we have to repeal and replace and i am glad i shown what i would replace it

with. that's not cutting it and it's interesting. all three of us are being critics of romney care and probably he isn't going to ask any of us to be the secretary of hhs, but i just can't understand why he will not say i thought it was a good eight dever massachusetts. we have the evidence and it's not good, so i made a mistake and therefore -- but he won't do that so that is what he said it's very frightening. what i'm going to do is buy the crash off of the coast and set up my liberty ship and we can all get our health care on the liberty ship. >> i would also like to underscore what was said this is why it is so critical that congress gets it right this summer. it will set an important tone on where the future of the health care system should go if the health care law can get repealed. and i will say also that it should be a cohesive plan and not just the kind of the

alphabet soup plan of everyone's idea that makes no sense. we need to be able to explain to the american people as has been done in this book and in saving the american dream and everyone else has their own ideas on what to do but they all fit together in an important they come and i think that is another important feature moving ahead as this debate continues. do we have anymore questions? we are bumping up on our time. >> to the congressman's point that i have a great respect for on the house side with retailing the entire foley and there is a battle and more conservative members in the republican caucus that are for the albright repeal so how we move away from if we repeal portions of all and the tax and everything else, the horrible portions of it, how do we move to where we are not making a data law better?

>> there's a huge amount of discussion on exactly that point to a few repeal it will you improve it? that is such a misunderstanding of how truly monstrous this is. they could pass the bill every week between now and november whatever the election date is and they were only on the margin be able to make this law better and it still wouldn't pass the senate so they have to continue to keep up the drum beat as the educated the american people about what really is in this law. they had a huge part of all that they just put in an order to be able to pretend that it was a deficit reduction flaw and it's just outrageous. shine a light on that and then talk about the independent payment advisory board, then you talk about the employer mandate and its job killing. they just need to keep up the

drumbeat and there are some members i think this sort of begun to realize the need to have handles to explain to people what is in kill all or they are going to believe the president is right when he says don't worry that this it was just a bunch of the small stuff. what was the fuss about? all we are doing is putting 26-year-olds on their parents' policy. the only way they will understand is of the congress continues to say here is what is and the law. $575 billion in the new taxes and half a trillion dollars of cuts to medicare, the unbelievable expansion of medicaid is going to bankrupt the state and mandates on businesses, the mandates on individuals. all of those. part of wall that shouldn't stand. >> we will try to take one more question if we have it. okay, one more in the back if you could wait for the

microphone, thanks. >> with the loss ratio there has been talk about the impact it will have on health savings accounts. it doesn't appear that they are telling these plans right now. can you talk about what kind of time frame are we looking at and perhaps address that? >> we don't know for certain yet what the impact will be on the health savings accounts because the rules haven't been written about about what is going to count in terms of the medical loss ratio. a lot of it depends on how the employees' contributions are treated and how or the individual payments done and in what way will all of these counts to the minimum that is in this? we know some better setup now probably will feel under any structure. some may qualify in a lot remains to be seen how those rules going to affect.

i believe we are talking not until 2014 until i would think they would go into place, so that's when the impact would be. i suspect for the election there will be a lot of talk about how lenient these rules will be because you don't want to frighten anybody and then after the elections they will appear to be very tight because we know the president doesn't support the health savings and he believes they are wrongheaded and he's talked about that as saying he thinks that they are a myth people would consume health care so he thinks this is a wrong approach and isn't going to be very sympathetic to them. >> the concern with the medical loss ratios, the federal government is telling health insurance what percentage of the premium has to spend four actual medical care versus administrative costs. the problem with health savings accounts is that the insurance itself doesn't trigger until people reach their deductible

which is higher and which is why the insurance is cheaper. yet the insurance company has to keep track and has to know that you have reached the deductible so therefore they have to do all of the administrative costs making sure of really to giving out the $50 million the doctor said you spend $100 on your man over here and so they know how to get to that point. so even though they are spending less out of the medical care, they still have to do the administrative cost to figure out if someone has reached the deductible. and that is what -- they are just telling them if they want to put in the small we are going to get rid of the health savings accounts i think you actually did have a hard time passing it because the democrats see that these are valuable. so what they are doing is they are killing them and the strangling them through regulation by saying here is this really narrow the restrictive rule and they are not going to be able to comply

with it and therefore they wouldn't be the legal policy but that is the other example. that is just the specific one to show why i think they are really on the chopping block but its way out in the back. >> and about 12 million americans have an hsa and they are very popular particularly among the younger population that want insurance to be there for insurance purposes catastrophes. but as michael said, the president doesn't like them, and a few small companies that only offer the hsa have already gone out of business and so that is a precursor and then if you look at flexible savings accounts that we were able to pull off the $5,000 this year its 2500, so we are seeing the end of that so i think the writing is on wall for the fact this isn't something that's part of the agenda on the president or the hsa. >> the way the rule, what comes into the question has said is

part of it is paid first out of the health savings. well, if that doesn't count as a pay off against the premium, then you get into the problem with insurance companies are turning up the cost and not making a payout and they are going to be in the violation of the rule. now, so if that is counted as being paid out against the premium it might qualify then you have the other problem about the contribution that the employer made to the health savings account, does that count as a premium cost? in which case you pay the premium more expensive and the payout may not qualify meeting the minimum loss ratio or not so that is why they are going to be important for how they play out. >> they basically said that if a person pays for medical care as their health savings account that doesn't count. it only shots to the accounts that the insurance company pays for it that they have to calculate how much the individual was paying in medical expenses. and part of the administrative

cost, so it's really way of rather doing it more explicitly. >> and they've already said you cannot use your hsa account for over-the-counter meds and so what does this mean? people go to the drug store and get an over-the-counter mehdi and now if the one that they have to go to the doctor come get a prescription and this ads to the cost of health care. >> now you don't need the generic drugs to get a over-the-counter you get a prescription for the brand name drugs you can buy that with your hsa. >> i would like to end it by saying what we said at the heritage foundation details matter and the more the american people know the details i think the less that they will like it. so thank everyone for the panel. we do have books available when you come out, so please feel free to pick one but let's think the panel one more time.

now joining on book tv is richard brank director of education for the studies institute. first of all, what is speed? >> we are a nonprofit educational foundation around since the 60's. philip buckley was our first president and our mission is to educate for liberty by going out to college students all across the country providing them the intellectual foundation for their conservatism. >> you also publish books and i would like to look at some of those. let's begin with this one edited by lee edwards, reading the right books to read the guide for the intelligent conservative. >> he is a scholar at the heritage foundation, and what he has done is a huge public service a lot of public kids today are conservative and they don't know why they are

conservative, he gives you a little 100 page unaudited bibliography that says to be a smart conservative, not just a talk radio conservative, you need to read these books like road to serfdom by frederick hayek, ideas have consequences, the conservative mind by russell just to name a few. >> matthew spaulding has a new book out. what is this book? >> it's called we still hold these truths and we are excited about this book because not only is it an important primer on the founding principles of the nation, cpac has actually adopted this as a theme for the conference this year. we still hold these truths. what are these truths that we hold to be self-evident, life, liberty, the pursuit of happiness, it's about preserving the american experience. >> who is matthew spaulding? stan mckee is a senior scholar at the heritage foundation, and his job is to link the internal principles of current public policy debates. >> how do you publish books at

isi? >> just like any other publisher, we are looking around for the end of the conservative movement. so, you know, people will send us proposals. we've been publishing for about 20 years comes for example, one of our big books is rick santorum's book "it takes a family" and he's a horse caught fire in the primary but he was a senator from pennsylvania he wanted to put forth additional conservatism. that wasn't just about economics but it was about how to make economics work for families. >> one more book i want to ask about and that is the closing of the muslim mind. islamic this is a very important book. he just spoke on the topic at georgetown university two nights ago, and this is letting -- everyone talks about coming in a, what the conflict is between the west and islam but people really don't know what are the fundamentals, so his argument is that there w a