said, today in 2005, uprighted suffers more grief for losing a rifle and a general suffers for losing a war, and it's really true. in general is very hard. it should be expected that many people fail at it. that command is famously hard. the military has a tradition of firing generals and there wasn't any shame minute. the military has completely lost the tradition. generals essentially are only fired by the president for political reasons now. tom wants to understand what happened to this culture, and show he follows these generals, following the genealogy and looking at what is to be a general and why is it that -- what is going to -- i can't read the whole but for you, but

basically, this is exactly the book we need. we need is an institution to ask ourselves these questions about how we all the leaders accountable. this is the book about how organizations need to hold themselves accountable for their performance or else they stop becoming effective. it's a book about the american military. all sorts of wonderful ramifications. an organization that needs to improve or die. >> and we have been talking with scott moyers who is publisher of penguin press, some of the upcoming titles. >> up next, author sally pipes argues against president, software initiative and presents her own plan to restructure the american health care system. this is about an hour 15 minutes.

>> good afternoon. token to the heritage foundation . new book and everyone he joins us on the website. we would ask everyone here in house, if you will make the last courtesy check the cell phones have been turned off as they prepare to begin the program. it will post this event within 24 hours on our website for everyone's future reference. hosting our discussion today, director of our center for health policy studies. also a past recipient of the heritage w lennon and recurrent award for her outstanding contribution to the analysis and promotion the free society, to kill in her work on the as-shipped debates. before joining heritage she served on capitol hill working on the house side for then representative jim demint as well as representative wire rack. she also worked in the senate.

[applause] >> obama thank you. thank -- pinkston all of you for being here tonight. president obama mentioned his land park legislation. they're is no wonder that the americans continue to at this like the health care law what now like it. it seems everywhere there is a new bridge or contradiction the surfaces more doubt that the solyndra plan connection work. further complicating matters is that decision by the supreme court to consider the loss constitutionality. while we wait to see the case on route all, it is still critically important that americans are reminded that unless the supreme court strikes down along in its entirety there's still plenty to be concerned about. there are going to hear from a distinguished panel of health care experts and provide an

alternative vision for a responsible health care reform proposal would like. let me take a few minutes to introduce them. first, sally pipes, president and ceo of pacific research institute, the author to notable books on the health care law. the truth about obamacare which was published in 2010, and turn newest book, the pipes plan. the top ten ways to dismantle and replace obamacare. second, we will hear from michael tanner, a senior fellow at the kennedy institute. and an excellent review of the health care law and bad medicine, a guide to the real costs and consequences of the new health care law which has been newly updated and revised. finally, last but not least we will hear from greece mary turner, president of the galen institute. following the enactment of the health care law and tom miller

at the american and apprise institute and cars charlie, bob moffett of the heritage foundation charge together to publish the book why obamacare is wrong for america. [applause] will start off this -- with sally. >> well, thank you. and delighted to be here with my friends. cahuenga 2700 page patient protection and affordable characters passed into law on march 23rd 2010. how fast two years have gone. almost the second anniversary. as nina mentioned, it was interesting to me that the state of the union on tuesday evening the president devoted only 44 words to health care reform. at the contest to do with the fact that they now also said

that only about 53% of americans support repeal of this legislation. so i wrote my first book, the truth about obamacare, because when nancy pelosi said we have to pass this law to find what senate, republican read something into hundred and 70 pages to actually find out what is in it. unfortunately she is heard my buck. my new book, the top ten ways to dismantle and replace obamacare was in response to the people there was criticizing the members of congress who support repeal. you don't like the law what is your plan. i thought i would to of ten. plan giving staffers ideas. i would like to say of extending health care is similar to unravelling in onion, many layers and many tearful moments. we all want to find affordable accessible, quality care for all

americans. that is our goal. there are two visions, one focuses on an powering doctors and patients and the other focuses on increasing the role of government in our health care taxes commanded, subsidies command ultimately controls on insurance companies. obamacare 58 speeches on health care as other talking early but switched in august to talk about health insurance reform. so the president gave 58 speeches but ultimately wants medicare for all. at think he really wants a single-payer canadian-style health care system, which i grew up in canada. how do we achieve universal coverage? the united states in 2010 spent 17% of gross domestic product on health care.

it's a lot, but we demand the very best. patient. the one everything right now. canada, the country and prompt spends about 10% of gdp on health care. of course canadians demand much more in health care, so you get long waiting lists. the fraser institute, where worked until 1991, we started a publication called waiting your turn, attacked a hospital waiting lists in canada. last year the average wage in canada from seeing a primary-care doctor to getting treatment by specialist was 19 weeks. that's almost five months, and is the longest time since the reporting. it's very, very important that obamacare be repealed and replaced with an agenda that brings about affordable and accessible quality care. the o the point is that doctors, i believe that a number of doctors, a lot of doctors are going to get out of the practice and was this law is repealed.

about 70 percent of doctors are upset about obamacare, and it's going to impact negatively on how they practice medicine. the other key pnt is, the study shows that 69 percent of doctors steel -- feel that the best of the protestant not going to go into medicine, and that is very discouraging for the future health. in my book i talk about an and propellers, about 14. we don't have time today. universal coverage and to bend the cost curve down. we're not trying to achieve universal coverage. 23 million americans will still be uninsured. all at 16 to 18 million people to medicate. if elected the and a chart number, 79 of them are already

eligible for up medicated s shipment haven't signed up. i believe it's because doctors are very low reimbursement rates, even lower treating medicaid and medicare. there for these people turn up at emergency rooms because they carry there. in the cost curve down, president of the bill that costs 900 billion. kim in a 940. this cbs's today it's already up to one-half trillion, and the police as many of us on this panel, the cost of this legislation will be about two and a half trillion, maybe even more because of them caused tremors -- cost drivers, those are going to be huge cost strivers.

a moment to talk about most politically astute in bringing in the cost drivers after the 2012 election. individual mandate i think is very bad idea. again and institute, or filing an amicus brief in the supreme court case on the individual mandate and its impact on uncompensated care and what that's going to do to the cost of care. the corps will have three days of hearings starting march 26. we expect a decision at the end of june. the court is considering a number of issues, the individual mandate, the issue of several ability, can the states be forced add all these 18 million people and, of course, the anti intention act. if this is attack, which i believe it is, how can the court -- can the government start counting the tax before it

actually is introduced? to the will be -- because they will appeal to see the impact until 2015 when people file their tax returns. so it is a very, very important issue, the individual mandate in the end constitutionality versus constitutionality. the real problem is, if the court rules that this mandate is constitutional is a big first time that the federal government will have the power to tell us not only do we have to buy health insurance, but will be the limit of that power. will we be told that we have to live on broccoli and have no meat? summit to very, very important case and a key to obamacare. many economists, myself included, believe that if this legislation is not repealed and replaced -- and the president really wants a single-payer system -- private insurers will be crowded out of the market is ultimately it will be a public auction.

some private insurers will not be able to compete. and agree steady showing private insurers are already out of the market in insurance. we will all be left in a canadian-style single-payer system where care is rationed, we face long waiting lists and have a lack of access to the bill is technology and treatment. canadians have in a standoff, where we going to go? and believe the president, nancy pelosi, and harry reid have an ideological position that government should be making decisions for us other than ourselves making individual decisions about our lives are to be built. it's a very frightening scenario on repeal i think a few things to be done right now. it over to percent tax on medical devices, the independent payment advisory board should be repealed. a number of democrats alike as well. that's a very important part because that's point to control

a lot of our seniors receive their medicare, health care. repeal a class act. casting sibelius' said, we cannot make the class act sustainable. they're not moving forward, but the gop will introduce a bill next week to repeal that class act. it is very important that it is repealed. don't know if the senate will vote to repeal or whether the president will veto. he did sign the bill to end the 1099 reporting requirement, but i hope the class act can be repealed. how do we achieve universal coverage? and these are the solutions. i believe that in 2012 when need a new congress, new president, and early in 2013 congress can repeal the patient protection and affordable character replace it with an agenda and the things that i is a hint. so what is there places and the? and our doctors and patients.

support held savings accounts. that's one of the first. change the federal tax cut. the government that has into this mess in the first place. 60 percent of americans get their health care through their employer. we did it with pretax dollars. individuals, if you lose your job you have to buy your health insurance with after-tax dollars . the public to see them early on change the tax code so that individuals can get to health insurance with pretax dollars. in people's in the will to buy their health insurance accosted lines. why should a young man in new york, stay with guaranteed issue community rating, have to spend $500 a month on health insurance and he's a young invincible like a lot of year today he should be able to buy health insurance plan that suits his individual needs. melson need to get states to reduce the state mandates, about 2100. me at 20% to the cost of

insurance. if i want to buy health insurance that has in vitro fertilization and should be altered, but why should mike tanner have to buy an insurance plan to subsidize. if nina wants a health care plan that covers alcohol rehabilitation that allows her to survive all of this work on obamacare, she should be able to get it, but i don't want to subsidize our. [laughter] getting the state to reduce the mandate, medical malpractice reform. amelie there should be a state issue, not a federal issue. the cost of medical malpractice, the cost of defensive medicine is about 210 billion per year according to price waterhouse coopers. we have seen in texas when they did men now reform, 16,000 doctors have gone back to texas. rates have gone down, and and many of last year rick perry, the governor signed a law, the

loser pays, which is very important. the president says a car and over again, doctors to to many tests. well, the practice defensive medicine from the very reason that they are free to being sued. we also need to expand the access to help savings accounts. believe the president does not like of savings accounts. but that's where readers can reduction in premiums and particularly for younger people i think we need to deregulate the state based exchanges. a number of states have returned the money. a number of gun waivers. of course california was the first to actually take the money because everything liberal happens in california, but we need to, as i say, support a to say. we don't need government controls state based exchanges telling insurers what's going to be an essential benefit plan. we need to do medicare reform. we cannot continue with these

entitlement programs, medicare, medicaid, social security, as they have been going on. medicare will be bankrupt by 2024 if we don't make changes. when it was set up in 1965, the average person left to age 65. today they live to age 80. and so we need to raise the eligibility age. we need to means tested. why should a person like warren buffett apace less tax than the secretary, why should someone like warren buffett beyond a government-run program? medicare should be there fencing is the really needed. raise the eligibility age and the premium support. then we can control costs. if we do premium support all of our seniors will be dying in the street. seniors will be dying in the streets unless we make changes to these entitlement programs. and in medicaid, we need to do

-- the need to change to medicaid, the block grants and this is an important part of the supreme court case on the power of the federal demint to force states to expand them a ticket per ramps. the question i ask, who do you want to be in charge of your health care? hmo bureaucrat, a government aircraft or you? the premier of newfoundland and canada said i went to the state, mount sinai hospital to get my surgery done. i was going to be along with an ontario. he went to mount sinai, paid out of pocket and had his surgery done. when he came back the canadian media was furious because this is their signature issue, singer pair health care. danny williams said, had it down there because it's my health, my heart, and 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 of replace is the only solution. as our dear friend says, if you think health care is expensive now, wait until it's free. thank you. [applause] >> thank you very much for coming out. thank you to the heritage foundation for having me here. for those who are stuck inside the beltway, first of all, i'm sorry. second, you will know that the heritage foundation and the cato institute don't always see eye to eye when it comes to health care. in fact, grace murray often has the lock us in a room together until we can come to some sort of terms. but one thing we absolutely agree on, and that is that the patient protection act is an

absolute disaster be repealed in its entirety. and going to focus my remarks on just one aspect of it. even though the president on the devoted 189 words of his state of the union address to the question of deficits and debt, i believe that is truly the overriding issue of our time. after all, we're still borrowing $0.34 a very delicate this country spends. in about $15 trillion on the books debt at this point, and if you include the unfunded liabilities, social security, and medicare are total indebtedness exceeds $120 trillion. on that context the cost becomes crucial. and if you all remember, of course, there was that great moment just before obamacare past in which harry reid and

nancy pelosi and the rest of the democratic came out on the steps of the capitol and really dislocating their shoulders patting themselves on the back so hard because they send it down the cost of the patient protection act down to just $940 billion i remember when 940 billion was actually a lot of money. now realize it's a rounding error in the latest bailout. but it really is a substantial amount of money. thank wasn't even dry on the bill before that 940 billion number began to unravel. that may have left out a few things. there is that cost of implementing the bill. but the congressional budget office estimated $115 billion. thus the cost of everything from hing of the new irs agents are

going to have to enforce the individual mandate to hiring people to oversee the exchanges, the new insurance regulators, all of this is going to have a cost. this is in washington window, authorized but not appropriated and therefore it does not have to be counted as a cost because is not actually being spent yet. it will be in the future, but they don't actually counted. and then, of course, there was the slight of hand or by a dissident that medicare would be cut by 23 percent in order to help fund. this was the notorious doc fix program. in fairness that cut was actually in current law and had been since 2001. and every year congress has looked at this and not being particularly suicidal they postponed that cut, but in order to get the cost down to

940 billion, it was assumed that in 2010 for the very first time that connection to take place. not to assume that anyone in washington is actually cynical, but the very same time they are assuming that 23 percent cut will take place, and introducing a separate bill to repeal a. when asked about that, they said zero, no, that's a whole separate bill. you can't count that as part of our cost. in know, just think how much better your household budget would look if he could say your mortgage as a whole different cost. that essentially what they're doing. region actually did the repeal. we get the usual postponement of the. it has been postponed twice. if he had been watching that dustup over the bill tucked up the payroll tax, you know the part of that is actually another

year postponement of the 23 percent cut. so we can sort of scratch that $350 billion savings as well. in addition to that there was some double counting that went on. famous washington bookkeeping. the bill, as you know, reduces medicare spending by 500 billion going forward in addition to the 23 percent cut. wiping out the medicare advantage program and by doing some things of that nature they expect to save 500 billion. they use that to extend the life of the medicare trust fund and simultaneously from the cost of subsidies under obamacare. even in washington spend the same dog twice as a problem. many you can't -- can't double count that. there are a number of these

gimmicks that are built-in. if you take all these out and and all the costs in the fine that the real cost of this bill is upwards of two and a half trillion dollars and will add some 800 billion to the federal deficit of the first ten years of operation. now, that probably understates the problem because since then the fund a couple of other things. for example, they actually included $50 billion of revenue the camp on the class act, a giant ponzi scheme that took them $50 billion. to counter the revenue but to not count the payout. since it turns out that the class act is not going to actually take place. you have that 50 billion in cost. and then finally, the cost of subsidies. and when the bill was passed they originally estimated 9 million americans will be put into health care exchanges.

the estimates now are in excess 20 million americans will go in, and even that probably underestimates it because there will be an incentive on the behalf of business to dump their employees. it is cheaper because they have to pay the penalties of two or $3,000 for nine insurance someone versus 7,000 for actually paying for their insurance. you can dump it on the exchange. the federal government will subsidize it. the more people that get dumped into the exchange is the more subsidies the federal commitment will have to shell out, and even if you just go from the nine to 20 million americans, there will add about $500 billion to the cost of the spill over and above the 3 trillion a sudden we're

alreadtalking about. so we just keep piling more and more costs into the spill. we have about 600 billion in texas, 3 trillion in cost. if you notice, there's a shortfall which is a problem we have been dealing with the behalf of the federal government. he could of summed up the entire state of the union address into words, we're broke. we don't have a couple of trillions of dollars flying around to continue to pay for this very costly and wasteful and dangerous program. i think if you leave aside all the bad impact on health care we're going to hear about the increase in waiting times at all the other things it will do. we need to repeal this simply as a matter of fiscal sanity. thank you very much. [applause]

>> that afternoon. thank you for hosting us today, and thank you did chilly for hosting this. thank you all for coming. 2012 as the year that counts. this is the year that is really going to determine that only the future of health care in america, but i believe the future of our freedom. if the law stands would honor can congress not commandeer us and the states to do in violation of constitutional principle. either we will turn our health sector into a centralized system control but a few in the policymakers all we will get to work fixing there very real problems that do exist and putting in place policies that get the incentives right to put doctors and patients in charge of medicare decisions and that truly begins 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 law is fully up and running we will have 87 million people in this program. that is not an acceptable outcome, and it still leaves 20 million people uninsured. we have to fix this. when the court makes this decision it can range from trying out the whole lot to live in the whole lost and. or some complex range of decisions in between. i think probably the most optimistic and perhaps most realistic scenario is that there the individual mandate unconstitutional and so narrow frame. they leave the rest of the longstanding which will be a big

mess because people are going to a think that the president's, al the times that he talks about this law, you just mentioned a few things, a 26 year-old on their parents' policy, cue insurance reforms, preventive care. they don't understand the massive complexity of this law. he never holds up this chart. [background noises] that the joint economic committee did last year tried to depict one-third of this house low. 159 new bureaucrats and commissions. the american people are necessarily confused about this law. the president, when he and his secretary in another stalker of this, they just talk about these few small provisions, not about the whole lot and what it's a sweeping impact is going to be in the health sector.

we heard in his speech last night. forty-four words devoted to health care. the administration is adopting a strategy of silence after spending two years of almost, year-and-a-half, getting this house law passed. they stop talking about. not surprising because the law is usually unpopular. the latest tracking poll just out this morning from the kaiser family foundation said that -- shows that the law remains as unpopular as ever. the majority of americans continue to oppose along and overwhelming majorities object to the individual mandate. most because they believe it is an over reach of government power, but also because they think mandated it insurance, and now it's only going to get more expensive, and they're right.

the individual mandate is center stage because of the march -- the upcoming supreme court arguments, but another poll was interesting. the majority, 55 percent, believe that parts of the hull foster would be implemented, even if the court strikes down the individual mandate and three in ten think the ruling against the mandate will effectively mean the end of the entire law. so that really feeds into the president's trying to confuse things to try to get people to think. it's just the small 26 gerald on their parents policies. the free preventive care. eventually filling the doughnut hole of the medicare prescription drug benefit. after the 2010 elections which i think really were referendum on obamacare, the president was pretty belligerent in saying,

no, no, no. people really -- it was and about obamacare. i just didn't explain of all enough. he insisted that the law only needed a bit of tweaking. but i think his democratic political advisers eventually got him. they and his white house advisers eventually reached a really inescapable conclusion, and i thought it was best put by democratic pollster pat could delve who said just after the election, the economy, as important as it was, was not the decisive factor in the selection it was health care. it is health care that killed them, talking about the 63 democratic health members. the american people found this to be a crime against democracy. they want it repealed, and the issue is going to go on and on.

but the american people want most from health reform was to get their high cost down. could there possibly be any more misnamed small then the affordable care act i think not. mr. obama repeatedly has said during his campaign that health cost for the average family will go down by $2,500 a year by the end his first term. costs are rising faster and have a number here's. another kaiser family foundation survey found the premiums for their rich family policy increased by $1,400 alone. three times faster than the year before. there are many more mandates coming from washington and limit the cost continue to go higher and higher and consume a bigger share above family budgets as well as employer budgets.

the 500 million in new taxes will certainly increase the cost of health insurance for there. there's nobody else to pay for this but us. one way or another, whatever pocket they're taking of a, we're going to pay the bill. a number of factors, of course, contribute to rising health care cost. the mandates are going to send costs soaring. the congressional budget office assumes that the average family policy will cost $20,000 per year by the time the law is fully up and running in 2016. remember, that policy is no wonder going to be optional. it is mandatory if the supreme court upholds the provision of the law. $20,000 per year to purchase a health insurance policy that the government tells you you have to

have. mckinsey and company assumed that tens of millions of people are likely to just say i'm not buying this policy. the government is requiring insurance companies to summon a policy in . why should i buy a policy file can buy it at the time i needed for the same premium of what had been paying had been buying it all along, and already we're seeing that happen in massachusetts with this individual mandate. we mayctually wind up with a worse problem of uninsured as americans follow the incentives. should i spend $695 or two and a half percent of my income has a fine or by 2500 on health insurance policy. figure out that they can send their employees to the exchange

and simply pay the fine. former congressional budget office director a sense that as many as 35 million additional people will wind up in the taxpayer subsidized exchanges as a result of the incentive for them to be down from their employer plans into exchanges, and we can have all of a conversation about exchanges, but they will be really very likely whining uncovered to does not point to look a lot different than medicaid today. medicaid pays doctors and hospitals so little, especially private physicians. it just can't afford to see very many medicaid patients. that is the program.

the president wants us to think that it is just the small stuff, 26 year old, free preventive care. and this will tsunami coming gas that is, if the president is reelected in the slot stays in place, even if the individual mandate is struck down there are huge, huge consequences for our economy. i believe job creation will continue to stall. we already see it. and the cvs in alexandria where i left. they put in automatic checkout facilities. lower wage jobs are going to vanish because employers simply cannot afford to pay the huge health-insurance costs or even define for lower income, low wage workers and replacing them with technology. a very jobs that people need to get their foot on the ladder to get into the workforce of the

ones that are going to be killed first. imagine also, when you have employers and may be tens of millions of americans deciding to violate federal law as a matter of the family budget decision, what does that say about our civil socie in america? what is that going to me for our country when tens of millions of people and hundreds of thousands of maybe millions of businesses decide to violate federal law, i think that's really going to have a corrosive effect for our economy and our ability to function as a civil society. one final thought. i was talking with a very wise staff member on the senate side, e-mailing back-and-forth about this latest directive from

health and human services that catholic hospitals and catholic churches and catholic employers must provide preventive care that includes contraception including tracks that produce abortion and sterilization as part of their health plan. and the president apparently called the president of the u.s. council of catholic bishops before the enough to was made saying, don't worry about it. we're giving you a year to comply. and timothy dole and representative brightly said after that, they're giving as a year to figure out how to violate our most fundamental conscience and principal? is not going to work. so he put them in the very difficult position of saying we're going to violate federal law, pay the fine, or violate

our conscience. so that is an example of why it is not just the individual mandate that is in question before the supreme court. the very deep in any of this long is unconstitutional. violating the tenth amendment, the first amendment with the violation of religious freedom. first amendment guarantees religious freedom. the individual mandate, whether are not that is upheld, if it is , then what is our constitution saying about the ability of free citizens to govern ourselves, make our decisions, or whether or not the federal government is going to come in and order our lives and confiscate our 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're paying for your mortgage or rent, in order to compile a federal law. that is what this law must not stand. if the court upholds it it will be back at the ballot box in 2012, and the american people are going to have the final say. thank you very much. [applause] >> well, wonderful. i think all three of you for excellent remarks in reminding us again almost two years later of the problems we have with this health care law. i just want to underscore another trend that we see which is, this is just a we have today there is still mounds and mounds of regulation and information that we will still have to wait to see. so i think that really underscored the danger of moving forward with this up, because we even today are not clear as to what the final package will look

like. we have time for questions. please, if you have a question for our panelists, raise your hand. let's start down here. >> how would it be politically possible to repeal this thing if you need 60 senators to do it? in the most optimistic scenario not going to have 60 senators. >> well, keith tennessee who actually worked in the white house in the senate for a long time has written a detailed post on this. he is now with the hoover institution. he said that because much of the law involves spending that you really only will need 51 votes in the senate and are and to repeal most of the major spending provisions that michael particularly talked about. and you can't spend any money. then the rest of the law really is that going to a half -- it's going to crumble.

so the majority in their house. remember, they passed a big piece of this through reconciliation in 2010 in order to get it through after scott brown was elected in massachusetts, and the only had 59 votes. so a lot of it could be undone through reconciliation. you might look up the more detailed the description of it. ..

>> i mean, the sort of free visiting situation is like being able to drive your car into a tree and then pick up the phone and say, hey, geico? you know, now's a good time for me to have that auto insurance. you're waiting until you're already sick and then becoming insured. that's a very bad risk for insurers. you can pass a law and say insurers can't discriminate against you. okay, insurers will comply against the law, but what will they do? well, you'll have an awful lot of insurance offices on the sixth floor of a walkup so it's much harder to come in and sign the paperwork, which they will do. or the easiest thing is you just don't have, if you don't want a lot of cancer patients, for example, in your insurance plan, you don't sign up any oncologists in your network of doctors. so that you, you know, basically, if you've got cancer, you're looking around for which insurance policy to join, well, i'm not going to sign up for this one because i won't be able to get treated.

so i'll have to go over here to this other one. so what you'll start seeing is a rush for quality among insurers as they, bassically, try -- basically, try to have a lot of health clubs that they'll reimburse for and very few procedures for people who are actually sick, no heart surgeons, oncologists, people who are sick. so you'll change the nature of insurance to one who treats healthy people and stops treating sick people. you want to lower the cost of insurance for people who are young and healthy, making it much cheaper to sign up, and then allow them to stay in the plan throughout their lifetime as they get sicker, the insurance companies sort of build that cost in, and that makes a much more sensible market. >> but then -- >> oh. >> but then it starts -- [inaudible] regulations by requiring these insurance companies to include, say, oncologists in their network. >> sure, sure. you can constantly change, you

know, chase the wheel, so to speak. i mean, you can constantly try to cover the new regulation, but people are always smarter, they'll always find a way around it, and it'll just cost a lot more and produce a lot less care. >> i was just going to add that, um, you know, under the affordable care act they put $5 billion in to, um, help those people who have pre-existing conditions if they've been out of work without insurance for six months or more. and remember richard foster said, well, five billion will be gone by 2012. this is between 2011 and 2014. well, the administration said about 400,000 people would be moving into these to get the insurance in the high risk pool. well, only 31,000 people have actually signed up for the insurance in the states' high risk pools which makes one wonder how many people there really are with pre-existing conditions. even though so few have signed up, about five states have gone back to the feds saying, you know, there's not enough money

for us to make the high risk pool to work. so it just shows the example of this is going to cost us so much more than the administration and the cbo have ever said. >> and can i just 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 were buying the insurance because it was too expensive. so they set out a new directive saying, no, we're going to cost cut the cost of new insurance and, therefore, they're running out of money faster. the government just doesn't understand how to make a market work. only markets know how to make a market work. washington does things through directives and spending your and my money, and it's just not going to work in one-sixth of our economy. >> there's a question back there. >> isn't the insurance for --

[inaudible] at least $3,000, and, um, as far as universal access, i guess this is -- [inaudible] what do you think about an optional direct care load so you encourage the states to reduce their restrictions on -- [inaudible] more concerned about the cost? and just finally, romney saying -- [inaudible] is totally incorrect. um, he -- [inaudible] i know the campaign, they told me it's -- [inaudible] from march -- may 2011. you used the term universal health care, universal health insurance which is, of course, subjectively worded, and even -- [inaudible] said only two-thirds of the uninsured got coverage. so it's also inaccurate. there was another question in the poll that asked should we

not be requiring the insurance purchase, and th only got 51-44. and another question asked, can we afford to continue the law, and that got in the negatives. and also the sampling of the poll was not provided. >> do you -- go ahead. >> just real quick on the whole idea of universal coverage. i think it's a mistake to focus on the number of people with insurance as opposed to a healthier population. we tend to conflate the idea of health with health care with health insurance. and the three things are entirely different. what the goal is at the end of the day is a healthier population. one way to do that is through health care, seeing doctors and hospitals and so on. but it's not the only way. and one way to pay for seeing doctors and hospitals and so on is through health insurance, but it's not the only way. and in terms of your bang for your buck, the studies repeatedly show that buying insurance for someone is not,

does not give you the biggest bang for your buck in terms of health at the down end. you might be much better off using that to expand access in other ways, say community health clinics or things of that nature. or you might be better off spending that money on something that has nothing to do with seeing a doctor, but more to do with promoting health, promoting healthy lifestyles, getting people to eat better, work out more, things like that, that have a much better impact on health at the bottom end. so we shouldn't necessarily end the health care plan by be whether or not it gives a whole bunch of people with coverage. you know, having a piece of paper in your hand that says this is health insurance, it doesn't guarantee you see a doctor. in canada you wait to see a doctor. and simply seeing a doctor is not going to make you healthier if you then go out, stop exercising and eat too much and don't follow the doctor's advice and stuff like that. it's not going to do you any good. so the three should not be conflated. >> i was just going to say that, you know, the administration is

saying now 2.5 million kids are on their parents' health care plan until the age of 6, so this is a huge -- 26, so this is a huge success. but the kaiser family foundation showed that the average family premium last year was $15,000, up 9%. the previous year it was only up 3%. and i wonder if those 2.5 million children up to the age of 26, how many of them had, you know, individual plans before they were covered and decided it was cheaper to leave and that go off and join their parents' plan? there could be a lot of shift just from one type of insurance to another. >> i tnk we are fortunate enough to have former congressman john shad dick, even though he's behind the pole here, so i can't see him. i hope that's you. [laughter] >> the extraordinary cost of this legislation which was misrepresented to the american people -- [inaudible] in addition, over the last year there's been ample evidence of the provisions which are

outrageous failures and clearly not going to work. yet the congress, specifically the house, does not seem to be enacting much legislation. how, i have two questions. one is, how can we make obamacare an important and critical issue in the 2012 election, because i do think it was a referendum in the 2010 election. and, second, shouldn't the congress -- specifically the house -- be repealing some of the outrageous or outrageously expensive provisions and sending them over to the senate so that we continue to remind the electorate of how bad this policy is and how much it's going to do? >> well, congressman, what we need is your continued lead in congress to make sure obamacare remains a key issue in 2012. and fortunately, the house is actually going to be taking up the repeal of the class act, the long-term care provision that democratic, um, members have

called a ponzi scheme of the first order. last -- they're going to be taking that up next week. i believe they have the independent payment advisory board, the rationing board and medicare up for debate. there is certainly going to be attention to the individual employer mandate and its focus on killing jobs. so i think that's right. i think they need to continue to keep a focus on this, on in this law and shine a light on it. one issue after another, so that the american people do understand that it is so much more than the half a dozen things the president's going to talk about. and it really is this monstrously complex law that your leadership and getting us to understanding how we can reform health reform in the right way has just been crucially important. and i'm glad that you're continuing to be affiliated with the heritage foundation to keep

your voice in the public domain. we need your, we need your wisdom. >> i would say part of the problem is let's say that congress has the attention span of a gnat. [laughter] and, you know, they think they took a vote, they promised the first vote they took would be on repeal. they took it, it passed, died in the senate and everything does, and they said, well, we do what we said, let's move on to debating some other crucial issue, naming post offices or whatever. [laughter] and it did come out today. it was announced today that they will finally have, they were directed to come up with a replacement plan. it was announced today they will finally have a replacement plan that they will announce sometime after the supreme court rules the legislation as a whole. so, you know, they don't seem to be in if any rush -- to be in any rush to get out and do this. and i think it's partly because the pressure has been off from the american people. we all, people, people have gotten cynical.

we all want to repeal it. as you've seen the numbers, 53% in the latest poll still want to repeal it. it's about a 15, 20-point margin in almost all the polls, say that they want to repeal. that hasn't changed. the bill has not gotten any more popular no matter how many times it's been explained to people. but there's so many other things on our mind, and people respect calling their congressmen, they aren't writing and asking for it to be repealed, and frankly, if the congressman hasn't gotten a phone call the night before, they move on. >> and i think it is so very important that we keep the drum beat up. you know, op-eds, radio shows, we've got to get the american people reengaged. they were engage inside the election of november '10, and we've got to get this back up. norman coleman, the former republican senator from minnesota, just yesterday who is an adviser to mitt romney said, well, you know, the gop is not going to repeal this. i thought, you know, where is this coming from? it's certainly not going to help

mr. romney's campaign. we've got to keep up the pressure for why it is so important because if mr. obama is reelected in 2012, he will continue to veto, um, repeal bills like happened, you know, with the senate on january of last year. and it's just so very important that the drum beat. because in canada, you know, after -- since 1974 we still have the single-payer system. there are some private clinics that are working. but by 201 it will be impossible to get rid of this government program. you can never get rid of government programs when they're in place. so we've got to do it now. >> i just want to underscore, too, that's why it's so important as this court case becomes the topic of the news of the day as the case gets closer that we also don't forget that putting all our eggs in that basket is going to solve this problem. so we must be vigilant that we can't just depend on the courts. we have to depend on congress to do their job and to do their job completely and fully and continuing the road to full repeal.

next question. dr. unger. >> my name's chris unger, i'm one of the doctors -- [laughter] i'd like to take my scalpel to this whole problem, and i'd like to just cut it. let me ask, first, a comment for everybody. when the icd-10 system could perspectively come into existence, the impact on that as it intertwines with the declining reimbursement in electronic medical records could have another colossally damaging effect on this system. mostly what we're talking about is shortages of just about everything. and most of you know that there is now a very alarming shortage of oncologic drugs, and we see shortages of immunizations, shortages of nursing care. and we see this every day in our lives. i have a question.

if there's a lawyer in the room, what would happen if following took place? an insurance company moves into the area of scranton, pennsylvania, and sells insurance without any mandates at all. pennsylvania has 53 mandates. these are those other mandates that don't get talked about. what happens then? they sell very low-cost insurance that has very high-quality and very high coverage that actually pays people in an incredible way. what happens after that? >> it would be illegal under pennsylvania law. they would not receive a license to sell within the state and, therefore, their entire business activity wou be illegal. >> is the law in pennsylvania worded loosely enough to fight it in pennsylvania courts? >> no. >> it's too tough? >> yeah. i mean, this has been litigated. i mean, essentially, the insurance commissioner has the power to license who sells insurance in their state. if you don't get it licensed from the state, you're not allowed to sell insurance. >> and it wouldn't fulfill the

individual mandate either. >> if i may take the liberty of asking a question, too, that follows with that, which is if the health care law does go into effect, will we, in your opinion, have yet another two-tiered health care system for the haves and the have nots? >> you know, a lot of people say i'm going to be all right, i can afford to pay whatever i need for health care, and i'll make sure i have a catastrophic policy. think that is just, the health system is a, is a network, a web, it's a vital, integrated system. in which hospitals are, provide better surgery because medical device companies are able to come up with new and better surge call techniques -- surgical techniques and diagnostic techniques and machinery. drug companies are able to produce new and better medicines that doctors can prescribe to keep people out of hospitals. you can't can't , if the systemt

working and the pharmaceutical companies have to go through so many hoops, they have fewer drugs or just can't do that anymore. health insurance companies, i have a paper on our web site called a radical restructuring of health care that talks about health insurance companies simply leaving states because they can no longer figure out how they can comply with all the rules and regulations and make up a market in health insurance. and doctors, 40% of doctors thinking of leaving practice when this law's fully in effect in 2014. the infrastructure of the health system is declined. and, yes, some people are going to be able to buy their way out. we may find people going to canada or offshore hospitals being set up. but the quality of health care in america will decline for everyone. and people will not be able

to -- if the drug's not created, there's no way you can get that drug. >> i have a slightly different perspective. i actually think the bill's going to be fine -- >> law. >> the law. it's going to be fine for big pharma and big insurance. i think -- that's why, you know, big pharma spent $150 million lobbying for this bill. they showed up at the white house. went over and met with the president and came out with all sorts of agreements to spend money in campaigning for this bill because they know every insurance plan in america has to coffer their prescription drugs, there's going to be a whole bunch of new expansions in medicare for them, they're going to have brand name drugs covered under the doughnut hole where they were going to generics and stuff. so they came out ahead. big insurance, you know, they dropped the public option, and they got a mandate that people have to buy their product. a $70 billion a year bailout for the insurance industry. now, the small and medium companies can't comply, they're going to go out of business, but

that's great for the big insurance companies who are going to control the last little bit of the market. the ama lobbied in favor of this bill because with, because they think that's going to mean that their doctors are going to get special treatment under this, they're going to get the doc fix put in and things like that. so i think this is, this is a great bill for big business. i think it's just the little guys that are going to get stepped on in terms of all of this. >> and, of course, it's amazing that the american medical association only represents about 17% of doctors, yet the man on the street thinks the ama represents every single doctor. my worry, as i said in my little talk, is that, you know, private insurers will be crowded out and, you know, a lot of docs say to me, well, we're going to do our private concierge practice, and we'll be fine. but if you look to canada,hen the province and the government took over the health care system, the canada health care act outlawed any private medicine, private payments. so i think we have to be very

aware this could be an ultimate, um, consequence of the affordable care act if it's not repealed and replaced. private medicine could be outlawed, and we'll all be in the medicare for all system. >> better get our frequent flyer miles ready then. question up here. >> if this bill is -- i'm sorry -- as i believe it is too, why is it our three top presidential contenders are all each in their own way for some form of obamacare, and apart from the question more practically, what do we do as voters come november in the presidential election? >> yeah. you know, last night newt said he wanted to make the moon the 51st state. [laughter] so i'm thinking of moving there. [laughter] you know, it really boggles my mind. the fact is, and we talk about why are we not doing more to repeal it. the fact is the two leading presidential candidates on the republican side right now

supported an individual mandate. mitt -- newt at the federal level, mitt at the state level. they both support exchanges. they both support a lot of the insurance regulations going on, the community raiding and guaranteed issue provisions. i mean, for all the base firing barbs at each other, there's not much of a dime's worth of difference on health care. they both supported the prescription drug benefit expansion, $17 trillion unfunded medicare part d, both of them were in favor of it. so it really is hard to draw a contrast, and i think it's going to be much more important at the congressional level who the congressional and senate candidates are and where they stand on this because they're all giving l service to, oh, they'll repeal it. i don't want see either of them leading the fight. they'll sign it if it comes out of congress, so, you know, that's where the fight's going to have to be. >> i think that's right. i think congress is really going to have to lead on this, and as

the bill shows up on the president's desk to repeal as much oz it as they can -- as much of it as they can, then all you'll need is a president who'll sign that. i think that, you know, romney says he'll repeal, you know, repeal is the first thing he wants to do, but then he says, he says, well, and we have to repeal and replace, and i'm glad i've shown what i would replace it with. [laughter] that's not cutting it. [laughter] >> and it's interesting, i mean, i keep -- well, all three of us have been critics of romneycare, and so probably mr. romney is not going to ask any of us to be secretary of hhs. [laughter] but, you know, i just can't understand why mr. romney will not say i thought it was a good idea for massachusetts. we have the evidence, and it's not good. so i'm, i made a mistake and, therefore, we're -- but he won't do that. very, very fright ping. so what i'm going to do is buy an old ship, not the one that crashed off the italian coast.

i'm going to set up my liberty ship, and we can all get our health care on my liberty ship. >> i would also like to underscore i think what was said, this is why it is so critical that congress gets it right this summer. it will set a 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 a kind of alphabet soup plan of everyone's idea that makes no sense. i think we need to be able to explain to the american people as has been done in this book and in heritage's plan on saving the american dream and everyone else has their own ideas of what to do, um, but they all fit together in an important way. and i think that's another important feature moving ahead as this debate continues. do we have anymore questions? we're bumping up on our time, but -- >> to the congressman's point who i have a great respect for on the house's side with

repealing the entire law, i know that there's a messaging battle, there's more conservative members in the republican caucus that are for outright repeal and only outright repeal. so how do we move to, or move away from if we repeal portions of the law, class act, mlr, device tax, everything else, like, the horrible portions of it, how do we move to where we're not making a bad law better? >> a huge amount of discussion in the congress on exactly that point. if you repeal it, will you improve it? i think that's such a misunderstanding of how truly monstrous this law is. i mean, you could take -- they could pass a law, pass a bill every week between now and november whatever the election date is, 6th, and they would only on the margins be able to make this law better, and it -- it would still not pass the senate. so the house has to continue to

keep up the drum beat as a way of educating the american people about what really is in this law. they had a huge part of this law that they just put in there in order to be able to pretend that it was a deficit reduction law. and it's just outrageous. and you shine a light on that. then you 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 drum beat, and there are some members -- i think that they have sort of begun to realize you need to have handle to explain to people what's in the law, or they're just going to believe the president's right when he says, oh, don't worry about this, it was just a bunch of the small stuff. all we were doing was putting 26-year-olds on their parents' policy. the only way they're going to understand what's in the law is if congress continues to say here's what's in the law, $575 billion in new taxes and half a trillion in cuts to medicare,

the unbelievable expansion of medicaid that's going to bankrupt the states, mandates on businesses, the mandates on individuals, all of those. part of the law that should not stand. >> okay. well, we'll try to take one more question if we have it. going once? okay. one more in the back. wait for the microphone, thanks. >> um, with the medical loss ratio, there's been talk about the impact it will have on health savings accounts. it doesn't appear that they're canceling these plans right now from from what i've seen, but can you talk about what kind of time frame are we looking at and could you, perhaps, address that? >> well, yeah. we don't know for certain yet what the impact will be on health savings accounts because the rules haven't been written yet about what's going to count in terms of the medical loss ratio. a lot of it depends on how,

which side hhs comes down on, how are employee contributions treated, how are the individual payments out of the account treated, how -- what way do all these things count against the minimum payout requirement. that's in this. so we know that some that are set up now probably will fail under any structure, some may qualify, a lot remains to be seen how the rule rules go into effect. i believe we're talking not until 2014 until, until everything goes into place, so in this, that's when the real impact will be. i suspect before the election there'll be a lot of talk about how lenient these rules will be becae you don't want to frighten anybody, and then after the election the rules will appear to be very tight because we know the president actually has said he does not support health savings accounts. he believes they're wrong-headed, he has talked about that. there's some quotes by him saying he thinks they're based on a myth that people

overconsume health care. so he thinks that this is a wrong approach, and i think he's not going to be very sympathetic to them. >> the real concern with these medical loss ratios where the federal government is telling health insurance which percentage of the premium it has to spend for, um, actual medical care versus administrative costs, the problem with health savings accounts is that the insurance itself doesn't trigger in until people reach their deductible which is higher, which is why the insurance is cheap. but yet the insurance company has to keep track of the, has to know that you've reached that deductible so, therefore, they have to do all the administrative cost of making sure, of really figuring out you spent $50 on this doctor's visit, you spent $900 on your -- $100 on your meds over here so they know how to get to that point. so even though they're spending less on medical care, they still have to do the administrative costs to figure out if someone's

reached that deductible. and that's what i -- it's just, they're killing them. if they would have put in this law we're going to get rid of health savings accounts, i think you actually would have had a hard time passing it because a lot of conservative democrats see that these are valuable. so what they're doing is they're killing them, they're strunging them through -- strangling them true regulation by saying here is this prescriptive rule, and health savings accounts just respect going to be able to coy ply with it and, therefore, they would not be legal policies. there are other examples, but that's a specific one to show why i think they really are on the chopping block. but it's way back in the back 40. >> and i was going to say about 12 million americans have hsas, and they are very popular and 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, you know, a few small companies that only offered hsas