but as we saw in massachusetts, true reform requires much more than talk. as governor i vetoed the bill blocking charter schools. but by legislature was 87% democrat and my veto could have easily been overwritten. so i joined with the black legislative caucus and their votes helped preserve my veto. including -- when it comes to education reform, candidates can't have it both ways. talking up education reform while indulging the same groups that are blocking reform. you can be the voice of disadvantaged public school students or you can be the protector of special interests like the teachers unions. but you can't be both. i've made my choice.

as president, i will be a champion of real education reform in america and i won't let any special interest get in the way. [ applause ] i will give the parents of every low income and special needs student the chance to choose where their child goes to school. for the first time in history if i'm president, federal education funds will be linked to a student. so that parents can send their child to any public or charter school they choose. and i'll make that a true choice. because i'm going to ensure there are good options available for every child. and should i be elected president, i'll lead as i did when i was governor. i'm pleased today to be joined by the reverend jeffrey brown who was a member of my kitchen cabinet in massachusetts. that cabinet helped guide my policy and actions that affected the african-american community in particular. i'll look for support wherever there's good will and shared

conviction and i'll work with you to help our children attend better schools and help our economy create good jobs with better wages. i can't promise you that i'll agree on every issue, but i do promise that your hospitality to me today will be returned. we will know one another. and we will work to common purpose. i will seek your counsel. and if i'm elected president, and you invite me to next year's convection, i will count it as a privilege and my answer will be yes. [ applause ] the republican party's record by the measures you rightly apply

is not perfect. any party that claims a perfect record doesn't know history the way you know it. always in both parties there have been men and women of integrity, decency and humility who have called injustice by its name. for every one of us a particular person comes to mind. someone who set a standard of conduct and made us better by its example. for me that man is my father, george romney. [ applause ] it wasn't just that my dad helped write the civil rights provision for the -- for the michigan constitution. though he did. it wasn't just that he helped create michigan's first civil rights commission. or that as governor he marched for civil rights on the streets of detroit. though he did those things, too. more than these acts, it was the kind of man he was and the way

he dealt with every person black or white. he was a man of the fairest instincts and a man of faith who knew that every person was a child of god. [ applause ] i'm grateful to him for so many things and above all for the knowledge of god whose ways are not always our ways, but as justice is certain and whose mercy endures forever. every good cause on this earth relies in the end on a plan bigger than ours. without depends on god, dr. king said, our efforts turned to ashes and our sun rises into darkest night unless his spirit pervades our lives we found out when g.k. chesterton called

cures that don't cure, blessings that don't bless and solutions that don't solve, end of quote. of all that you bring to the work of today's civil rights cause, no advantage counts for more than this abiding confidence in the name above every name. against cruelty, arrogance, and all the foolishness of man, this spirit has carried the naacp to many victories. more still are up ahead. so many victories are ahead. and with each one of them we will be a better nation. thank you so much and go bless every one of you. thank you. thank you. [ applause ]

follow c-span's road to the white house coverage is available on our website cspan.org/campaign2012. in the candidates on the issues section you can see speeches from president obama and mitt romney on major issues like the economy, the deficit and national security and health care. we've got electoral college maps, campaign commercials, web videos, information on key state races and more all at krrks span.org/campaign2012. coming up later today here on c-span3, a senate confirmation hearing for a postal service nominee. president obama has nominated steven crawford to serve on the postal board of governors. he's a public policy professor at george washington university. that hearing gets underway at 2:30 p.m. eastern and it's live here on c-span3.

this is c-span3 with politics and public affairs programming throughout the week and every weekend 48 hours of people and events telling the american story on american history tv. you can join in the conversation on social media sites. under a formula from the late 1990s, doctors who treat medicare patients are scheduled to see payment cuts, but congress has never allow the cuts to take place. the senate finance committee yesterday held a hearing on the issue by doctors representing different parts of the medical community testify.

albert einstein once said, a great thought begins by seeing something differently with the shift of the mind's eye. today we hold our third round table on medicare payments. we're here now to see things through the eyes of those who receive the payments and provide the care. that is our physicians. ere year the str leads physicians to fear dramatic reductions in their medicare payments. next year physicians will face a 27% cut if we don't act. congress has intervened to prevent these cuts each year, it is time we develop a permanent solution. we need to repeal this and end the annual doc fix ritual. the year in year out uncertainty

is not fair to physicians or the medicare beneficiaries who need access to their doctors. one thinking about new ways for medicare to pay physicians, we must clearly focus on controlling health care spending. physicians can help us find the solutions. they're after all on the front lines of health care delivery. 97% of medicare beneficiaries see a physician at least once a year. and beneficiaries with chronic conditions see their physician at least monthly. by ordering tests, writing prescriptions and admitting patients to hospitals, physicians are involved in up to 80% of total health care spending. we need physicians to suggest changes to medicare physician payment system that will spur high quality, high value care. i look to today's panelists to

offer solutions in both the short-term and long-term. i hope like einstein said they can help us come one a great thought by seeing something differently. we need solutions that will work for both primary care and specialists. and they need to work for beneficiaries with chronic conditions. after all these beneficiaries account for 2/3 of total medicare spending. for your candid and direct suggestions from panelists on how we can better begin to compare and control health care spending. senator hatch will be here he's currently on the floor. in the meantime, we'll introduce the panel lists. beginning to my left dr. artis, president elect of the american medical association. next dr. glen stream president of the american academy for family physicians.

thinker will be frank apel ka, vice chancellor and professor of surgery at university of louisiana state health science center. dr. weaver the assistant medical director of heart and vascular services at the henry ford health system. finally, dr. barbara mcnanny, chief executive director of the new mexico oncology and hem ology consultants. your written statement will be included in the record. please limit your statements to three minutes since we have fewer senators here today. i'd like to limit your comments to about three mince each. i'd like this to be more in nature of round table not a formal hearing. that is after each making statements of a few questions, i like us to interchange back and forth. you want to say something, pipe

up and say it. that goes for all our panelists. you start, we're very happy to see you here. >> thank you, chairman bacchus and members of the committee for convening this important round table discussion. i am president elect of the american medical association and internal medicine and infectious disease specialist in lexington, kentucky. we all know that the sgr has failed. it must be repealed and replaced with alternative payment and delivery models that support high quality and high value care. as we move forward two factors are critical, first, physician practices wildly vary and the development and dissemination of innovative practice and delivery models are proceeding at different paces. a large multispecialty practice is currently better positioned to implement broad scale innovations than is a small, rural practice. flexibility in a menu of

multiple solutions are needed on a rolling basis. and secondly, alternative models must cut across medicare silos. when physician care achieves overall medicare program savings, physicians and medicare should share those savings. currently additional physician services that prevent costly medical care drives steeper cuts under the sgr. this incentive structure has to change. physicians have begun transition into alternative payment and delivery models. this includes for example, 154 medicare accountable care organizations and the center for medicare and medicaid innovation is testing many new models. many innovations are being conducted in the private sector as the committee heard at its june round table. the am, a strongly supports these initiatives and is helping physicians with the transition. for example, our ama convened

physician consortium for physician improvement has related methods for outcomes and overuse of care and is expanding its work in this area. congress can take immediate steps to help many the transition. first, congress should require cms in the innovation center to offer opportunities for physicians to enroll in new models on a rolling basis. practices can then plan for needed changes and join as they become ready. this will increase physician participation in new models and significantly aid the transition for small, solo and rural practices. second, congress should require cms to modernize its medicare data systems. due to cms's antiquated systems, providing physicians with actionable, realtime data to guide decision making has been difficult. physician access to such timely and relevant data was a key element behind the success of the private sector models discussed at the previous june

round table. third, congress should provide medicare funding to cms for quality measure development, testing and maintenance and for measure review and endorsement. this is critical to ensure that meaningful and up to date measures are available for federal quality programs. the ama is eager to continue our work with the committee to transition to a new stable system that strengthens medicare. thank you. >> thank you. dr. stream. >> chairman and senators thank you for inviting the american academy of family physicians to state our views. we believe health care in the united states is inefficient and delivers lower quality care largely because it undervalues primary care. the afp is convinced that no single alt v payment method will rebuild primary care. we need a combination of methods. afp supports a blended payment system that includes fee for service, a care management fee and a quality improvement

payment. we advocate for this reinvitation of primary care because we know it works toim prove health care and restrain costs in the long run. the evidence for this is accumulating rapidly and our statement provides several examples. findings from pcmh programs are compelling demonstrating success in improving quality and restraining health care costs. earlier this year afp sent recommendations. the key recommendation is in order to build a system of care that will be consistently more efficient and produce better health we need to pay primary square differently and better. we call to your attention the medicare physician payment innovation act hr-5707 introduced by representatives. it makes a notable step toward recognizing this critical need to pay primary care differently. the cms innovation center has several programs testing systems that support primary care.

for example, the primary care -- the comprehensive primary care initiative includes several health plans in various markets that will offer a per patient, per month care coordination fee for primary care physicians whose practice are patient centered medical homes. the program administered by the agency deserves your attention. currently without funding this program is designed to disseminate up to date information about up to date therapies and techniques to small practice practices, the afp strongly recommend that congress fund the service extension program. we ask for your continued support of the primary karin sentiv payment, the 10% bonus payment to providers for certain primary care services. the commonwealth fund recently published a study that the pcip if made permanent yield a six fold lower return in costs. the net result would be a drop

in medicare costs of nearly 2%. senators, we all want the same thing. better health care at less cost. there's a proven way to go along way toward achieving that outcome. invest in primary care. we have ample evidence that doing so will not increase the overall cost of care per individual per year. thank you for your commitment to the health of this nation and family physicians are eager to assist you in making the differences we need. >> thank you, sir. next. >> chairman and senators thank you very much for this opportunity and good morning to you today. i come to you to speak on behalf of improving the care for the surgical patient and inspiring quality amongst surgeons. so on bea half of the american college of surgeons there's a couple key points i would like to make and be brief. we have several programs and initiatives that we have been working on to inspire quality, to improve the quality of care. we believe that that actually helps reduce the cost in health care today by reducing things

like surgical site infections, readmissions and complications that patients suffer. there are two key programs that i would like to bring to your attention, one in the short-term and one in the long-term. the short-term approach is to look at the various clinical registries that we've developed over the years and those go back, ten, 15 years worth of work where we've accumulated millions of data points on patients that drive quality improvement. these registries are the cancer registry, where we have over 11 million lives that we actually track the outcomes and drive improvement in cancer care. the trauma registry. to act perhaps focus more explicitly today on the national surgery quality improvement registry. that's a registry that ban in the v.a. some 15 years ago and now today is in over 500 hospitals. it's driving quality improvement, reducing patient complications and reducing cost related to those complications. we've worked with cms and it's time to improve that work with

cms to bring those registries to this next level of the value proposition that cms is working on to strengthen surgele care and i prove the quality of care across the country. we'd like toex pand from 500 hospitals to every hospital that has surgical care. long-term view, the long-term point is how do we replace the sgr. we've been working on a proposal that ties together all these value initiatives that we have been working with cms on. all the value programs into a value based update using targets of improvement. targets of improvement in cancer care. targets of improvement in chronic and prevention care. targets of improvement in rural care. focussing those is the targets for updates. bringing physicians and hospitals in alignment on a set of targets that actually replaces the sgr are something that we value. improving the quality of care and reducing the cost related to bad care to overuse of care to

unsafe care to poor call of care. so we think that there's an opportunity to further explore this as a value based update to replace the sgr within the context of the framework that we're currently using throughout all of our programs both public and private to stimulate a better health care system. thank you for this opportunity. i look forward to our dialogue. >> thank you, dr. dr. weaver. >> chairman and ranking member. i'm dr. doug weaver. today i'm pleased to speak to you on behalf of the american college of cardiology. if the college can make one suggestion it would be create stability in the system. it is badly needed rite now. the current uncertainty around medicare physician payments, around the aca and its

initiatives is seriously impeding progress by physicians and hospitals toward delivery and payment reforms. the college has had several decades of experience in developing and applying quality improvement tools including clinical practice guidelines for diagnosis and treatment of common cardiac diseases. appropriate use criteria which allow physicians to better apply the right test and cardiac procedures. then a clinical registries in which physicians and hospitals can submit their data around cardiac procedures or whatever, they then get it back and are able to benchmark it against the whole nation as well as locally. we believe that broader use of these tools will improve quality, will produce better patient out comes and will lower cost. let me tell you some of the lessons we have learned in these years. number one, data is key.

efforts to improve quality and efficiency must be grounded in the use of the best scientific evidence available. the collection of robust clinical data, measurement and feed back to doctors on performance. doctors are data driven. they have competed throughout their entire training to be the best and they respond to credible data. in particular that that is produced by their specialist societies that have identified particular problems that they feel need to be improved. number two, flexibility is necessary. new payment models must be crafted with collaboration of clinicians in pairs. one size does not fit all. we applaud the beginning efforts to reward care coordination, but cms needs to seek out additional local solutions that increase value and reduce cost. third, incentives must be ali

aligned throughout the entire delivery system, to include the payer, the specialist, the hospital and the skilled nursing facility. currently, we are too often competing with each other instead of being aligned. payers are trying to reduce costs, hospitals are trying to fill beds and the physician is uniquely positioned to ensure the patients get the highest quality care at the lowst cost if -- if the current system is revised to insent this approach. rewarding physicians for providing the right care and using an appropriate amount of resources is essential to solving the medicare spending crisis. the college urges congress to insent vise a greater expansion of and use of quality and utilization improvement tools such as ours. i look forward to our dialogue. >> thank you, sir. >> thank you, chairman, ranking

members. thank you for the opportunity to participate in this entire round table discussion. by name is bar ra macand any, i'm a medical oncologist practices in new mexico. i'm here today on behalf of the american sot of clinical oncology which represents 30,000 oncologists. it supports your efforts to transform the medicare payment system to encourage high quality, high value care for individuals with cancer. we hope that congress will replace the sgr and soon. the sgr has created great instability in our practices and is eroding a very effective network of care. the vision is that of a fair and responsible system that rewards evidence-based care and recognizes that many cognitive services including end of life counselling are critical to treating patients with cancer. any new payment system must preserve quality, enhance access to care and first do no harm.

quality for cancer patients providing accurate diagnosis, appropriate evidence based therapy deliveried safely and a strong support system for the human needs of the patients and the families. they've developed a quality program in which thousands of oncologists participate voluntarily. we call it the call oncology practice initiative. i participate in this program, i know from experience the beneficial effect it has had on supporting me in full quality in my own practice. it is frustrating that i also have to report through medicare less practice enhancing quality program. we believe that leveraging cope would be an immediate first step that congress could take to promote officialsy and reducing the administrative burden on oncologists. secondly, we urge you to rely on the expertise of oncologists as you move towards transformation

of cancer care, payment and delivery. policies that have the effect of dmis mantling community cancer care could kpater bait the existing care. cancer doctors have developed a sophisticated infrastructure that allows us to administer dangerous and toxic therapies safely while allowing patients to remain at home with the people they love. therefore we would love to emphasize that new oncology models must be tested through pilot programs that reflect the diverse populations that we serve before they are generally implemented. any change in the payment system has the potential for unintended cons kenss for a very vulnerable population. however, oncologists are already involved in many pilot projects to test new payment mechanisms which could help control costs. i'm the recent recipient of the grant from the medicare

innovation center to test the model based on the medical home concept of bund patients. my project involves seven private practices from maine to new mexico. we can save money while providing better health and better health care. i'm happy to talk about that further. we stand ready to assist you as you stand forward. i'm happy to answer any questions. >> thank you. i have several questions. one, since physicians are so involved with such a large percentage of health care payments in our country, it seems to me between sgr for physicians only and yet physicians are so involved many the health care payments that are made elsewhere in the system, perhaps as we look at

sgr there may be some way where physicians are reimbursed in a way that involve them in choosing the care given to patients more holistically. currently people say we're too stovepiped. one stovepipe to some degree is sgr. any thoughts you might have on how we collapse some of these pipes and specially the role of physicians because physicians are so heavily involved i think the figure i have is about 80% health care dollars are related to decisions made by physicians. your thoughts on that. anyone who may want to pipe up? >> i'll start. thank you for that question because i think that's something we all chat about