.

saturday, the run for congress? she is interviewed by washington d.c. delicate eleanor. -- delegate, eleanor. what is next for the economy? steven more, and foreman reagan economic policy adviser on taxes and the end of prosperity. and "foreclosure nation." every weekend is filled with books and authors on "book tv.' look for our entire schedule online.

>> here is kathleen sebelius about to testify at a senate appropriations committee on the annual budget. the white house has requested a net $79 billion for 2010. -- 807 $9 billion for 2010. region $879 billion dollars for 2010. job in the cabinet but also think the best job in the cabinet. your response please include comprehensive health reform, preparing for a possible pandemic influenza, addressing entitlements but also by medical research, substance abuse, drug safety and quite a few others. i certainly look forward to working with you cooperative lee in any way that i can. this hearing will focus on your

discretionary budget but i would just like to mention some, what we are doing on comprehensive health reform. i know that you feel very strongly that prevention and public health must be at the heart of any serious reform in healthcare system and i commend you for your work in that area. i also believe in reform to the healthcare system must address the injustice of people with severe disabilities for being forced to spend their lives a nursing homes because we are not provided an option of home-based services for the disabled. that is why i have introduced a committed to choice act which president obama strongly supported in cosponsored when he was here is a member of this committee so i look forward to working with you on this issue. today we just want to talk about the fy2010 budget. also about the funding included in the recovery act or the stimulus that we passed. that included $10 billion for the nih, $1.1 billion for comparative effectiveness

research, $700 million for prevention activities into billion dollars for discretionary health information technology activities as well as funds for head start, communities services block grant and health professions. so, we will cover as much as we can. again we welcome you to the subcommittee. i leave the record open here for a statement by senator cochran and i would then recognize you madam secretary. your statement will be made it part of the record in its entirety, and as a matter of introduction, kathleen sebelius became the 21st secretary of the department of health and human services on april 29th of 2009. in 2003 she was elected as governor of kansas and i thank you for coming to i was many times. i always enjoy seeing you and iowa and working with you. she served in that capacity until her appointment as secretary.

she serviced kansas state insurance commissioner graduate of trinity washington university in the university of kansas. madam secretary, and since-- >> mr. chairman i am happy to join you in welcoming the secretary to the hearing. thank you very much. >> thank you. i will leave this record open for your statement. >> please proceed as you so desire. >> thank you chairman harkin and senator cochran and members of the committee. i want to thank you for the impartation to come and discuss the 2010 budget and for a start by thanking you for your hard work gang leadership on a fulbright the of health issues. we certainly face great challenges in the country today and i look forward to working with you to tackle those challenges together. health reform is one of the issues i know that is front and center and the senate and house right now and i think that there is great agreement, we can't

continue with the status quo. the president is committed to health reform. we have seen businesses and governments and families and providers come together two of knowledge that the crushing costs are influencing families bottom line, the competitiveness of our businesses and we have got to find a way to deliver higher quality healthcare for all americans. i do agree with you senator, that prevention and wellness are a central component of that transformational health policy and some of those building blocks as you say, have already been provided. i look forward to being part of that discussion as it moves forward in terms of health reform. now, i think the budget we are considering today puts us on the path to health reform and adheres to the principles outlined by the president,

building on the investments in the 21st century health system. the american recovery and reinvestment act funded some priority areas, including making a substantial down payment on health reform. there is a focus on fraud which is costing taxpayers billions of dollars each year and we intend to do more to crackdown on individuals who currently cheat the system, said the attorney general and i, the first time ever at a cabinet level announced an interagency effort to fight medicaid and medicare fraud through improved data sharing, real-time information that will be available and increase the number of strike forces that have been successful in a couple of areas and we would like to see them increase their operations and the budget includes some recommended increase to help health and human services achieve our part

of the bargain. we also have initiatives in the budget to move toward a central goal of health reform, improving the quality of care. the patient centered research that is funded in this budget helps give doctors and patients access to better information and better treatments, helps empower consumers and providers, so we hope that not only will we be looking at cost-saving strategies but improve the quality of healthcare for everyone. the budget invest $354 million in target activities to combat health disparities. senators, i just came from a dialogue with close to 30 stakeholder is representing various minority populations and communities who are very interested in working on closing the gap on quality of healthcare delivered across america. the gap exists for higher income

americans versus lower income americans and certainly the gap we see persisting in ethnic minorities and low income and the damage populations and that is the continued priority with the department. we have included over a billion dollars in hers the in the health resources and services administration to support a wide range of programs dealing with workforce issues. clearly a critical component of health reform is having enough providers to deliver that care to all americans, so the funding will enhance the number of nurses and doctors, the number of dentists and mental health professionals and particularly, also targets minority and low-income students to encourage more access to the medical pression and an increased emphasis that make sure seniors get the care and treatment that

they need. finally, the budget will support our work at the department to protect public health and safety of our citizens, as the chairman has recognized. we are not only dealing with an on going presentation of the h1 and won the flu virus but also the ongoing preparedness and operations to respond to whatever outbreaks nays strike next and threaten the health of the american people. there is no question that the investments made in pandemic planning and preparation by this committee in congress over the years has allowed our department to respond efficiently, but we need to continue those efforts and make sure that we are well prepared. we don't know what the next steps of this virus might be. when it comes back in the fall, in this country or what will happen exactly this summer when it presents itself in the southern hemisphere in

conjunction with their flu season, so the president has submitted supplemental request to support the federal response to the recent outbreak, and the funds in addition to those provided in the 2010 budget will allow our department to continue to be the primary health agency responding to this outbre and remain prepared to protect the american people. so, mr. chairman the president is committed to a safer, healthier and more prosperous america and we feel this budget will help achieve those goals, investing in reform, improving on the quality of care and continuing to provide essential services that so many families depend on. i look forward to taking your questions and those from other committee members and more importantly, to work with you on these important goals. >> madam secretary, thank you very much for a could summation and isaiah said it will be made part of the record in its entirety.

madam secretary, there was an article in the post this morning on healthcare and all the costs and what we are looking at, and it pointed of two important things. it said here pockets of medical excellence dopp the landscape but a least 100,000 people die each year from infections they acquired it in the hospital. well 1.5 million are harmed by medication errors. and down here-- the institute of medicine estimates that one-third of all medical care is pure waste, such as duplicate x-rays, repeat lab tests and procedures to fix mistakes. so, as we look ahead for healthcare reform, people wonder how we are going to pay for all of this. one-third, according to the institute of medicine, is pure ways. that must come out to be about

$700 billion a year. i don't know if that is right or not that even if it is half that, it seems to me that is an area where we could work together and with the ig's office and others to really begin a really concentrated, concerted effort to look at where it is that we might make changes. you in your capacity as the secretary, or that we might be able to work with you in finding those areas where we can cut down on the waste and what we can do to cut down on the number of infections that people acquire and the hospital. it is becoming dangerous to go to the hospital. warren more people are getting sicker and hospitals, and so i just throw that out in saying i hope you will be looking at this, just come on board. i know you have only been here a

month and a half. >> six weeks? something like that. i would hope you and your staff would get together and look at this and see what it is that you can do or what we can do together to really go after both of those. >> mr. chairman let me just say i appreciate the concern and share it. we have already issued a challenge to the american hospitals to work in conjunction with our departments to reduce by two-thirds the number of hospital related infections. it has been proven that using a fairly simple hospital checklist has a dramatic impact on hospital infections, so we are using some of the funding provided by congress in the recovery act to do just that, to challenge hospitals and also increase the state capacity to do inspections. that is one area. i don't think there's any question that we know where there are, as you say, pockets

of high@@@@@@@@ @ @ @ @ @ @ @ @ there is a lot of excess of and redundant care right now that is probably not only costly but does not really add anything to the health outcomes. that is another area of concern. this research will help promote the best practices and share that research about what helps and what is cost-effective. i can guarantee that in the department, we are very focused on trying to identify what does work in a cost-effective manner and what draws the best health outcomes and show that across t. technology come again funded in the recovery act, will have i think a dramatic impact on lowering medical errors and sharing best protocols and putting some transparency behind

what is effective or not. ufr the started down the pathway with the funding provided in the recovery act. there are more investments in this budget we hope move forward. >> madam secretary thank you. as long as we are talking about the recovery bill, a top priority for me was the prevention and wellness fun. you mentioned some of it. actually we got 5.8 billion in the senate bill. the final amount was 1 billion, but that's okay. 650 million was dedicated to proven strategies to reduce chronic diseases. and we could have, obviously, specified exactly where we wanted all of this to go. but, we looked at sort of open, expecting that your department and us here on this appropriations committee would have an ongoing dialogue about what was the best strategy.

..

the most significant prevention or you hope will end up still end of the most significant prevention and wellness in the united states -- the leadership of the department was very important to collect a broad a way of ideas. i can assure you that no final plans have been made. we wanted to get the leadership on board and be delighted to consult with the u.s. remove forward. sharing your expertise -- i know this is an area you are passionate about and have a lot of expertise to share. we look forward to coming back to you before a plan is finalized >> outstanding. >> mr. chairman, thank you. madam secretary, one of the

other responsibilities i have had since been in the senate is to chair the agricultural committee in addition to this appropriations committee, and it occurs to me as we look at things done in the rural areas of the country your department and the department agriculture's share a lot or have overlapping responsibilities and i wonder if you have thought about how maybe these can be coordinated and improved efficiencies or in other ways make available needed benefits like health screening, vaccinations, feeding programs. i just thought of those, the wic program, administration for example. in the case of a flu virus outbreak a would be an important resource for making available

vaccinations. do you have any thoughts about whether we need to improve the official sees of these programs buy maybe combining that into one department rather than having a division of responsibility between the two departments? >> well, senator, i can tell you that in my short tenure here at the department already had a number of conversations with the secretary of agriculture, tom vilsack, who i served with as governors in neighboring states and senator harkin's home state, tom vilsack was the to term governor and actually governor when i got elected and i learned a lot from him so there was a lot of collaborative discussion underway on everything from food safety issues as we've redesigned the food safety initiatives under the fda, looking at obesity, clearly food, nutrition and classrooms.

a couple of programs you mentioned we haven't had on the screen yet but i think we definitely need to add those. the president is interested and committed to having cabinet secretaries work in a very interagency fashion leveraging the assets of the agencies and not replicating or duplicating programs that work well in one area but borrowing good ideas and trying to work together in a collaborative fashion. so i think you have made some important suggestions and i will certainly circle back with those with secretary of agriculture. >> the president's budget request creates or suggests there should be created a new mandatory t.a.r.p. program. under the current formula these bonds are distributed more to cold weather states than they

are warm weather states or at least that is my observation. when the new liheap program is designed how do you intend to address the funding disparity that affect low-income rural states in the south? >> well, senator, i have to tell you that i was not aware of the disparity until i began some of the visits in preparation for my confirmation hearing, and it was raised by a number of warm weather senators that the money runs out before it gets hot in the summertime, and what i said at that plant and intend to continue to do is take a look at the way the funds are distributed because i agree with you people are in jeopardy if they are sitting in 100-degree homes the same way if they are

in 30-degree homes and the same kind of impact is had on vulnerable populations, so i can assure you we would not only appreciate your input, but i will certainly take into consideration and ask the folks administering the program if we are looking at the issues of warm weather states because i think it is of concern. >> thank you. i have a couple more questions but i am going to yield two other centers that are here. >> senator kohl. >> thank you and secretaries sebelius, welcome. as you know the weaver for wisconsin senior care program is scheduled december 31st this year. currently this program provides over 100,000 seniors in my state with high quality cost-effective prescription drug coverage as i presume you are aware. according to the cbo it does so achieving ongoing savings for

the federal government at the same time. by understand governor jim doyle, who i know you are very familiar with, has applied a waiver to extant senior care through 2012 which would allow this successful program to continue. can you tell me the status of the waiver application and whether or not we can hope to achieve that weaver? >> senator as you know that 1115 program is the only one left in the country where the state only drug program is being conducted and i know it is wildly popular and it's been enormously successful treat you will be pleased to hear not only did my good friend, jim leal apply for the waiver continuation before i got to the office but was in my office three days ago and will fly in the request to make sure i did not forget and as you might be aware the president is going to green bay wisconsin on their state to talk about health

reform and i don't doubt he is going to hear something about this popular program. it's my understanding we are in the final stages of review that people in the agency are aware of model me how popular it is but how successful it's been and i am hopeful we will be able to give you news in the near future. >> i will take that as a somewhat positive. >> i don't have the definitive answer today. i hope i would have it, but close. >> i happened to give a speech monday at wisconsin to 400 people involved in issues that apply to seniors all across the state and i had something like a dozen lines written in my speech. the only one there really got any applause was my reference to the senior care program and how effective it has been. >> i can tell you in the discussions i have been involved and in health reform i asked our

were folks just because before i came to this position as a governor and as someone who shared ideas with other governors not only did i have the state looking at how successful wisconsin had been and what things we could do to mirror it but the health reform team has the program and we want to look at it as a possibility to include as one of the options it definitely has caught the attention of lots of folks outside of wisconsin. >> thank you. secretaries abilities, i am sure you are aware there's been much media attention holocausts two or three times as much to fund the medicare recipient in some locales across the country that it doesn't others. we've seen articles in several publications come to the conclusion health care quality does not increase with higher spending. in fact "the washington post" reports health care costs in my

state, lacrosse, arnall were than the national average yet quality is much better than the national average. i'm sure this is one of the most toughest, one of the toughest problems you are going to be confronting in your time as the secretary to read you have initial on to take advantage of those areas during a great job in controlling costs and extend it across the country to those areas that are not? >> senator i think the you have just defined the challenge as how to take what is happening in the pockets as a senator harkin said earlier across the country and sort of scale up so not only do we reduce overall cost increase quality. someone said the other day, you know, there's a lot of discussion about rationing health care and this expert said

he thought we were doing currently in america was rationing quality which i thought was an interesting lines, but we do, you know, i think the comparative effectiveness research that was funded $1 billion worth in the recovery act is a big step in the direction to inform doctors and consumers, patients with what is happening and what the best practices are. i think there are certainly in my age studies that can lead to that and the cdc is looking at areas we can improve quality the part of it is learning from the folks running the health systems that have been identified as delivering high-quality care to lower-cost. we have some improvements currently proposed in the budget and medicare demonstration projects.

one of the areas we know is very erratic, what happens to a patient when you get released from the hospital? right now 20% are readmitted and a lot of evidence leads to the fact that is because of lack of follow-up care, which is very expensive and certainly not good for the patient, so we are trying to expand best practices in that area looking at bundled payments so providers are more concerned with ultimate outcome and not with contact with patients. we think that would be an effective strategy and driving and encouraging voluntary collaboration with symbol practice doctors so they have more coordinated care strategy, cetron and to take what we think is working and encourage others to follow the practice and use some of the medicare incentives and payments to enhance and