many people. there were three men running. 11terry who is what is known on the national stage and has attracted most of the attention since he got into the race. the other wasbrian moran, a state lawmaker, whose brother is in congress. he comes from northern virginia. people thought it would be a battle between those two. in the end, the final candidate comes from the second-least populated county in virginia on the border. it stunned everyone. . .

in the end he won all across virginia including in the congressional district of jim moran, his opponent's brother. host: your story has the headline "the contest will play out on the national stage come this fall." why is that? guest: yeah. well, so virginia and new jersey are the only states in the country that have a big election in november. it's one year after president obama took office. and virginia is a state that has become a real battleground nationally, a state that used to be solidly republican. and in the last couple of elections has trended blue. president obama carried virginia. he was the first democrat to carry virginia in a presidential election in 44 years.

republicans think they have an excellent schans of sort of starting what they hope will be a national comeback. michael steele has been here. mitt romney has been here. you can pretty much expect to see every republican presidential candidate make their way through virginia. the democratic nominee, you can expect to see him get a pretty good boost from president obama as well. host: so a little bit about the republican candidate. what can you tell us about him? guest: bob mcdonald. he was the attorney general. one of the great things that's going to be happening in the fall, it's going to be a rematch. he got his job by beating the democratic nominee in one of the closest elections in state history. he's a guy who's been running in the middle already, talking about issues like jobs, higher he had education and the -- higher education, the roads and rails of the state.

he has lengthy ties to pat robertson. he attended regiant law school, the law school founded by pat robertson. host: tell us a little bit about the financial standings of both of these candidates and how it will play out this fall. >> crede will have to sell his campaign quite quickly. it was a very expensive race for him but i expect him to do that pretty fast. both candidates are going to get a ton of money for the national stage, just millions and millions. this might be one of the most expensive races in virginia history. >> rosalind helderman, thanks. guest: thanks for having me. host: in a few minutes we're going to hear from senator tom coburn about the administration's plans to pay for health care, issues about the pay-as-you-go rule. other issues as well. and later, howard dean.

he'll be talking about health care. we'll be back in a few minutes. >> this morning a discussion on the national single payer health care system. witnesses include the former editor in chief of the "new england journal of medicine." live coverage beginning at 10:30 eastern on c-span3. in the afternoon, the senate banking committee holds a hearing on the u.s. auto industry. they'll hear from white house and treasury department officials. that's live at 2:30 eastern also on c-span3. both hearings also online at c-span.org. >> every weekend the latest non-fiction books and authors on "book tv."

saturday, how do you run for congress with $7,000 and your sixth grade students managing the campaign? tierney cahill gave it a shot. she's interviewed by delegate eleanor holmes norton. sunday, joe rosenberg takes you inside the revolution. how the followers of jihad, jefferson and jesus are battling to dominate the middle east and transform the world. and what's next for the economy? steven moore and former reagan economic policy advisor arthur lafer on "the end of prosperity." and later, a real estate attorney on the housing crunch and where it's headed. every weekend's filled with books and authors on "book tv." look for our entire schedule online at booktv.org. >> "washington journal" continues. host: senator coburn, senator baucus says that when it comes to this fall that a health care

bill will be on the president's desk. do you think that will happen? i hope so. we have problems in health care that we have to address. we have to address costs, access. but we also have to address our global exet yitness -- competitiveness. we now have over 17% of our g.d.p. spent on health care. it's almost twice what the rest of the world spends. there's no question we have technology that the rest of the world has. we have care that the rest of the world doesn't have. but we need to fix it. i think everybody agrees with that. the question is and the real important details is, how do you do that? do you have the government take over more of it or do you allow real allocation and real access for people, maintaining personal choice, personal freedom and personal time? health scare about individuals.

we tend to think of it as a program, but it's really about people. it's about what they need when they need it, and what their physician thinks they need not somebody outside of that. whether it be an insurance company or the government thinks. host: and a public plan, as it's been called? guest: first of all, just put in perspective for a minute, what does the government do well on health care now and what does it do well financially? medicare is $38 trillion we're going to transfer to our children that we haven't paid for in medicare. it has $80 billion at a minimum of fraud a year. medicaid is unsustainable as well. the states are drowning in medicaid costs. and it has about $40 billion worth of fraud. so if you look at indian health

care and what we promised to give people and then don't or you look at v.a., even though v. >> is improving it's still not up to the level of the health care of the rest of the country. the idea that a bureaucrat somewhere will make decisions about health care and coverage i think is unattainable to most americans what most americans want is the ability to afford the health care to get it when they want it, where they want it and by whom they want it. and i think we can accomplish a great thing for the country coming together. if we solve the real problems that are out there. we spend $2.4 trillion in this country on health care. and about a third of that doesn't help anybody get well or prevent it from getting sick. so we don't need more money in health care what we need is better value. i think there's a lot of ways to do that. host: the discussion that took place a few weeks ago about controlling costs, do you see

anything substantial coming out of that? guest: i think the way you control costs is to create a transparency where people can see what it costs and give them decision-making power with some economic -- small economic risks. i had an orthopedist in my office yesterday told a story, an interesting story. a lady had what she thought -- had hurt her knee. he thought she had a torn anterior cruciate ligament, the ligament that holds the femur to the tibia. she couldn't relax. he spent about 15, 20 minutes. still couldn't get her to relax to do a good exam. so he wrote an m.r.i. for her. so she came back in a week and she hadn't had the m.r.i. but she had a glass of wine in her hand. she said, i think if i drink this 15 minutes before you exam me, i'll be able to relax. well, the fact is she did. he could do an exam. did he have a torn anterior cruciate. he operated and fixed her knee. but he didn't spend the $1,800

on the m.r.i. because it wasn't necessary. the point is, she had some skin in the game so she decide rather than pay $300, $400 out of her own pock tote get this m.r.i -- pocket to get this m.r.i., she would figure out a way to relax and be examed. most of the time in the country somebody is making a decision about their care on the physician they choose and the way they want it and also has some slight economic cost in the game. and we'll lower costs. we spent $300 billion on defensive medicine tests a year that nobody needs, for sure, except doctors feel like they need because they're afraid they might have a lawsuit. we have cost shifting of $200 billion. right there we could save that $500 billion first year. first year in health care if we designed a plan that would allocate the resources in a way where people had control of it

and doctors didn't think about getting sued more than they think about their patients. host: senator tom coburn, our guest until 9:00. if you want to ask questions -- you envisioned this powerment, i guess, to folks in terms of a tax credit? gipp yes. what we think is it's highly unfair. the tax code today is highly unfair. if you're an upper middle income or above, you get an average of about $2,700 in tax breaks from the federal government through getting your health care. if you're poor or you're lower middle income, you get about $100. what we propose is to equalize the tax code and get everybody in the country, every family in the country $5,700. that rietzs each year as a

decreed -- rises each year as a refundal credit for your health care. you can keep the insurance you have. if you want to stay there, you stay there. you goat choose what you want. -- get to choose what you want. the studies say we'll get everybody covered in a way that gives them personal choice, gives them the freedom to access it where they want and how they want it. and we'll also allow them to choose the time and the actual physician. think about medicaid for a moment. we have all of these people on medicaid. yet 40% of the physicians in this country -- the cost to them is greater than the reimbursement for it. so we've promised all of these people health care. but what we've really done is say you can only have 60% of the physicians out there. you can't have the 40%. it's much higher with some specialists that won't take

medicaid. under this plan we would take medicaid, make it a defined contribution, plus add the $5,700. so we have every medicaid patient at a level of contribution that's above what the average cost of health insurance policy is today. they got an insurance policy. they no longer has a stam temperature on their forehead that says you're a medicaid patient. so what we are doing is giving them an equal basis as everybody else in the country. so we give everybody the same access to the same quality and the same choice. and while we do that, we save the states $900 billion. host: first call is from austin, texas. democrats line. go ahead. caller: thank you. i'd like to ask the senator three quick questions. first question, eight years the republicans were in charge and they didn't do anything about the health care cheap.

second question. my wife is employed and paying $200 every two weeks on insurance. those people that just got laid off those jobs, the insurance didn't go with them. how are they going to pay their insurance bills? how are they going to keep insurance? and the third question, why dot republicans keep calling president obama's plan socialized medicine when it's not socialized medicine? if you're unsatisfied with the insurance -- satisfied with the insurance you have now, you be keep it. but if you're not satisfied, the government will furnish insurance for you. what that's going to do is bring down the prices. the big insurance companies don't want this because they want to keep rung rampant on charging people for insurance. >> first question i agree, they didn't get done what they should have. they weren't bold. i think president obama has brought this to the forefront. i said in my earlier statement i think we need to do something.

the third point that he made -- second point is, under our plan they'd still have the tax credit. whether they're laid off or not. to be able to buy any insurance. so you take cobra plus a tax credit plus the ability. and remember, that $200 every two weeks is about a third of the cost or a fourth of the cost of the health care that she's actually receiving. why be critical of a government-run plan, insurance plan? and i'm not alone on this. the fact is, is the government hadn't proved itself responsible in any health care program that has run so far. you put it into the political nature. what ultimately happened with the public plan is if in fact, you can get insurance from a public plan cheaper, everybody's going to move there. and what is estimated is

120 million americans will leave the insurance they have today and go to a government plan. the cheap with that is the government plan won'ting fiscally viable. so what will happen is we'll convert it from a government plan to a government medicare plan, very similar to what we have for medicare but then we won't be able to fund it. so rather than pass on another $38 trillion to our children what we need to do -- and i agree with you. the insurance industry isn't really insurance. it's prepaid medical expense for which they extract a large component that doesn't ever go to help 18%, 19% that never helps anybody get well. it doesn't prevent anybody from getting sick. so what our plan does is say we're going to force competition. and through forced competition, you're going to see prices go down. but you're also going to see that nobody gets denied. automatic renewability. auto enrollment you can roll out but you get auto enrolled.

right now we have 16 million people eligible for medicaid who aren't getting it because we can't effectively put them on the rolls where as this auto enrolled them and they can opt off if they don't want it. so i think the -- look. if we make health care partisan, we won't fix it. and i think republicans and democrats agree. we have a cheap. we want to get access for everybody. we want to make sure we have an affordable system. but most importantly, and this is where we really part company, you can create a public plan, but if you haven't done anything to lower health care costs -- i'm talking about the real costs throughout when you purchase health care -- you haven't made it sustainable. the cheap in america is health care costs have been rising an average of 2.7% per years. that's because we haven't had competitive forces. and the thing that will make forces competitive is individuals with their -- empowering the individual rather than the government to make

those people compete for their dollars. host: florida. mike on our republican line. caller: good morning, senator coburn. guest: good morning. caller: i can't help but agree with you more. if you can answer a question for me, can you name a government program that hits these two benchmarks? number one, that has been successful. and number two, that has come in at the cost that you guys have told us that it's going to cost us. can you name any government program that has ever hit that? guest: i can't name that outside of medicare. there isn't any federal government program that truly comes in on budget on time anymore. it's because of the way we purchase. the cheap is -- the forces that allocate the resources in health care. we've got more money than we

need in health care right now what we need to do is have the forces competitive. ask yourself why we have $5 billion a year just in fraud on durable medical equipment through medicare. why? because the system. because it's a government -- it's designed to be defrauded. we spend all of this money trying to chase those dollars. if there were real transparency in the market, people wouldn't buy x wheelchair for this when they could buy x wheel chair for this. we have one case from florida, your state, that was sold so many times they collected $5 million on one wheelchair and never delivered the wheelchair. this came out of dade county, florida. so the point is, who is best designed to decide what you want, where you want it, and who you want to get it? you are. and if there's an economic incentive associated with that,

with you and that you never allow some bureaucrat, whether it's insurance or the government to get between you and the provider. you're going to make the best decision for your economic and your health interest. one other point that has to be discussed is we don't spend money on prevention in government programs. and the only way we truly get out of the health care dilemma we're in is to prevent the chronic disease that we're seeing today. today we have sick care. we don't have health care. and we have five diseases that consume 75% of all of our health care dollars. all of them are preventible. if we were to change the emphasis which we have in our bill where we take this large amount of money the federal government's already spend and put it into prevention and wellness. and that's why you can cover everybody with a government plan. but if you don't fix the sustainability, if you don't fix the decrease in this increase in

costs, putting everybody in a government plan or everybody that's not insured today in a government plan doesn't fix that. so what you have to have is you have to have an emphasis on wellness and on prevention. and the management of chronic disease. and there's a great example out there. if you look at the company's safe -- company safeway, they have 200,000 employees, health care costs have risen one-half of 1%. that's 40% less than the rest of the industry. what's the difference there? they incentivize their employees into prevention and wellness and management of chronic disease. they aggressively managed it. they got -- they actually paid them money to do things. and consequently, their expenditures on chronic diseases have dropped through the floor because they're now managing them and they're preventing people from getting so they're controlling blood pressure, body mass index. they're incentivizing wellness. and that's what we have to have as a exoan yentd of any plan

that -- component of any plan that we put forward. host: texas, good morning. our independent line. caller: good morning. host: good morning. you're on. guest: good morning. caller: good morning. i've been listening to the republican's argument about the h.m.o. system for four years. it's been a failure for four years. i think we can all agree on that. guest: i agree. caller: one of your comments about not having a single payer system -- and i am on medicare and i love it. it's socialism. would you define socialism for me, please? guest: i'm not sure i said medicare was socialism i may have. i certainly may have in the past. socialism is when you take from those and give to somebody else on a plan with the government at the central area managing the system. medicare works. but we can't afford it. we've got a $38 trillion. your medicare right now is being paid for by the tax that are

going to fall on your children and grandchildren. so sure. the other thing we're starting to see which may or may not worry you is we're already starting to see rationing in medicare. medicare decided this month that you can't have a virtual colonoscopy. you can only have a higher risk, more invasive procedure to screen you for colon cancer. and they made that on monetary decisions rather than on the best practice for you as an individual. and that may be ok and it sounds ok. but if i have an individual that has congestive heart failure and maybe has high risk for having a significant sedative to have a colonoscopy versus i can have him swallow a camera in a little pill and put him through a test, which is better? is it better for that patient to put him at the risk of having a colonoscopy with a potential colon perforation or is it better to run him through a scanner with a camera and look

at their colon that way? so the point is, is government-run health care leads to rationing. we had it with a significant -- a significant cheap with some drugs. we have all of these people on chemotherapy. the center for medicare services decided they would tell us when we could and couldn't use that medicine because they were spending too much money on it. that's fine. it probably was abused. but the result was, somebody with severe congestive heart failure needs more blood as far as hemoglobin than somebody who doesn't have it. if they're both undergoing chemotherapy, they require a different transition zone of which you would give something to stimulate the red cell production. so the last thing i want is somebody at the government deciding what you should get in terms of your care. and the whole idea that we passed the stimulus bill was comparative effectiveness. if you read the scholars out of

england, they'll tell you the worst thing they did for the health care of the english people was to use its effectiveness to guide them in government-making decisions on what care you got and didn't get. >> as far as program sustainability is concerned, as far as your proposal, how do you keep money coming in to give folks the money to pay for health care? guest: it's a zero tax increase and zero revenue increase what we do is we say if you're getting your held insurance from your employer and you like that, you stay there. but the value of that health care will become taxable. now, let's say you're not buying, you're getting it from your employer. the average person making $60,000 a year in this country would get a $200 tax -- $2,700 tax cut. so they'd still have their insurance plus $2,700 a year more. all of this can be rolled over into a health care so you can buy anything else you need whether it's your drugs, your glasses, your hearing aid or for

your kids. in other words, what we did is it's a revenue neutral. what we're doing is equalizing the tax benefit for health care to everybody gets the same. host: washington, d.c., good morning. our democratic line. caller: good morning. hello, c-span and senator co-burn. nice to talk to you. guest: good to talk to you. caller: i think we do have rationing in this country already. it's called show me the money. i got a prescription for a steroid nose medication, took to the pharmacy. the pharmacist spent about 10 minutes typing my information in and came up with $96. now, i don't know how much of that is going to pay antonio banderas to do the commercials, but certainly that's quite a bit more than you pay for a generic. guest: i agree. caller: it's kind of amazing what we pay for in this country.

and i do believe if you look at it, we probably do subsidize much of the rest of the world's -- guest: we do. you're absolutely right. americans, the price that they pay for drugs subsidize the rest of the world's drugs. there's no question about that. caller: we do. and what i would like to say though -- my comment is i think we need a kitchen sink approach here. i don't noad know if we're getting it from either side. it seems like the republicans bring out the tax credit argument for lots of different things. it seems in this case it's also the case. but democrats, i'm not even sure what the democratic proposal is yet. but had we taken a kitchen sink approach, have we brought in health care experts and officials from every single other country in the world that has, you know, a quantity take y and equal take thively better healt -- qualitatively better health care than we have? guest: that's a great question. i have spent time on the swiss

plan, which is probably one of the most effective in the world. they spend 11% of their g.d.p. they have health care equivalent to us. everybody over there is on a plan. but they have options. you see all sorts of health insurance innovation from them. let me comment about your nasal medication. we're still the only place in the world where you have a true competitive market in pharmaceuticals. and so you get a prescription for it. the economic choice is you could have taken an over-the-counter now and effective had 80% of the same effect or bought a generic steroid nasal inhaler at about 1/3 the cost. point is -- and i don't know of your individual situation. but if you have insurance coverage, we don't -- in terms of your drugs, you don't make as

good of a choice. but if you have personal coverage, what has is people who don't have the means, which you may have, to pay $90 end up not buying anything. so what's happening is the noncompliance of what your physician may say i you need, the noncompliance rises because people can't afford the access. most republicans disagree me on a refundable tax credit. most of them don't like that. my goal was to fix it to where everybody has the same shot of health care and everybody gets covered and everybody gets freedom to choose because they're controlling it. so if you're not fortunate enough to have employer-based insurance, what happens is you have a good shot at getting a higher