adding a pay czar to monitor the firms receiving the aid. an announcement is expected today. . >> the republican proposal drafted by a troopegroup calls r increasing nuclear power.

no new nuclear plants have been ordered in the united states since 1978. the bill calls for increased oil and gas production on public and private land and offshore. the house is in at 10:00 a.m. eastern on the senate side, patrick leahy's decisions to began supreme court nominee so the mayor on july 4 h13. meanwhile, the brother of judge sotomayor says the critics appeals judge do not know him. he called his 54-year-old sister tough as nails. he had assertions that -- assertions derogatory and insulting. millions of dollars received in

free travel and lodging is legal and that it saves taxpayers money. the government watchdogs say it allows donors to exert influence for a small investment. u.s. magistrate judge hears arguments today about whether walter kendall miers and his wife should continue to be held until they go to trial. the former state department employee and his wife, accused of spying for cuba, have been behind bars since there arrested thursday. "the boston globe" is reporting that the new york times co. has hired goldman sachs to manage the possible sale of open code the boston globe." the report says they have begun accepting bids. >> "washington journal" continues. host: gov. howard dean joins us,

the author of "howard dean's prescriptions for real healthcare reform." guest: i do not think we are blind to get much agreement between dr. dean and dr. coburn on this one. the idea that we were better off with insurance companies is a crazy idea. there are more bureaucrats telling doctors what to do than there ever were in the united states government. host: as far as prescriptions that the obama administration one for health care, how did they fall in line with what you are prescribing? guest: that is the plan in prescribing. there needs to be a public option. the most effective, efficient plant in america -- taking care of people with medicare. yes, there are serious problems. compared to what the private insurance companies have done to

doctors and patients over the last 15 years, we are better off with medicare. i fully agree with the president. people should be doubled to make a choice. people should be able to choose what they want. if employers want to continue to offer private health insurance to their employees, they should. i think we need to have an alternative like medicare for people over 65. it is high satisfaction. it covers everybody. it covers you wherever you go. much lower cost than the private insurance companies. we know from studies that have been done and repeated time and time again that public health care does a better job for its patients than private health care. not-for-profit health-care has a significantly better rate of outcome than for-profit health- care. the senator is wrong.

he is well intentioned, but he is just from. host: as far as management is concerned, what kind of expansion to the federal government is needed? guest: let's be blunt about this. there's a lot of talk about spending another half a trillion dollars. all we are doing is moving money out of the private sector balance sheet into the public sector balance sheet. if people do this and people choose a public option -- this is a choice left to the american people. we have insurance company bureaucrats making decisions for you. the president is proposing that you get to choose your own health insurance. if you want a public plan like to parents or your grandparents have, or you cannot have that. i think that makes an enormous amount of sense. that is the way we should go. if you do not have a public option then you should not do

reform because it is not really reform. you should not put $1.5 trillion into the system we now have. the system we have now does not work. it does deliver good health care, if you are one of the 80% of the people who have it. it is going up five times the rate of medicare costs. it is going up at a cost of + the right of the canadian cost. host: what is the most efficient way in your mind to do it? guest: what the president is saying is if you want -- if small businesses would like to get out of their health insurance obligations, they can do that in this plan. they can sign up for the government auction or for the private option. that takes the burden of the cost of the businesses.

we're losing jobs to canada and china. they do it indirectly through taxes. their taxes are not going up at 2.5 times the rate of inflation every four years. our business premiums are going up for 30 consecutive years. that is insane. to get your question about taxes, here's where i depart from the administration. it is understandable that nobody in washington wants to pay for this. there's a lot of stuff about preventive health care and we are going to tax health care benefits and all this stuff. nobody wants to make tough choices. the tough choice is a carbon tax. the blue pay the highest percentage of their income in gas tax are the people who are least affordable to do its. a lot of americans without a lot of money have to drive long distances both ways to get to their jobs. the best jobs are also where the

most expensive housing is. people with modest means sometimes have to drive 50 miles each way. those people pay a disproportionate share. i supported this time because those are the very people who do not have health insurance. if you said to an average american, would you give me permission to raise your gasoline tax by 10 cents a gallon if i could guarantee that you would have health insurance that you would never lose? you and your kids would always have health insurance. i bet you that 80% of americans would agree to that. host: our guest will be with us for 50 minutes. if you want to ask him questions, you can do so on -- republicans, 202-737-0001, democrats, 202-737-0002, independents, 202-628-0205. does taxing health care plans?

guest: i would prefer not to do that. if you tax -- that is essentially what senator mccain wanted to do during the presidential campaign. in the long run in this country, the employer based health-care system is a detriment to our economy. i also do not think you can uproot it overnight. there was a survey of ceo's. much to my surprise, most people run a major companies prefer employer based. they think they can get their arms around the cost. they like it and they feel they have some control over it. a lot of innovation in the health-care system comes from the employer based system through most of the good will miss work comes out of the private sector. they say, how can we get our arms around this? sometimes they make sure their

employees use the gym. they have all this programs. they have certain foods in their cafeteria. if you work to tax health care benefits, which is what senator mccain intended to do, i think that is too fast. and the employer based system is going to end, let it and because people wanted to end. the key to president obama's program is, if you like what you have, you can keep it. the government is not going to tell you anything. they are going to give you more choices than have now under the republican insurance company rule. let the american people make the choice. if they make the choice, maybe the employer system will end, and maybe it will not, but let the american people decide. host: governor dean has written a book.

is this out yet? guest: it is out on iphones. you can't pick up an -- you can pick up an app. host: how much did the president and sole with you on these issues? guest: i do not think that would be proper. i'm not giving him a piece of the royalties either. caller: with all due respect, dr. dean, i researched the candidate in 2004. there many articles dealing with their healthcare reforms during your term as governor. quite honestly, it was not a good thing. sure, all the children in the state were covered under a health-care plan, including those whose parents already have health insurance.

you had taken thes-chip monday and demanded money, and rationed care. i read a story of an elderly person who could not afford to get false teeth until the next year. it drove doctors out of the state treated drove private insurers out of the state. what you're left with was a mess. i really do not have a lot of faith in this. the united states is not competitive because we are subsidizing it cheap, foreign labor. we refuse to put tariffs that they put on. they put a 20% tariff on all imported goods. we are subsidizing the house version of our jobs. -- we are subsidizing the outsourcing of our jobs. guest: i do not think you said one thing that was true.

we use medicaid and mated a middle-class entitlement for people under 18. other the massachusetts, which has just put under eight republican governor, we have put in some form of universal health care. we have the highest rate of insurance of any state in the country. we have the highest rate of insurance for children of any state in the country. i did this in 1991, in my very first term as governor, so it is not a mess. we told them back in 1991 to do what obama is now proposing. that is, you will not turn people away because they're sick. you will not charge or sick patients more than 20% above what you charge your well patients. there were a lot of fly by night insurance companies that were putting 20% in their pockets and in their shareholders' pockets. we have one of the highest

interest rates in the country. i think you're just getting that information. the thing about the elderly, it is true that when there were huge medicaid shortfalls in the budget crisis during the first bush recession, we had to cut healtout dentures. that is true. . it is not true that the rest of the world as a 20% tariff on all of our goods. host: your state's health-care plan came up in a conversation we had yesterday. i want to show you what he had to say. >> howard dean's wife is a family practitioner. i have not had a conversation

with her. i just read what she wrote. she dropped out of the medicaid program. reimbursement rates were not sufficient for emergency for doors open. -- for her to keep our doors open. when you start talking about reform in the system and covering more people, but if you are reimbursing doctors at a lower rate from what they are currently receiving, then that little plastic card that says i have insurance, therefore i have access, you do not have access if there are no doctors. part securely -- the special your primary care doctors, who we want to incentivize. we want to encourage people to stay healthy. we want more doctors like that. you are paying them less and less. the best and brightest are not going to go into medicine.

guest: it is interesting that two of the doctors on the program -- the republican doctors and i are at such odds. dr. coburn has a different point of view. he is very conservative and by not. dr. gingrey is quite wrong. my wife is named judith, not elizabeth. good thing he is in congress because i would hate to see what he would do to patients. caller: how come none of the democrats or any republicans are calling -- i believe in talking to people in the health-care industry. illegal aliens cost us $300 on

$1,000. who is going to address the situation? guest: the numbers are not right, but the problem is right. we do not pay 30% of our health care costs for undocumented people. here's the dilemma. if you are a doctor and somebody comes to you, you have taken an oath to do the best you can to get them well and get them treatment. somebody ends up paying for that. their cause gets spread around -- the cost gets spread around. it does make a real difference. the obama plan would not cover adult undocumented people. that is a tough choice as a doctor to say that, but we cannot be abandoned for people who are sick all over the world. -- we cannot be a magnet for people who are sick all over the world. that is a decision that has to be made.

i do believe that we ought to cover the children treate. i also believe that if you do not cover children, you end up with a much sicker adults. should we cover undocumenteds? no for adults and yes for children. why do we have this problem in the first place? that gets to the entire immigration problem, which is probably more than we want to talk about on the show. it is not as high as 20% or 30%. it may be in some areas. there are some places where that could be true. as a national figure, it is not so. host: the discussions about providing health care, where do prescription drugs fall into this, and especially how they will be paid for? guest: prescription drugs will

continue to be paid for as they are, as a combination of insurance and out-of-pocket cost. one ththing that will happen is there will be more focus on trying to get the best drug for your money. there's something called comparative effectiveness research. for some reason, the republicans do not like this. it is the facts. host: is that a generic versus brand name? guest: yes, there are some generics that are as good as brand names in we should know what they are. i think the conservatives are worried that the government will tell you what to do based on what the research does. that is not so. if you have a generic drug and a brand-name drug and they both do the same thing, they both of both be as effective for every patient. with a few exceptions, there will almost always be a time when you need the proprietary

drug. i did the government knows this and they do not impose any of the kind of controls that conservatives are talking about all the time. they know that drugs were equally for 70% of the people, and there may be 30% of the people that you need to have the brand-name drug for. you need to give doctors the flexibility. the idea that we should not now with the facts are, that makes no sense. host: dallas, taxes on our independents line. caller: dr. dean, i agree that we need to move to a not-for- profit health care. like you said, open medicaid to everyone. guest: medicare. caller: medicare, right.

if we had to create a new tax, just like they take your fica out of your check before you have a say in it. i think 2% instead. if i am paying 90%, as long as everybody else will take 2%, i think that's a good idea -- if in the 2%, that is a good idea. guest: they do some form of it in every other democracy in the world. why is it that here we are struggling with their health care costs and making us economically and competitive. we're losing jobs. every country does it differently. yet, the conservatives are renting and reagan about too much government control. -- the conservatives are ranting about too much government control. we should at least give people the choice. the president is not trying to

make anybody get into a system that they will like. why are the republicans against giving america the right to choose? host: the e-mailer asked by the u.s. is ranked 37th in the world. guest: because our system is not effective. you can get terrific health care in this country. most people do. the problems are that a lot of people did not have very good insurance. if you have a $10,000 deductible, or a lifetime limit of $100,000, that will cover most of the pretty well. this is insurance. most people is not good enough 3 there will be the tragedies of people who get cancer, or people who get a very complicated disease. -- most people is not good enough because there will be tragedies.

these other countries -- everyone is covered. everybody has a medical home, a primary care provider who knows when you need to go to the emergency room and when you do not. who can get you through the complicated medical system. everyone else has a system that is understandable. medicare has its faults, but everybody understands that you are covered. you go to the doctor. you pay some. medicare pays some. everybody has insurance and you do not have to worry about it. if you are under 65 in this country, it is crazy. kudos? there is no real system. other countries have a real system. for. -- who knows? host: senator colbern mention of the swiss model. guest: the swiss model is interesting because it is entirely private.

it does not have a big government run program, unlike almost all the other countries. the other only exception is in another lessonthe netherlands. this was modeled depends on regulating the insurance companies as if there were private utilities. in the states that did inde regulate -- in the states that did not deregulate, they tell the companies, to profit they can make and they limit that. that is what the swiss model does. i do not think -- i think our insurance companies would resist that. dr. coburn would like the swiss model. i think that would be fine, but i do not think we will ever get the insurance companies to say okay to that. caller: my question is -- i am

on medicare and that is my only insurance. i recently had a device put in and i had my bill from the hospital that was $29,000 for an overnight stay. i was speaking to my brother-in- law. he had a stint put in with a private hospital and private insurance in his bill was $190,000 and he stay overnight. can you explain to me how there can be that much difference in the same procedure? guest: that is a wonderful question and it shows how ridiculous our health-care system is in this country. neither bill means much. the bills do not reflect what the hospital cost. it reflects how the hospital

games out there charges. they are allowed to charge a certain amount for insurance companies and a certain amount for medicare. i remember -- my dad passed away in 2001. i remember getting his bills. i'm a physician. is so hard to understand those things. the medicare bills are much easier to understand and the private insurance bills. the answer is, it does not cost five times as much in one hospital as it does in another. that is just what they feel like billy knew for. it makes no sense. if you're not so well off and you are under 65 and you do not have medicare, you pay a lot more if you have no insurance then you do if you have insurance. the insurance companies negotiate you have to pay a certain amount for any particular procedure. the hospitals can charge whatever yothey want. the system is insane.

i'm glad you called in. that's a perfect example of how little sense our current system makes. host: a previous caller asked how hospitals would change under either of these programs, primarily what the obama administration wants to do. >> if you continue with a private entrance, hospitals will continue to do what they're doing. if you continue to keep that insurance, you will continue to get the rat's nest of unintelligible bills. if you are in a public plan like medicare, if you choose that option, you will get a bill that reflects what the government and the hospital and negotiates, just like they do under medicare. people say that means the government will tell you what to do. no, it means there will be sensible prices.

and there is a feedback mechanism. the government does not get to tell you how to run the hospital, but the government does get to put downward pressure on our price structure. we know that hospitals that have some financial pressure to operate operate more efficiently. host: does not lend itself to republican claims of rationing health care? guest: no, they have a high- priced political consultant who tells of how to say this. there is no rationing of health care and the united states except by price. if you cannot afford insurance, then there's rationing of health care. there's not a board that tells you what you can have and what you cannot have. for the most part, that does not exist in other countries either. there is some rationing in canada because you have to wait in line to get procedure sometimes. although, there were satisfied with their system than we are.

there is some rational 9ing britain who will not pay for your expensive drugs for the end of your life. -- there is some rationing in britain. we are not going to have united states rationing in united. -- we are not going to of rationing in the united states. conservatives were against medicare. we got medicare passed under lyndon johnson with almost no republican support. they thought it every step of the way. here we are and medicare is the difference between whether seniors are dying in droves or whether they get recendays and h care. you have to put these conservative ideas aside. they get told what to say by a very high-priced political consultant paid what they say is not show. -- what they say is not so.