debate. all those voices are part of the health-care debate. host: thank you for being here. we will continue our conversation about health care reform. later we will be talking about energy reform. >> tonight is the annual radio and television tower --

correspondents' dinner in washington and c-span will bring you live coverage, including president obama's speech, beginning at 8:25 p.m. eastern time. >> people don't want to think of roosevelt's conservation as much as a policy as much as a passing. almost 240 million acres of wild america. so now as people are talking about environmentalism and the green movement, roosevelt is becoming the key figure to understand because he was the only politician of his day that the board darwin and understood biology and understood bird migratory patterns and understood meeting habits of deer and elk and antelope and actually did something. >> sunday, the first of two hours with douglas brinkley on wilderness warrior, sunday night at 8:00 on c-span or listen on xm satellite radio or download the c-span podcast.

>> there is still time to get your copy of c-span's 2009 congressional directorate. with information on house and senate members, cabinet, supreme court justices, and the nation's governors, plus district maps and how to contact committees and caucuses. $16.95, on line at cs -- c- span.org/products or call 1-877- on-c-span. bamako washington journal" continues. we are host: continue with our conversation on health care reform from -- with earl blumen hour, democrat from oregon. arlen to reference "the new york times." health care reforms moment arrives, again. talking about the convergence of politics and economics at this point, which the white house budget director peter orszag called a remarkable moment did the right, students of history realize they are only now

entering the riskiest days when more details generate real opposition. to date, a fragile coalition of stakeholders have been attacked at the table. but it may not take much for their guiding principle of shared responsibility to fracture into shards of self interest. what are the prospects of health care reform this year? guest: i think there are better than what they have been in a generation. president obama, when he addressed the a and a held up a magazine i had given him the week before, "harper's magazine" october of 1960, talking about the crisis in american medicine. it has been with us a long time, but what is different now is that we do have a president who has campaigned on this, focused not just running for office but after he was in office. and the forces that are at work on average every day americans are such that the pressure is not going to let up and we do

have something that i have not seen in my political lifetime in terms of people coming together understanding that we cannot continue going like this, we've got a president willing to provide some leadership, and there are some obvious solutions that can actually bring us together. host: what are the prospects of specifically public option? guest: i think they are reasonably good. it is ironic, there are some who are convinced that the public auction is tantamount to a single payer canadian system. there are others who are holding rallies room country saying that a public auction is a sell out to the insurance companies. but as a practical matter, a public option would give more americans a choice. we keep the insurance system in place, but in many places in america, people don't have actual insurance competition. there is just may be one large

provider, maybe two. this would give all americans a choice with an opportunity to have some modest subsidy to make sure that it is affordable. i think back on its merits, the case is compelling. the politics, we will see, but if it with a pretty good shot. host: how do we pay for it? guest: first and foremost it is important to understand that we as a society are already spending 16 cents to 17 cents of every dollar we spend on health care system and the federal government is providing billions of dollars every year. 16 percent of all federal outlays just for medicare. there of two fundamental principles -- what -- and i support the president and a thing there is bipartisan support, is to squeeze more value out of the spending that we have right now. there are some extraordinarily high cost low value areas of this country with medicare that

is simply shortchanging the patient while shortchanging the taxpayer. i do not think there is anybody who on the believes we cannot expect significant money out of that. the president thinks it can provide half the savings. i think if we do our job right, we can meet our target. will there be some additional costs associated with it? absolutely. it is going to be on the order of magnitude of $50 billion a year. that is less than half the cost of one year of the bush episode in iraq. this is within our capacity. host: our first call is on the democratic line, and become -- andy from lake oswego, oregon. caller: i am president of an education association and i have been on the front line bargaining for contracts, and have witnessed the ever

escalating costs of health care dominating the sessions. i am not seen anything in the debate in congress that convinces me that what will come out will be anything that actually rains and the cost of health care, which is the most fundamental issue. frankly, it seems to me when single payer was taken off the table -- i'm an investor and i invested in pharmaceutical companies, health care, hospital companies, and 8 tons of money off of it personally -- but the for-profit model does not work. it is generally recognized that somewhere between -- it comes out of the money coming out of pocket for profits. i am not seeing anything in the debate in congress that convinces me a tiny bit that the cost of health care will be brought down. in fact, when i start hearing that my members benefits are going to be taxed and that is going to be used to pay additional money into the system, which i am hearing is that the cost of health care will go up and not down. i need to be convinced frankly that anything that will come out

of congress this morning to actually lower the cost of health care. guest: thanks. first of all, i think it is important that sophisticated people like you stay involved with the debate, with those of us at home, and here in congress. and i can say for certainty that your representatives in the education association are actively involved. there are three things that are driving that cost. first and foremost, we have a huge number of people right now who are either uninsured or who are getting inadequate care. every year the contracts that you negotiate, the health care benefit for those who have health care, are picking up more and more of the slack. and if we don't deal with having a comprehensive national approach, what will happen is inevitably those costs are going to escalate as more and more people drop out. this is a huge source of cost increase and we are going to fix that. the second deals with what is happening in areas where there

are rewards for inefficient services. in oregon, that is much less the case because we are a low-cost, high-quality state. but that is not the case around the country. we need to change the reward so you are an incentive right now -- or again it shortchanged over a billion dollars a year because of the way that we perversely reward some people for procedures rather than treating the needs of their patients. last and by no means least, by being able to have more choices available for people rather than just cherry picking -- many of those insurance dollars are spent in denying people coverage. the united states spends more money denying people coverage because of our fractured insurance system than some nations pay and health care in total. by having this reform that makes clear that pre-existing

conditions -- you will not be jerry picking -- that is another area of savings. those are three very specific things part of the work we are doing and how that will make a difference for you and your members. host: mary on the republican line from hancock county, ky. caller: good morning, c-span. thank you very much. i wish you had a 24/7 program on this, you guys letting people colin and stuff like that. i'm a chronic pain patients -- i'm not good mornings, but, sir, i don't know -- we do not in this country want socialism in medication. i do not want somebody telling me how i could do what, when i can do what and where i can do it. i have pre-existing condition, i have -- i am taken care of, my

husband is also a union man and he is not a democrat. guest: it is not a requirement. caller: if you all want to help pay for health care, pay for your own in the congress and let the president pay for is an each member of your family instead of the american public paying for your insurance. pull it out of your own pockets. guest: first and foremost, i do not have a government sponsored health plan. people in congress who do are treated just like any of the other millions of federal or employees, not dissimilar to what many of the americans who are fortune enough to have come employer provided health care. but first of all, there is nothing here that is going to be "socialized medicine." it will provide another health insurance option so that all

americans can benefit from what york viewer just called in, because there is not everybody who has that choice now. we have had medicare now for over 40 years. some people resist it because they were afraid it was going to be open " socialized medicine." after 40 years we have gone from having american cedar -- senior citizens having the worst health condition in the country to having the best, and it has not socialized. they have their choice of doctors for those of us who, fortunate enough to take advantage of the program. i think that is an illustration that you don't have to fall into the rhetorical trap. and there are 40 years of -- is 40 years of evidence. host: of the independent line, richard from connecticut. caller: good morning, congressperson. i take herbs and supplements come and so does my wife, at the

cost of probably $60 to $70 a week, and we do not get rebates or a tax deduction for this in any way. now, the 1994 pact, if you ask some of the older senators, they will tell you that this act received the most public comments ever of any act of all the time they were in the senate. but since that act, the fda has been trying to end run this act and, out these decrees -- i forget what they actually call them -- not legislative, but trying to take away the power. the fda can't even control or do a good job at the food supply, and is a revolving door. what i would caution you, sir, is -- it is coming.

that should be defeated. if you believe in choice and the american citizen, a defeat that. that is coming out of europe, part of nafta. lastly, i have been watching the senate proceedings and they talk about malpractice -- that is the problem that drives up the insurance costs. yes, it does, and insurance doesn't drive up the cost, but i was subject to a medical accidents and unless you died or you are severely in a,, you tried to sue them, you need money to sue the system. guest: ok. host: talk about medical malpractice. guest: i just want to make a reference, something coming out of europe, i do not see how that will relate to north american free trade agreement but i will try to circle back on what the

caller mentioned because it is new territory for me. merkel malpractice is cited as one of the major -- medical malpractice decided as one of the major factors, but one article about a city in texas having the highest medicare costs and the nation, this little town. but compared to help pass so, in the same state with the same laws governing medical liability, had a wildly different cost. there are other drivers. in oregon, there are concerns that i heard from my friends in the medical profession about the impact that's medical liability has on their costs, and it certainly has on things like obstetric, for instance. but we are a high-quality, low- cost state. so there are other variations that are much more significant, based on the evidence i have seen.

host: laura on the democratic line from denver, colorado. caller: i have a question about health care. i have been with kaiser permanente for 11 years. in november when the switchover of everything going on, they were going to george three-time is the amount, and it went about doubled each month so i had to quit after 11 years. so i am wondering when they say you get to keep the insurance that you have, that is really not true. and i would like to know which country does this work in? guest: first, let me say that nothing under the legislation we are working on an house, sort of unprecedented effort where you have three committees working hand and glove literally with the members, the leadership, and staff producing -- nothing in

that would prevent you from keeping the insurance that you have. the president says, and i happen to agree, and it cannot deny people who are happy and satisfied with their coverage to be able to continue with that. stay with their insurance, stay with their doctor. that's great. what we are proposing is an alternative to many americans is simply don't have competitive choice in the areas that they live or can't afford it, so that they have a fallback. that is what we are attempting to do. if our proposal was enacted, then the person who felt uncomfortable with how they were being treated by their insurance company would have another choice, a guaranteed choice, with the public plan, they would be able to go into an exchange where there would be other choices that will be available to them and we would health even the rules of the road.

so even people with pre-existing conditions -- i get a hint of that from your caller -- would be protected. they would not be denied coverage because of pre-existing condition. which will help extend the promise -- the promise of insurance would be to spread risk and it would spread it around the country and help stabilize costs while giving people more choices. host: joe on the republican line from princeton, new jersey. caller: good morning. you talk about the health care service in oregon has been provided. i am in member -- they did a survey last year that showed the state of oregon health care is in crisis. almost half the people have major problems, a large percentage have minor problems, about 89% total of the problems were either major to minor in the state of oregon. rising health-care costs and service. to bring that kind of a system

to a national level steers the heck out of me. i happen to me on medicare and frankly i do not like the idea i was forced to take medicare -- guest: you are not forced. there is no law that forces you to take medicare. you can pay for it out of your own pocket, you can come up with other options. but we spend 16 percent of the federal budget to give people a choice, making a huge people -- different lots of americans. there is no gun in your head. caller: medicare has to be my primary and by private insurer has to be my secondary and now medicare is gatekeeper for united healthcare and instead of getting the test that i need before preventative maintenance, i have to wait a year for a prostate exam, concerns about pet scans and cats can't ping allowable and my wife had lung cancer -- guest: i would strongly recommend. you have great people in new jersey. i strongly recommend you talk to

your member of congress about being forced to wait a year for a prostate exam. let me go back to my comments, objective data by independent sources that evaluates the costs of health care and looks at the outcomes in terms of how long people live. the rates of various diseases, how procedures people -- people " look and compare community to community. the objective evidence is that the overall costs and oregon are no war and the outcomes are better. are people concerned in oregon? you bet they are. they are concerned about the costs of health care, concerned about having enough doctors, they are concerned about the trend line. that is one of the reasons i am working hard on this legislation is because we are in a position, whether in a state that has high quality-low-cost before low-

quality-high cost, we are all on the path that is not sustainable. i have concerns about my friends and family. i had that conversation with my son and dinner sunday night when he came over in terms of talking about what is happening to his premium costs. so, yes, people are concerned, but the objective data suggest there are lots of variations and the data suggests there is room for improvement in ways that will not cost the taxpayer a lot of money and, in fact, will be able to improve the quality of health care what the money we have. most of you introduced a trio of health care bills and one was talking about medicare costs. explain that legislation. guest: part of what i am hopeful we are able to do under medicare is to stop penalizing the state's that are efficient. they ought to be rewarded. we have what we call an

inefficiency bonus. so we are able to send a signal through the pricing mechanism that this is what we want. we need to start bending the curve, which is the famous phrase you hear around in washington. right now there are -- the system of rewards procedures, the system rewards tests and activities, but it doesn't reward outcomes. and we need to change that. again, that notion is the only way you pay the person build your house is five the number of faucets that he installed, the house would look much different than if you had an overall contract and follow a plan. that is what we need to do and we need to start rewarding the people who are meeting patient's needs, and we can change the medicare system to be able to deal with it in ways that are more compassionate and more effective. it another piece of legislation

i introduced was to make it reimbursable for a medicare paid dr. to sit down with a patients and their family when they are dealing with the end of life, the most the local situation and of us would ever face with a lot -- loved one, and actually for the most people, the bulk of their lifetime health care is spent in those last few weeks, months, of life. and yet, right now, we don't pay a doctor to take an hour and work with the family to find out what they want, what they need, give them information. but we will pay all sorts of money to have another tube inserted, another test. we have to change that, and we can. and this is an area where i think there is strong bipartisan support to give people the care they need that will actually probably save money and increase satisfaction. host: the independent line, from

louisiana. caller: there is a reason why congress has a single-digit approval rating, you are probably one of them. disingenuous salesman for the rich, money talks and the people walk. your precious obama -- the committee for the health care, the panel for health care, had every representative on that panel was there from the insurance companies. not one person -- even though the public is in favor, and the majority of people are in favor of single payer health care just like every other industrial country -- were not allowed on the panel, not one person. 19 doctors and health care professionals -- professionals were and audience protesting that were thrown out. there are two ways you could

look at having a national defense. you can spend the vast amount of money, the majority on bombs and terrorize the world, supporting your imperialistic wars that people don't want that you just spend more money on that you don't want. you can do that or you can spend the money on keeping your people healthy, well-educated, said, and howls. that is how you have a strong national defense. but not you guys. you are not our government anymore. you have about as much credibility as a you give us now. host: did you have any questions? caller: fy was a single pair on the panel, why won't you talk about it and keep injecting the insurance companies, why do we have a health care system that benefits of the insurance companies?

these insurance companies are nothing but gangsters. host: ok. guest: well, the conversations i am involved with, there has been spirited discussions on a whole host of options. i just mentioned -- it was kind of interesting that some people are convinced that the public auction was a sell out to the insurance companies and others are convinced that it is the path to single payer. representatives at a hearing in congress in the house this week that dealt with single payer. the present and that the vast majority of americans just want to get rid of all health insurance and want a single payer system -- first of all, that is not what happens in these countries. you can buy health insurance and other countries that have single payer. but that is not where the

majority of the public is. much more nuanced than that. many people act like they're dr. -- they were apprehensive about major change. they are uncertain about certain areas. we have attempted to be able to deal meaningfully with problems. absolutely we have to have more consumer choice. i think it is incomprehensible -- some of the benefit books that employers provide give the choices among health plans. we want to standardize, in common english, we want to have an honest competitor with a public plan that will be able to get the basics to people. this is a complex and spirited the fate -- debate, but i think what is happening and capitol hill is trying to reflect the realities of what we have now

and how it is financed, how it is organized, with where we want to go. and i think the options we are provided -- providing, making medicare more efficient, giving consumers more choice, providing resources for people to get into the system will can't afford now, and to reduce this notion of health insurance co. spending all of these resources to keep people out by changing the rules so that we got a level playing field, i think these are things that the vast majority of the american public want and i think it is the nexus of where we go in the future. host: let us take our last call from elaine on the democratic line from oakland, california. caller: yes. host: you have a question? caller: i would like to know about the health care. i was born in 1962, the oldest and my family is 49 years old, i

live in oakland, calif., we have bacteria in our walls from china -- just people died -- three people died last month. if it was your family -- bush took all my money -- tell me jesus said you have a right to have a better. i was born in 1952, waiting for years for this, and a good to court today and all of you guys -- 5 percent white supremacists -- host: we wanted it there. congressman earl blumenauer, thank you for joining us. guest: up my pleasure. host: we will be back with the president and ceo of oil and gas company anadarko out of dallas, texas, talking about energy reform, climate change, and the economy. we will be right back. [captioning performed by national captioning institute] national captioning institute] [captions copyright nation