dial those up or down to get at a number that the american people will benefit from by having more people in the health care system, fewer people at the emergency room, fewer people without -- who don't have a doctor-patient relationship that keeps them well, the relationship that charles was talking about. many of our doctors were on the solutions group. we think access to care is important. david, do you want to talk about that? >> i want to mention on the score, as you know, the majority party is first in line for scoring their legislation so we are at the end of that line. and we are -- those at the front of the line we haven't actually heard all of their numbers but it is important that we have a bill that is a common sense approach. that is where america is on healthcare. >> [inaudible] >> let me just say --

>> [inaudible] >> if i could just finish, we are not going to have a bill that is large are than the g.d.p. of most country which is what we are beginning to see roll out. that will be important. and as we move forward and actually have legislative language that we can get the scores back we will be making them public. >> do you really think you can put out a bill whether fees, tax raises, something that could be identified as a tax, i mean that any healthcare bill could be producing? >> i think what is important is to try to identify the right policies and what is important on healthcare is we have an open debate on this that the american people are part of that we don't follow the stimulus model where it is drafted in secret and pushed through without committees exercising their authority over the legislation because it is not so much about us but do the american people have a voice in something like this. on stimulus we are talking about money but here we are talking

about people's health. so, this is why we want to contribution these ideas. i think that we can get a lot of support for what we are doing and i think the american people need to get behind what we are doing and clearly if we move forward and this bill is on the floor we are going to have to have a bill that is paid for and that is going to depend on what the scores are that come back. until we get them i think it will be differ and let me say my colleagues in the majority on the ways and means don't have a score on any of their bills. we don't have legislative text from them and they are at the front of the line. so hopefully -- but today is about talking about an american vision for healthcare reform, one we believe will get a lot of support. >> don't you have a ball park of the cost or how many will be covered of uninsured and don't you have a ball park of how it will be paid for >> we do have ideas. one section of our bill says if you are a dependent and under

the age of 25, if you can simple ly stay on your parents' health insurance that covers seven million people. we want to talk about those with the american people. we think that can be done. we think hopefully that will be a bipartisan provision that people get behind. >> [inaudible] a lot of people [inaudible] >> and if you don't get your way of no government involvement [inaudible] >> i intend to reach out to senator conrad and others and get more specifics from them and where we live in the midwest the idea of co-ops is not an unusual idea. i would like to see what they are thinking about there. it depends how independent they are allowed to be, whether they would be a reasonable competitor or not. but remember, the very same people in had debate who were saying there won't be enough competitors were the same people when we added prescription drugs

to medicare who said there wouldn't be enough competitors and those people most of them the day that program started said there are too many competitors, people won't be able to choose. i think the marketplace, you don't want to underestimate the marketplace dallas. you don't want to underestimate the kinds of of things that mr. camp just mentioned. if you expand family coverage to people who are just out of school who haven't yet found a job that includes insurance to keep tell on family coverage, that is seven million. if you made it more likely that people who could have insurance at work sign up for it, that is 10 million. so, suddenly you are talking big chunks of numbers out of the government responsibility and you are putting them back to where individuals can be responsible for their own healthcare. the other thing here that you don't want to overlook is efficiency in the system. there are probably unscorable but let's see if the democrats can get them scored. if this is is an i.t. savings in the system, we are for health

i.t. if there is a transparency savings in the system, we are for it. i think all of those things will ultimately save money, whether the majority can convince the c.b.o. to score those or not is something we will be interested in seeing. but we will have a significantly lower price tag thand there are four or five different places to go and efficiencies in the system and competitive marketplace are two that nobody is really talking about to the extent they deserve to be talked about. >> people are talking about [inaudible] is that on the table? >> it is certainly not part of our plan. and i can't tell whether it is part of the democrats' plan. mr. mccain talked about it. mr. obama said he would never if go there and angle he is there. mr. rangel said it was not be

part of their plan and now i think it is. i don't think it is necessary to tax that benefit. i think it is helpful to give employees more knowledge of how it is used. we have a marketplace now but it is not the kind of competitive marketplace that really controls cost. a marketplace where 61% of the american people under 65 get their health insurance at work and normally their employer is only talking to a couple of people about whether you continue with them or go to somebody else on an annual or triannual basis. i can see a much larger market mace with that, than that, if the employee also has some options beyond what is offered at work. that makes people who offer a policy at work want to be more competitive with the policy that is offered at work. if you are if you are a big insurance company and offering a policy through general electric or

anybody else you want people to stay with the policy. so suddenly the competitive dynamic is substantially different than it is today. so, competition, savings in the system itself, new technologies, new transparencies, are all part of keeping costs down as are just simply new ways to get people into the current system that are not there now by making things like you have to opt out of your insurance at work rather than opt in would be the things we would look at. and i guarantee you we will bring you a bill that costs far less than the democrats and will provide better results for the american people. thank you all. [captions copyright national cable satellite corp. 2009] [captioning performed by national captioning institute]

>> now a briefing on healthcare legislation with jim cooper and others. the congressman talks about his opposition to the use of regu r reconciliation. that would allow it to pass with 50 votes in the senate but would make it harder to change the bill. it is about 10 minutes. >> thanks for being here. sorry about all the votes. i'm jim cooper from nashville, tennessee. i support healthcare reform this year. has does everyone on this stage. we all share the goals laid out by the president in his june 2 letter. i believe that every american should have high quality affordable healthcare. i believe that reforming healthcare should be congress's top priority. let me repeat that. healthcare reform should be

congress's top priority. we should get it done this year. we are not here to slow it down. so, don't believe the phony talking points that you are being circulated with that are saying we are trying to slow down the process. that is not true. the process unfortunately is already creeking under its own weight and we have not even a seen many of the bills yet. so, don't take my word for it. on the contrary, we are trying to ensure that reform happens. we are here because we see healthcare reform bogging down in the senate and we are worried about the chance of achieving healthcare reform this career. what happens worries me abuse if it is bogged down we will have to go through the reconciliation process and many people misunderstand this. the way reconciliation works it only applies to a bill that reduces the federal budget deficit within the next five years and a bill that doesn't really reform the insurance or medical sector. so, essentially reconciliation does not apply.

essentially, you need 60 votes in the senate to pass a good health reform bill, not s51. that is a huge difference. so it is clear the target is at least 60 votes in the senate. when tom daschle was up for confirmation he said we should aim for 70 or 80. 60 is the minimum, not 51. there are many of my cheeks oll to speak. i think what we are trying to do is follow the tradition we saw yesterday when former senate majority leaders joined together to put forward a bill that covers every american and that is affordable. tom daschle can do it, bob dole, howard baker, we can do it as well. i will turn it over to my good friend and colleague from delaware. >> first i agree with jim on the legality of the situation in the senate. i think they are going to need

60 votes. that is exactly what the american people want. you often hear that the disease does not choose whether you are a republican or a democrat. i think the solution of this doesn't choose either. we need to work together hard on getting this done. i see many good ideas that have been introduced in the senate, discussed in the house. the republicans have introduced prim pri principles. these are all concepts that could be put that legislation and i think more than any other legislation we need to work on this. one of the central themes needs to be cost containment in some way or another. we have a huge cost issue with healthcare to individuals, businesses and the government and we need to work on that. we need to work on making sure the people are well and kept well and we need to make certain we have come one a solution that we can wrap our arms around and say this is good for the future of the country. i look forward to working with

my colleagues and everybody in the house, senate and white house to get this done. >> let me introduce a physician from huntsville, alabama, parker griffith. >> thank all of you for being here because this does require a bipartisan effort. every year that goes by without a health care reform bill we lose 18,000 american lives needlessly. this requires a bipartisan effort. a partisan bill will not get through the legislative process. we can work together, we know, we recognize we have strong polarizati polarizati polarization on many issues. this shouldn't be one of them. the access to affordable healthcare is something we are all agreeing on. we are all agreeing on the diagnosis. we are not agreeing on the treatment. but we have to come together to do that. i think that we will. i think that the effort of this group and many more downstairs

that are in agreement with us that despite our party differences, this is a must for american business and it is a must for the healthcare of america. so, i preeappreciate the opporty to voice that. i don't think that we can retreat into our r and our d homes. we need to work together and get it done. thank you. >> next is joanne emerson from missouri. >> thank you for being here today. i echo the comments of all of my colleagues. let me also mention the cost issue and we have to balance cost with access. there are a lot of cost containment ideas that we have had individually and collectively. that has to be part of the process because we have all seen how expensive the senate bills are and they will only get more expensive as they keep adding parts to it.

so, we believe that we all need to be involved in this discussion and it shouldn't just -- what comes up shouldn't just be written by those people who sit on committees but, rather, you should pull expertise of all of us. there has to be balance. >> unfortunately as you see we only have two minutes and 40 seconds left before we have to go downstairs and vote so that is the remaining time. >> are there particular things that you as a group are concerned about that you think are bogging down the process? >> we are really not here to discuss the particular bill or even provisions. we are here to discuss the target we should be aiming at, which is bipartisanship. which is at least 60 votes in the senate and hopefully abipartisan majority in the house. that is the target we should be aiming for. the senate finance committee has delayed consideration until aft afterthe july 4 recess.

we hope they will all focus on a bipartisan. >> but broadly [inaudible] does that mean you will have [inaudible] >> we don't know what a public option looks like. nobody has explained. there are probably 18 different types of public options that you could look at. that is fine but not all republicans are saying that. what i'm saying is that you have to look at what the option is and how you define it. and that is not an endorsement of a public option. it is just that we don't have any specifics on anything. so, how do you make a comment on it? medicare is a public option. that is what we are doing today. but so is some of the ideas that jim and i came up with and mike in the healthy americans act. >> some of you [inaudible] >> again, the key of this press

conference is bipartisanship. we are not here to slow down the process. we are here to hit the right target. so many press stories have just assumed that reconciliation applies. but it applies to a category of pills that the senate is completely unlikely to ever pass and wouldn't be called health reform so you have an anchor target of at least 60 votes. with the illness of certain senators, absence you have to focus on getting bipartisan support early. >> are you happy with the efforts of democratic parties to reach out to moderates? >> we have work on those and unfortunately there are 15 seconds left in the vote. thank you for being here. [captions copyright national cable satellite corp. 2009] [captioning performed by national captioning institute] >> there is still time to get your copy of c-span's 2009 congressional directory. with information on house and

senate members, the cabinet, supreme court justices and the nation's governors. plus district maps and how to contact committees and caucuses. online pass >> >> through donations? >> i think you get a little bit from the federal government. >> grants and stuff like that. >> maybe from response source? >> it might get government funding. >> viewers? >> 30 years ago america's cable companies created c-span as a public service. the private business initiative. no government mandate. no government money. >> the senate health education labor and pensions committee held a series of meetings last week on healthcare legislation. christopher dodd of connecticut is acting chair. is stepping in for nor ted

kennedy. this portion of the first day's session is about an hour and 25 minutes. and forth, on the opening statements. let me thank all the staff and others who spent as much time as they have on this legislation over the last number of months. this -- the opening line, is one that gets s s said quite offer we're doing legislation this is historic for all of us. mike enzi said, and will say again today and i agree totally, all of us here on this committee have dealt with major legislation in our lives. whether it is my work with orrin hatch on child care or working with other senators on the -- on the no child left behind act, the family medical leave act, i look at colleagues here, john, you work on immigration issues,

others, major bills we have all worked on over the years that are huge and significant. but this bill affects everybody. 100% of our fellow citizens will be affected by what we do in the area of health care. every consumer, every business, every provider as well. and so this is truly historic, the journey that we're beginning this morning in this committee to deal with this issue. it may be that none of us will ever work on another issue as significant as the one that we're charged to respond to as members of this committee working obviously with members of the finance committee and significance and importance. and so we begin the markup of the affordable health care choices act. though he's not with us here in person, we make no mistake about it, we're still led by our chairman, my friend, the senator from massachusetts, senator ted kennedy. his life-long quest has been to ensure that no american regardless of where they live or what they earn be denied affordable high quality health care. i know he wishes he were here today to be presiding over and

chairing this committee. as i said, i talked with him earlier this morning. he's doing well. i informed my colleagues he sounded strong and he said he'll be watching the proceedings as they go forward. he also wanted me to remind everyone that people are depending on us to get this done, get this job done, all across the nation, families are struggling to pay medical bills and provide for their families, and the time for action on this issue is now. it is appropriate that this bill was introduced by senator kennedy. for decades congress has been struggling to reform our health care system and for the last 40 years, senator ted kennedy has led that fight. every administration, republican and democratic administration, since the late 1940s under harry truman have struggled with this issue of health care. every single administration. democrats, republicans, have tried to come up with an answer on how to deal with reforming our health care in this country. no issue affects more americans as i said at the outset, not a

single american who doesn't have a stake in the outcome of the success of the work we're embarking on. no issue is of -- is more of a moral imperative and the richest nation on the face of this earth, shouldn't have to be well off to get well in our nation. imagine if you will two children, any one of our states in this country, that are represented around this table this morning, one child's parents are fortunate enough to have good jobs, adequate health coverage. they would like to go and see a doctor. the other folks, their child has fallen on tough times. not to any fault of their own, they have been laid off, cost of their family has been significant, they don't just -- not just their income but insurance has been lost. they can't take their child to see a doctor. we cannot accept a health care system in which those two children are not both being treated the same. because of the circumstances economically of one, and the other, it is a vastly different outcome in terms of what happens

to them. when a family can't afford to take their child to see a doctor and get the coverage they need, here, it is simply wrong. i don't know of any one of us that disagrees with that. we have a moral imperative to act and see that that gap is closed, that no one in this country, no child in this nation, no family ought to be faced with those kinds of outcomes. when the small business owner finds himself having to choose between the welfare of his employees and the survival of his business, it simply is wrong and we have a moral imperative, i think, to act to close that gap. when a grandmother can't afford the prescriptions she needs to stay well, and has to cut her pills in half, that is simply wrong as well. and, again, a moral imperative to act. when millions of american families working hard and p playing by the rules in the wealthiest and most advanced nation in the world lay awake at night fearing one heart attack, one car accident, one cancer diagnosis could mean not just medical hardship but economic ruin, that is simply wrong in my view and we have a moral

imperative to act. our legacy, the legacy of those who sit in service to the american people at this moment in history will be defined by whether we are able to act as a committee, as a congress in concert with the administration, the obama administration. our constituents judges, historians judge us as they will, let them say that despite our political disagreements and different perspectives, we came together and in recognition of this moral imperative and took action. i encourage a robust debate and i'm confident we have already seen some of it this morning and we'll have a robust debate on how to proceed. i encourage creative thinking and new ideas that every member of this committee are capable of providing in a debate such as this. but at this moment, in our nation's history, when so many have fallen through the cracks and so many are teetering on the edge, i'm not going to accept failure and i hope you won't either. senator kennedy will not accept failure and neither will the american people at a moment like this. just as no issue is more important, no issue has been

more difficult for the congresses that have preceded us to address. presidents since harry truman recognized the importance of reforming our health care system. but the issues involved are complex and the political realities are really hard and really difficult. this time is different, however. groups and individuals who in the past have lined up in fierce opposition are today sitting side by side, many cases, because they know what we all know, that is the status quo is not only unacceptable, it is unsustainable. some of these same long time opponents of reform have participated in town hall meetings, as i have, and i know many of my colleagues have as well in our respective states for the past number of months. because we know that it is not only through an open and collaborative process that we will be able to succeed, but also imperative to people understand what we're trying to do. this time is also different because this time we simply don't have a choice. the stakes are far too high to accept the status quo or not to

meet the challenges that we have been asked to address in this committee as well as in the others and, again, collectively as a congress. today we're spending more than $2 trillion each year on health care. no other nation even comes close to that number. nearly 18% of our gross domestic product is spent on health care. and by 2040, we're told by experts that 34 cents of every dollar we spend could be on health care. and for all of our spending, one in three americans went without insurance in 2007 at some point, more than one-third of medical procedures performed are questionable benefits and our nation as a whole isn't getting any healthier as we all know. as a nation, we continue to lead the industrialized world in infant mortality, adult diseases that were once never seen in children are becoming more prevalent, especially as the rates of childhood obesity continue to climb and we have failed to prioritize prevention and wellness, choosing instead to pay more to treat a disease

than we should have been in preventing the disease in the first place. make no mistake about it, the current path of our health care system is not only unacceptable as i said a moment ago, it is unsustainable. action on health care comes at too high a price for american families. premiums and out of pocket costs for individuals and families are likely to continue to skyrocket, increasing more than 80% in the past ten years. meanwhile, nearly 50 million of our fellow citizens are paying off medical debt, nearly half of all foreclosures and more than three out of every five bankruptcies, we're told, are being caused by high medical bills. we know that health reform is a difficult issue. if it were easy, we would have reformed our health care system years and years ago. but affordable health coverage for all americans is an essential. we owe it to our citizens to bring about the change that we need so desperately. if chairman kennedy were sitting in this chair, i wish he were, i know he would be saying let's

roll up our sleeves and get to work. so we have to do that. the bill we're marking up today is a product of a year's worth of work by committee members on both sides of the proverbial political divide and decades worth of study, of advocacy, of experience on the part of health care providers, patients and experts, who input -- whose input we are all very grateful for. what began this process, we started on a blank page, so to speak. we heard each other's ideas and put them on paper. and throughout this process we have incorporated many different viewpoints and strove to find consensus wherever we could. with this bill, the affordable health care choices act, i believe we will. we want to protect people's choice, and not to mandate choice and doctors and hospitals and insurance plans. we want to reduce costs obviously, for families and businesses and the overall cost of health care. and ensure affordable high quality health care for every one of our citizens. our goal is to also to

strengthen what works and fix what doesn't. if you like what you have, you ought to be able to keep it. if you like your doctor, you're going to be able to keep that doctor. if you like your insurance plan, no one is going to make you change it. if you don't like your doctor or your health care plan, and you flatly -- would rather have affordable options available to you, in my view, that must include a public health insurance option in addition to private options. that's a consend ttentious poin. the guarantee will be that no longer will someone with a pre-existing condition such as a heart attack or cancer or even being the victim of domestic violence be prohibited from obtaining insurance. availability and renewability of coverage will be guaranteed and health insurance plans will be prohibited from establishing lifetime or annual limits on benefits. this bill focuses on the development of quality measures that will help assess health

care outcomes and the appropriate use of health care resources. with this bill, we will transform the current system by encouraging prevention and wellness, two subjects bit way that i think enjoy broad support on this committee and among our colleagues as well, to really bend those costs, prevention is absolutely going to be critical. establishing an investment fund which will ensure adequate resources for prevention, research and the creation of a national prevention and health promotion strategy will focus federal attenti we will address our workforce shortages by encouraging primary care physicians to practice in medically underserved areas and assist more than 10 million citizens in need of long-term services an support. now is the time to bring about it change it our healthcare system. our families, businesses and our governments are struggling with skyrocketing costs. we cannot afford to wait any longer in my view. in the words of the president rl