companies to the cost of our healthcare, the status quo is unsustainable. t reform is not a luxury but a necessity. that is what draws us here this morning. it will take time between now and the fulfillment of our goals but i'm determined as i'm confident that all of you are that we get there and achieve those results and do so with civility and respect for one another. i have great respect for every member of this committee. certainly i want that to be the theme as we move forward, to respect each other's opinions, have good robust debate and achieve consensus are we can and move forward. that is the way i have tried to work in the past as a member of this committee and chairman of the banking committee in the past, working on issue of financial services. it has been my relationship with mike enzi. so, i invite that kind of process in this mark-up and i thank all of you for your

attacks on these issues and turn to senator enzi. >> thank you, mr. chairman. i appreciate the flexibility that you built into the program as we worked on it since you took over the reins less than two weeks ago. and i agree with about 80% of what you said, which is usually about where we agree on legislation, too. that 80% would make a huge difference for america. and that 80% would make a huge difference for america. there are some disagreements. i think those could be worked out. i don't think they can be worked out in this short a time frame as we're picturing all of this to happen. my republican colleagues and i have stood ready for months hoping to get a chance to help write a bill that would fundamentally reform the insurance market, that would offer new protections, to guarantee that consumers, all consumers could buy affordable high quality health insurance that includes people with

pre-existing conditions as you mentioned and chronic diseases. plans that would provide subsidies for low income workers to help them get coverage, and to harness the competitive forces to increase quality and drive down health care costs. these are concepts that enjoy broad bipartisan agreement. they are also policies that would fundamentally transform how we provide health care in this country. this could gain the support of 75 to 80 senators. i think that is a real landmark to shoot for people to have confidence in the plan. we won't be able to make everybody happy, but i think to make america happy we're going to have to have agreement, give and take, solutions that will keep 75 to 80 senators happy with the bill. and i think that will be a formula that will work and i think it is an achievable formula. and then it could be sent to the president for his signature and i know we're hoping before the

august recess, i'm hoping that we don't become the victims of a deadline when we could get it right. and we got to get it right. as you mentioned, this affects 100% of america. 100% of the consumers, 100% of the providers, 100% of the businesses. we have never worked on a bill that comprehensive, that affecting. and i regret that we find ourselves here today marking up this bill. the committee's activities today kind of represent a wasted opportunity to enact real health care reform that could benefit millions of americans. rather than considering the partisan bill before us, we could be marking up a bill that could gain real bipartisan support and make a difference for america. we did not start with a blank piece of paper. we started with a kennedy staff bill, and that is -- that third of the pile. and it is missing sections. it may be missing as much as

half. and the reason that we have all of these amendments to go with it is that we haven't had time to discuss and incorporate a lot of the things that are here into there. we did have a walk through and that was tremendously helpful and it is much less contentious than a markup. but we didn't have the time to really invest ourselves and our staffs at working through the kinds of things that were seen as being problems. i think there is a lot of agreement on it as we went through the walk through, we found areas of agreement and our staff sat down and worked those out. but we're doing it too fast to do an adequate job of really covering these things and so i appreciate the comment that the chair made about having adequate time to address the secs thtion that are missing to get this

done. it is essential that we get it right. there is no shortage of information out there last sunday and in the denver airport. the rand corporation had a new magazine out that was free to everybody. and it covered health i.t. and the way that that can save costs in health. and just yesterday i got a book from senator daschle, information cure, solving the health care crisis systematically through integrated health care management. i read that last night. it has a lot of good points in it. some of which we have not put in the bill yet, particularly dealing within ing aggregating information. it reaped benefits. we have found some common threads there. but we have neverin aggregateed

that so somebody might have something similar that is affecting them. each of the registers that we have are separate registers. but there is the possibility of integrating that information and aggregating it and coming up with new solutions for prevention and that's would cut costs. but i'm afraid we'll be on a much more limited basis raising expectations for people while we raise cost instead of lower costs. so i was hopeful and i'm still hopeful that we will take the time to get it right. but the bill we're marking up today is a bill that we were kind of excluded from having a part in, except for the changes that were made as a result of our walk-through. and we'll hope to have more input as the time goes by, but

the time is going to fly by as we have to do this. and the way that we work in committee is much better than the way we work on the floor, which is the next step, but even the amendments are rather contentious and what we need to do is kind of find the glimmer of an idea that is in each of those. each of those has something that is undoubtedly worthwhile, a lot of them probably have some things that would be detrimental. what we need to do is pick out pieces that would be helpful and incorporate them in the bill and we do that in a less contentious way. i know that staff last night got to go through some of those. and probably found some common solutions that could be incorporated that would be prevent us from having to go through those amendments. but when you just have one evening to do that, because they were working on what we came up with through the mark -- the walk-throughs, it is very

difficult to, you know, pick out the real meat out of what is in there. and each of us feels pretty strongly about some of the different options that we provided. so i know that the bill contains -- that we're discussing contains policies that were designed to appease one ideology rather than come up with a bipartisan solution for average americans, but most troubling of all, it is going to fail to achieve its stated objectives of expanding health health insurance coverage to all americans while allowing those who like what they have to keep it because there's some fine print in this thing that until we get that clarified, can kick people out of their insurance any time there's a renewal. this bill costs too much, it covers too few, and it will cost 10 million americans to lose the insurance they currently enjoy. those aren't my opinions.

they're the facts supplied by the nonpartisan congressional budget office upon. we talked about the scoring this morning. in their recent preliminary analysis, the ceo that the health choices act would spend $1 trillion to cover only 16 million individuals leaving 36 to 37 million americans uninsured. in addition, the misguided policies in the bill would cost approximately 10 million americans who have health insurance from their employer to lose their coverage. earlier this week and speaking with the american medical association, president obama promised that under his health reform proposal every american who had coverage that they liked could keep it. the bill fails to deliver on that promise. i agree with president obama that expanding coverage should not interfere with the health insurance of americans who like what they have. i also support the president's commitment to fly pay for health reform. unfortunately, the bill fails on both those counts.

the bill does not include any real payments to account for the trillion dollars in new spending. i understand that that's a finance committee challenge, but they're delaying their markup in an effort to have a bipartisan solution and to pay for it. the time -- the timeline on this isn't as tight as what we're saying. if they're taking extra time, we can take extra time, and it would be helpful if they discussed their pay fors before we discuss good expansion that we're going to have and especially when we get to talking about a government-run health care. so i think it's grossly irresponsible that we're not taking the time and that makes it difficult for us to support a bill that doesn't pay for the cost of any new coverage expansion. our nation is drowning in a sea

of debt. people are looking for us to have some kind of limits and unsustainable entitlement programs like medicare and medicaid which, of course, are two government programs will automatically add trillions of dollars in additional debt and this will exacerbate the crisis by bringing unfunded liabilities which in turn would raise interest rates and eliminate millions of american jobs. the emphasis we have and the speed in the timetable has been based upon how the economy has based with doing healthcare reform. we have to be sure that it isn't exactly the opposite of that, ruining the economy. the bill fails to address one of the fundamental worries of most americans and that's mainly the ever-increasing health care costs. health insurance premiums have more than doubled over the past seven years and skyrocketing costs have forced more and more small employers to either cut back and drop the health insurance they currently provide. rather than addressing the

fundamental problems that contribute to increasing health care costs, the bill would create a vast new government bureaucracy to promote health and wellness. under the bill the government would spend billions of dollars to build jungle gyms and sidewalks while mandating that they provide healthier choices. it has to begin with promoting healthier behaviors. we know obesity, smoking, lack of exercise leads to billions of dollars in preventable healthcare costs every year. rather than creating new health and wellness bureaucracies, we ought to be finding ways to encourage people to live healthier lives and make better behavioral choices. unfortunately it would make it more difficult for ceos steve bird who in one of the round tables talked about ways for workers to improve their health. we know the strategies will lower costs and it's incomprehensible to me why the

bill doesn't from moat some of the incentives and eliminates some of them. the fundamental flaws in the bill is a direct consequence of how the bill was put together. the bill was drafted exclusively by the staff who excluded republicans from the actual legislation. i don't want you to think they didn't get to meet together. my staff met together. i have to say that as we were finishing up the first day of the walk through one of the people on my staff said you got done more in the last four hours -- and that is how senator kennedy and i worked together in the past and that's not how we managed to produce a rather impressive record of bipartisan accomplishments in this committee. the process of putting this bill together was a departure of this record for bipartisanship. we start to principles and worked to solutions. on this, we started with solutions and worked back to

problems. in the haste to assemble this partisan bill, the kennedy staff has made numerous and unnecessary errors. it was compounded by an arbitrary timeline that had sufficient time to review the bill and tried to participate and many from negotiations to develop viable alternatives. we were given less than a week during that time we did the walkthrough on options. i appreciate that walkthrough. an opportunity for us to voice some of those concerns and get results. our constituents sent us here to work on tough issues. we each bring valuable and unique perspectives but all of that is squandered if we do this too fast and in secret. this is the most comprehensive legislation any of us will ever work on. it will fundamentally impact one-sixth of the nation economy.

and there is a good chance if we don't get it right that will double. it will affect the healthcare of every single american while expedience can sometimes be a virt virtue. this bill and the issue of health reform are too important not to take the time to get it right. i can think of no better way to highlight the flaws than contrasting it to the process as i mentioned with senator baucus and grassley as they followed it in the finance committee. both staffs worked together to develop a bipartisan list of options, actually starting with a blank piece of paper. they then spent several weeks holding roundtables an closed door walkthroughs where they spent dozens of hours discussing the complex issues with a range of policy experts and developing potential policies. i don't know whether the finance committee will ultimately be able it produce the bipartisan bill. there are several provisions that are still being considered

that i may disagree with and others may. in spite of that the process solicited input from every member and gave them a choice to air concerns. that is the process that allows norse to explore different proposals and ultimately develop a bipartisan bill. and weigh the pros and cons and develop a bipartisan bill. we've had that in this committee and it's been in such a compressed timeframe that i don't think that all of the things have gotten out or we wouldn't have that many amendments. to date, the walk through is the only similar opportunity at the health committee. we had no shortage of good bipartisan alternatives to discuss including proposals developed by senators coburn and burrb and senator widen and bennett. i hope this mark-up would provide an opportunity for the senators to discuss these ideas. with a bill that spends $1 trillion and leaves 36 million

americans uninsured i assume we all agree that this bill provides plenty of room for improvement. that's why i intend to take the opportunity of the mark-up to highlight some of the mistakes of the bill and try my best to correct them. not that i have the perfect solution. i'm just one person and we need input from everyone and that's what the process can provide. in criticizing the health committee process i want to clarify, my comments do not -- do not reflect the leadership of senator dodd. in recent weeks he's assumed a greater role in leading his their process and he has dramatically improved the process. it was in his leadership that they held a walk through and round table that helped to clarify and hopefully resolve a number of problems in this bill and i know that to have happened. i believe if we had more time, senator dodd and i and the members of this committee can resolve many of the open issues and possibly negotiate a truly bipartisan compromise. unfortunately, we probably won't have the time to resolve some of the more difficult issues, but

if he's willing i'd love to continue to work with him and the other members of the committee as this bill moves from committee to the senate floor. in fact, i'd like to do more of that before it actually moves out of committee, so i still hope we can have a bipartisan health reform bill that the committee can be proud of and that america will believe in. >> thank you very much issue senator. let me give you some good news. in the issue that you raised about the divergence question, aggregation, rather, issue involving our staffs have worked out the amendment as part of the issue on -- on this issue. so we may be able to get something done. and i appreciate my colleague's comments and to give everyone some perspective. since june of '08 there have been 14 round tables of bipartisan staff. 80 of the groups, since january we've had 13 hearings on this committee on various subject

matters and done 20 hours of walk through going through this. again, you can always argue for more and more, but at least have the opportunity to do it and 40 meetings with various stakeholders in the last number of months going back. so i appreciate the points being made, and i appreciate the spirit of the concluding comments here. my experience is we have to start a process. when the process begins, people sort of get together and do things to move on something. you can always dial that in different directions, but my hope is by working through this, the concentration and focus is that we'll have to get answers more rapidly. let me turn to senator harkin. >> thank you very much, mr. chairman. first, i want to salute our committee chair, senator kennedy, for his tireless and relentless and courageous leadership across many, many years, and advocating for a comprehensive health reform for

america. we are going to get it done this year. i also want to compliment and thank senator dodd for stepping in to provide his great leadership and commitment to getting a progressive and affordable and quality and c comprehensive health reform bill accomplished this session. we all know what the goals are. affordable and high quality health care, reduced costs for families, government and businesses and protect people's choice of doctors and hospital and insurance plans, but there is one goal, i believe, that is overarching over everything and it's the goal that i really believe enjoyed strong bipartisan support on this committee, strong bipartisan support in the senate and the house and is supported by the great majority of american people and that goal is to re-create america as a genuine

wellness society. one that emphasizes wellness and fitness and good nutrition and disease prevention. in other words, the goal of keeping people out of the hospital in the first place, and i was glad to hear the senator just talk about that in your remarks. i believe this is central to what we're doing. i've said many times, you can jiggle the system all you want. who to pay, what to cover and all of the plans and get all that out there, but if we don't shift, if we don't shift the kind of money we're putting into health care up front to prevent illness and disease, i don't care what kind of system you come up with, we're still going down because they'll be spendinging more money on patching and fixing and mending, pills, surgery and hospitalization and rather than putting money up front keeping

people healthy in the first place. we all know the statistics. we spent a staggering 2.3 billion per capita more than other country and they rank us 37th of 191 member nations and we're on par with serbia. we spend twice as much money as europe on health care, but we're twice as sick with chronic diseases and chronic illness. we also have to make sure we improve the quality of our coverage. i mentioned that and information technology. in other words, quit reimbursing for quantity and start reimbursing for quality and senator mckull see has led that effort and i compliment her for putting together a great title for this bill on quality. we have to strengthen our health care workforce so we'll have the doctors, nurse practitioners, pharmacists, oral health, mental health providers, public health

professionals and integrated health practitioners to provide carrot whole spectrum and senator murray has led our effort in that and has put together a great title covering the need for the workforce in the future. a lot of the workforce has got to be in the area of prevention and wellness and keeping people healthy. we have to take a look at our medical schools. i just spoke yesterday to a group of young people going through medical school, and were they taking courses on prevention? they don't have that. they may get a lecture on it once during medical school. are there residencies in prevention? you can get residencies in everything except that. so we have to look at how -- and most of this is tax dollars through the medical system for education. we should be emphasizing that doctors and other health professionals, i don't mean just in these, but other health professionals get training in prevention and wellness.

as i've said many times the truth is i don't have a health care system. if you get sick, you get care, one way or the other, but there's precious to keep you healthy in the first place. 95 cents of every dollar we spend on health care goes for pills, surgery and hospitalization and everything. 5 cents or less goes for prevention and preventing chronic diseases. so we have a huge opportunity here to really make a profound change and this is not just in the clinics. yes, there's a clinical basis and when we get to the title of prevention, there is a clinical basis for this. well, for example, right now medicare, medicare will reimburse for nutrition counseling once you have diabetes, but if you're pre-diabetic they won't provide for nutrition counseling so you don't get diabetes.

tell me how much sense that makes? medicare will pay for one colonoscopy when you go on medicare and won't pay for any others. that doesn't make sense either. so there is a clinical basis for prevention, but there is also the basis in our schools, in our workplaces and i say to my friend, that we've been many times with steve berg, and quite frankly, i believe what we have in here corresponds quite well and not some of it is in here and some of it is in the bill because there are tax credit and things for businesses to provide those kind of incentives to the payroll. so it's not all in our bill. some of that is also in the finance committee. so it's -- it's clinical. it's schools, it's workplace and it's communities. the trust for americans' health did a great study and they came out with it last year showing that small investments in

community wellness programs had an immediate payback, an immediate payback in the first and second years afterward. you didn't have to wait 10 or 20 years. they had immediate paybacks and so we had to think about the whole spectrum from early childhood through schools and workplaces through communities and clinical basis for settings and prevention and wellness. when i say that i might also mention that we can't forget about two other aspects of this. one is oral healthcare and making sure that our kids have good preventive health care in terms of oral health. we all remember the story, barbara, the young boy in your state that because he didn't get oral care got an infection and died from it simply for the lack of preventive care for a young boy on oral health care, and then the other great one is mental health. we have to integrate mental health care in all these aspects. you can talk to any doctor, and

i don't want to be accused of practicing medicine without a license. you can talk to any dollar, health professionals, they'll tell you that many of the physical illness people have have their genesis in mental health problems and many times it occurs in children and in young kids. so we have to not think about mental health as something we do after someone is really sick, but as something we do in the beginning when first signs are showing up. when we can get to young kids in school and places like that to get them through some difficult times with mental health assistance and that can do a lot toward preventing later physical illness. well, mr. chairman, we have a great opportunity here and a great opportunity to not only provide the affordable care, coverage, everything, but we have an opportunity here to really redirect health in america, to make us a true

health society and not a sick care, but a health care society and that's why i sort of laid down a marker some time ago. i said if we pass a health reform bill that extends coverage and does nothing to retomorrow our broken system by emphasizing prevention and public health then we would have failed the american people and we can't fail. mr. chairman, i know there are a lot of amendments to the prevention and title health of the bill. i found 171 amendments to be exact, and i thought we had done a good job at working. our staffs were working with the republican side of this to try to get to some agreement. i thought we had a few, but now we have 171 amendments. we'll be working our way through those amendments and i want to reiterate my continued commitment, mr. chairman, to support the strongest possible bill we can get in prevention and wellness and public health. so the lens that i will apply to

any amendment is whether they will accomplish the goal of putting prevention and public health at the forefront, not as a tag along, but as the forefront of the health reform efforts. i look forward to working with you, mr. chairman >> thank you, senator. storr gregg. >> thank you, mr. chairman. let me acknowledge that you and others have, senator kennedy's unwav unwavering personal and professional commitment to try to address the issue of healthcare in this country, making sure all americans have adequate healthcare. and obviously it is with considerable reyet he is not here today to participate in this because he is an exceptional force on this issue and somebody we all admire. i also thank you, mr. chairman for picking up the mail and getting on this issue a