uninsured and underinsured. there is enough money in the system to pay for those people who are uninsured and underinsured. in fact, we hear that families have found that nearly 7%, in 1987, 7% of their median household income was being used and dwoted for health care and now it's grown to 20%. in fact, americans spend more than any other industrialized country in health care for a working family. yet our health care, life expectancy is on par with cuba, on par with cuba. so we have got to make fundamental changes. as the gentlewoman said, to focus on prevention. four cents of every dollar is focused on prevention, yet we have some of the worst chronic diseases that continue over this period. we want to stress that folks will have more choices and bean

counters won't decide, but doctors will decide the type of health care they get and there is enough money in the system to pay for itself. those are the delee guideposts and the beacons we are using as we are drafting legislation in the house. . ms. pingree: i want to emphasize the points you made, every time i sit down and meet with a group of doctors, i feel like i'm in a completely different era than when i first ran for office in 1992, when i was first elected to be a state senator and i would meet with my local group of physicians the first thing they'd say is you keep your hands off health care reform, you know, we're perfectly happy with the way it's going. i'd meet the occasion member of the practice who wld say, you know, i've got a few sources of dissask but i mostly would meet with resistance and when i meet -- when i recently met with a grup of physicians in my district, i thought i was in a

completely different country. just as you said, it was physicians who were saying, i don't have any time with my patients, you know, i signed up to make people well and now i feel like i turn people away, i can't take low income patients because i can't afford it, i've got a room full of people that just fill up the paperwork for the insurance companies and then have -- half of the time the things i know my patients should have are denied. and the kind of treatment that they should be getting, they're not able to get because they're turned down time after time. i know people are going to find this hard to believe, but a group of maine physician, the maine medical association affiliate, actually took a poll of themselves recently and almost 50%, about 50% of them, said they were in favor of single-pair health care. now, we're not even debating single-payer health care in the current bill but the idea that physicians now, who once said to me, you know, keep your hands off medical insurance and the health care system, are now saying, i can't take it anymore.

you know, i cannot run a practice, i can't be the kind of doctor i wanted to be. and you hear exactly the same thing from nurses, from everything in the medical profession who just say, this is not working, how soon you can get it repaired so i can really give the care that people want? and i'm sure you all have had similar, other experiences you want to share. >> and i think the reason being is because they spend so much time on paperwork and it's so much like a service. they want to take care of people, they can't even keep them healthy, they spend all their time, you know, just curing ailments, so i think that as the culture changes and how we want to keep people healthy has not been very good for the doctors. just like with the hospitals. they're seeing so much uncompensated care. they can't hardly keep their doors open in my district several hospitals have already closed. they're just not able to keep the doors open because people

are just not paying their bills. so they felt -- they feel if everybody has some sort of insurance, maybe they would get something. and when we talk about reform, you know how much money we would save if hospitals didn't have to do all that cost shifting, that they could have, you know, spread the costs instead of charge people more who have insurance? you know, one of the other things we haven't talked about yet is medicare part d and how our seniors who fall into that doughnut hole very seldom come out of that doughnut hole and that's something that i brought up last week and that is one of my priorities. it's a huge challenge facing our senior citizen and i've been working with a.a.r. -- aarp on trying to figure out, how do we close that doughnut hole. in illinois in fact, out of the entire country, illinois has more seniors who fall into that doughnut hole than anybody else in the country.

32% of our seniors fall into that doughnut hole and very few of them ever come out. so we are working together and we need to do something about helping them and lately as you've heard the pharmaceutical companies are coming out talking about how. so i think we'll be able to come up with a very good compromise on how with we can all work together to help them and i think that we have to think about that. we think all of a sudden, you know, our seniors have medicare or medicare part d and that they're taken care of. nobody thinks about the fact that once you hit a certain point you're on your own until you get to another point. and, you know, there's a lot of money in there that you're going to have to pay on your own, besides the cost of the premium. you know, so there's a lot that we have to think of and at the same time i think there's a lot of places where we can find reform. ms. pingree: yeah, i'll just

jump in on that and only because the issue of the pricing of prescription drugs is a big part of my own personal history in politics and one of my great concerns. i think i have the oldest population in the nation in the state of maine. so between mike and i and the two united states senators, we cover some of the oldest americans and we're about 38th in per capita income. so we have a tremendous number of people who really struggle to make that decision every month, do they pay for their medication or put food on the table or pay their heating oil bill. now everyone may not agree with my particular perspective on this, but i think one of the big mistakes when the medicare part d bill was passed was that congress specifically prohibited negotiating with the pharmaceutical manufacturers for a better price. here we are, the biggest purchaser of prescription drugs in the world and when the bill was passed and luckily none of us were there so we don't have to take responsibility for that,

but there was no provision for negotiating for drugs. now, you know, every other country in the world negotiates for a good price for prescription drugs. so in a sense, it's like we pay the highest prices in the world so with we subsidize everybody else. i won't go onto my giant rant but this one was of the bills i passed when i was a state legislator on helping to regulate the pricing of prescription drugs and i will just say that one of the ways i really got involved in that and very interested in it was because maine is a border state we have a lot of seniors who get on buses, bus trips for seniors, and go to canada to buy their medication. and you can buy medicine in canada sometimes, you know, it's exactly the same drug that would you buy just across the border for 1/3 or a 1/4 of the price and it's not because it's a subsidized price up there because these aren't people with the canadian health care plan, but because the canadian government negotiates for a good provides -- price. so in my opinion and i've signed onto h.r. 684 which is from

representative barry, that bill would force us to look at this and to do something about the pricing of prescription drugs. and i think that's one other thing we have to address if we're really going to bring down the costs of health care. the one thing we know is that when people take their medications they stay much healthier. whether you're a senior citizen or someone with a high cholesterol rate and you need to keep it down. so we know the importance of medication and we know one way to drive down the cost of health care is to make sure that medicine is affordable. that's true of seniors and all people and it's certainly one of the issues that concerns me and one of the things that i promised my constituents back home, that even though we'd passed this bill in maine i would take it on as an issue here in the united states congress. and i know many share the same concern. >> i -- mr. boccieri: i applaud the gentlelady's perspective because there is no question that getting costs under control are the most important facet of any health care reform package.

and, you know, we talk about a health care delivery system. really, we have a sickness delivery system where we're actually doing a fifa service where folks are paid with the number of patients that they see in their hospital or their doctor's office, how about providing incentives to say that, well, we didn't see any patients today because they're all healthy? what a novel idea that would be to provide incentives for prevention and, you know, this is the type of plan that we're embracing here. our plan talks about prevention, it talks about rewarding citizens who are living healthy lifestyles, doctors who are able to have this relationship as the gentlelady from illinois had suggested, that we ought to have a relationship with our doctor, not necessarily one where you come in, you bounce in for five minutes and then he writes you a prescription and you're out the door. that's not health care. that's not health care. that's not even a health care delivery. to me that is something so far disconnected.

so our plan is going to make sure that we have more choices. better time with our doctors, more choices in who we get to see and who we're able to see and to make sure that doctors and physicians are scribing and prescriptioning -- predicting and -- describing and predicting and we shouldn't have a bean counter in an insurance company deciding whether we should have an m.r.i., we shouldn't have a bureaucrat in washington deciding if we get this prescription drug. it should be left to physicians and doctors and our health care professionals. and, you know, our plan is going to address the amount of money that we spend on health care. by getting these costs under control, by covering all people, making sure that all people have access to health care, we're actually going to lower the prices. we're actually going to reduce the costs of health care, because that diabetic that lost their job in canton, ohio, now can't get the vings that they need to give themselves insulin, they can't buy their medical equipment, they can't buy their

prescriptions and all of a sudden they have a situation where they have to go to the emergency room because they have an ulcer on their foot and they're using the emergency room as their primary care physician and that's costing all of us in the system four, if not five, times more. by getting those costs under control we're going to save money in the long run. more choices, better accessibility to the doctors we want to see and making sure that we have the opportunity to keep and contain these costs, keep them under control and making sure that doctors and health care professionals are prying health care and not bean -- prescribing health care and not bean counters. this is why i'm so excited we're tackling this issue. this is a matter of our competitiveness of the country and having citizens that are healthy and the well-being of our nation's at stake here. ms. pingree: i'm just going to read a quote from one of the letters i brought in because it just reinforces your point. this person is talking about their issues with the health care system and it's a maine constituent of mine and it says,

my wife and i struggled to get our provider to pay for special infant formula that our oldest son needed to live during -- due to his protein intolerance. this was despite our specialist doctor showing us a letter in which the insurance company had agreed in arbitration from a previous case to pay in full for the formula in cases like our son's. clearly one of those examples where it's a bureaucrat or a bean counter who's denying it just to save the insurance company some money. this same person also says, in another example my brother-in-law was denied cancer treatment that his doctors had recommended and only began his treatment after the insurance company overturned the decision on appeal. the delay may prove fatal to him. i mean, both of you have said this over and over again. people want to go to their doctor or their primary care provider and get the advice that they need, follow the treatment plan that they are recommend and not be told by a bureaucrat, as you said in washington or an

insurance company, they can't do it just because they're trying to save some money on your health. i agree with you. we need cost-saving measures, but not on people's essential treatment. mrs. halvorson: and that's so true and we hear story after story in our district office. you know, i have a letter here think a received and this one was especially devastating to me and it caused me to actually put in a resolution or sponsor a bill, but this constituent was a widowed mother of two. she was actually denied private health insurance because she attended grief counseling. her husband, who was the primary wage earner, died suddenly at their home in front of the family. you know, and as a way to cope with all of the situation that they went through, she enrolled the family in group therapy and at the same time she was also faced with trying to find new

health coverage for herself and her children, you know, because her husband just died in front of the family. now while searching for that new private insurer, she was denied over and over again because she was participating in that grief counseling. so that's why i filed h.r. 2236 which we called the grieving families insurance protection act because we do not think that health insurance companies should deny you health coverage due to family members needing grief counseling at awful times like this. ms. pingree: they really wouldn't allow her to have insurance coverage? and that was their stated reason? mrs. halvorson: she could not get health coverage because she was attending grief counseling. so they would not give her health care. and isn't that a shame? this poor family actually the

father, the husband died right there in front of them, the family obviously needed some help and they couldn't then get it. so these are the kind of things that we should never be putting people through. and that's the other thing, it's not just people not having health care, i don't want people to have health care and give them that false sense of security because then they think they automatically will be taken care of and we need to just make sure that people are being taken care of and they have health care, not necessarily just health insurance. . mr. boccieri: we talk about this notion of 46 million uninsured and underinsured folks. let's explain what uninsured and underinsured is. uninsured means you have no health care coverage. if you were injured or had to seek treatment for a routine

medical necessity, you couldn't go to a physician unless you were going to pay out of your pocket exorbitant amounts of money. underinsured is people who don't have quite enough. that factory worker that lost their job and health care insurance and then got rehired down the line but because they were a diabetic, that condition was pre-existing. they are underinsured, because they don't have insurance to cover all of their medical needs. we found in a recent study public lird last year that health care insurance companies, insurance companies spent $84 billion to block, deny and screen patients from seeing their physicians, $84 billion. in that same study, only 77 billion would be required to cover all of that 46 million

uninsured or underinsured. it would be cheaper to cover folks who are not seeing their primary care if physicians. we have the opportunity now with the bill we have rolled out to end pre-existing conditions, which have been one of the biggest albatrosses. not being able to see the doctor because you had a condition prior to your employment at some factory. this is something that affects middle-class americans all over the united states. if we address this, pre-existing conditions, portability from job to job, they are not using the emergency room versus seeing the physician they want to see and make sure we provide incentives for prevention so that folks are living healthy lifestyles and we are able to provide prevention

and allowing physicians to make those decisions and not bean counters, that is what is going to be the cure for our health care dilemma. ms. pingree: pre-existing conditions, it's shocking when you hear those stories. i heard about a state that didn't have a requirement that insurance covers you in spite of a pre-existing condition. someone told me that someone of child-bearing age, you could have a pre-existing condition. and why shouldn't your insurance company cover you, but they weren't going to cover you. why don't they just say, we want healthy people who promise never to get sick. i come from the state of maine where the state legislature has already required that insurance companies cover you in spite of pre-existing conditions. and that's a great reform. maine is one of the laiders of

health care reform. we have a high number of people who have insurance coverage, many of them on maine care system, medicaid. but the fact is, what my colleagues in maine told me and i felt it, that states can't go it alone. there are many states in the country that have passed these kinds of regulars layings, but it makes it hard to compete with the state next door or charges sick people more than people who are well and don't have a community kind of rating plan. one of the issues we are facing now, particularly in states that are having a hard time holding their budgets together, they are saying to us, let's make it the same kind of coverage from state to state. and you mentioned portbuilt. it is called job lock. people who stay in their job because they're terrified to leave that job because they

can't go without health insurance because their spouse is sick or their child is sick. we have people who say i could create a job vacancy for someone else who would like to work at this company because i'm going to start another business. people who have set aside to retire. they say i'm ready to retire. in this economy, where we can use any job we can find, having health care coverage would do more to boost the economy, i think than many other things. in the state of maine, as i mentioned, a lot of people are self-employed, they are fishermen or own a small entity, people say, we make enough to get buy. we make our own home repairs, but we are worried about our health care coverage.

and exactly what you mentioned earlier. those are the very people who when they do get sick have to go to the emergency room, who often depend and they depenon charity care. and i have the same situation. a lot of rural hospitals who depend on fund-raising drives to keep the doors open who are seeing us all the time saying, we can't keep the hospital open. what are we going to do? mrs. halvorson: something else we haven't talked about is the outreach that i have tried to do and i know a lot of members have done with our federally qualified health centers, theirs is a very important place for them because there is so much that they could do in the meantime for those who don't have insurance or those who aren't able to get the health care they need. and i have toured so many of them in my district.

they do a wonderful job. so in the meantime, we should be doing everything we can to make sure that people have a place to go where they can have a medical home, where they can teal comfortable and take their children. i know in illinois, we have family care where every child has health care. there are things bsh did you we shouldn't be doing this state by state. we spend a lot of time working on health care. we knew this was a federal issue. so this is something that needs to be done on a national level and it's something that everybody working together is going to be able to get accomplished. mr. boccieri: i know that there might be some apprehension out there from our seniors about health care reform. and let me stress to you that our plan allows you to keep the

doctor that you want to keep. if you like the doctor that you're seeing, you can continue seeing that doctor. if you don't like the doctor that you're seeing and would like to get into a different plan, it will allow you to go into a different plan, build more freedom under this bill. there will be more freedom under these proposals. and we're going to make sure that physicians are telling our seniors, health care professionals are telling our seniors the type of health care that they need, whether this m.r.i. was authorized, whether this cancer treatment was necessary and prudent. we want health care prolvesals to do that. we don't want bean counters making decisions based upon what the bottom line and dollars are going go to be. and the gentlelady was talking about what she did in the state legislature and in ohio we have a similar situation, where folks were delaying payments, insurance companies were delaying payments to doctors who ultimately run a business.

when you see your primary care physician, they have a staff, payroll, have to keep the lights on and pay utility bills, just like any small business. when you do look-backs and suggest whether this m.r.i. was necessary or authorized, whether this was x-ray was necessary or authorized and you delay those payments over a time period, the doctor can't keep the lights on in the building. and that should end. and we passed a bill in the state legislature called prompt pay to make sure that insurance companies were making best efforts to pay those bills on time so doctors could keep the lights on. and additionally, we were doing health care simplification, so we could involve a little bit of medical i.t., so when you roll into a hospital, god forbid, after an accident. when they pull up your name and pull up your identification,

they're able to identify who you are and your health care records. the military has been doing this for years. on our military identification card, we have the medical technology to pull up my medical records. if i rode into a hospital or a v.a. facility or a military hospital, on my card, they would scan it in and my complete medical history would come up. and on that, you would be able to tell what type of treatments you haand that is going to cost hospitals less because they won't run the battery of tests to see if this person is a difficult betic because they know what sa john doe's medical history. it's something we ought to explore for americans so they can have quick access to medical records. ms. pingree: i think it's one of the reasons why earlier this year we went along with the

president's proposal and invested so much on health information technology. it's been clear to people for a long time that so many different insurance companies and so many different kind of forms make it difficult for practitioners to run a business and hospitals to operate. and as you said, for people to get the kind of medical care they really need. we are about time to wrap up here and i will go over again from my perspective and certainly let the gentleman from ohio close with a few thoughts as well, but i want to emphasize again that from my perspective and my home state and what i hear from across the country, everywhere i go, people say can you get a health care plan passed? are you going to do something about all of the things we have been talking about tonight? women want the coverage, they want a choice. as we said, many times, if you like your plan, you can keep it. if not, there will be real alternatives. they want affordability. people are willing to buy health

care, but want to know they can afford it. this plan that has been released has a shared responsibility from employers and individuals alike. it has real components to control costs. it makes a serious investment in prevention and wellness and invests in the health care work force, something we haven't talked much about tonight. there is a tremendous shortage of doctors, nurses, those people that are needed to do this job to make sure that we can have good care. and that is part of the legislation, really look at investing in our work force. i feel hopeful that we have moved forward as far as we can. that there is a sense around here really from both sides of the aisle that we don't have to debate anymore whether or not there's a problem with the system. there may be differences about how we fix it, but there is a real commitment to fix it. and and the president says he

wants to do it on his watch and there is a tremendous commitment to pass the health care package that works for america and get on with it. and i yield to the the gentleman from ohio. mr. boccieri: i thank the gentlelady for assembling this dialogue on health care. this is very important. and americans who might be listening in, those folks who might be awake, after punching a time clock and working long hours, we want you to know we are working on this issue. now it's time to take action. and leadership is defined by action, not by position, but by action. and what i applaud this president is for his bold efforts to step forward and take action on an issue that remains a dilemma for america. this is about us as a nation being competitive with our foreign competitors. this is about how much we spend on delivery of health care and making sure that all americans

have access to the quality of care that we want not just because you can afford it, but because you are american. and let me just say these things. number one, number one, if you like your doctor, you will keep your doctor. if you don't like the plan that you're in, you can move to another. there is going to be freedom of choice. and there will be broad choices in the plan that has been unveiled in this chamber. number two, we want to make sure that health care professionals and physicians, doctors and nurses are administering health care and not necessarily the bean counters and bureaucrats that we find who are making health care decisions for too many americans. and the third issue that we need to emphasize is that there is enough money in the system already to pay for health care, the 46 mill -- million uninsured and underins