of employers to provide health insurers for their employees. this will just be telling them to keep on doing what they have been doing. it will have no effect at all on them. what affect it could have on other employers depend very much on how it is structured. as has been mentioned, when the things people are being very cognizant of is, how do we treat small employers and those kind of things. there is a literature, but it is certainly having a whole range of estimates depending on how the system is structured. i do think it is important to realize the reason why people talk about having shared responsibilities with employers. that is that we do think that the employer base system that we have, that the president is wanting to keep it. >> you do not know the job losses may be? i see numbers as high as four or

5 million. >> i have certainly not seen numbers like that. i think that would be exceptionally large. >> again, we simply do not know. there are certainly some concerns with this draft bill that there would be reverse instances or incentives for employers to drop their coverage. that is something we will analyze as we go forward here with the debate. we are anxiously awaiting the score from cbo so we know what we are talking about in terms of dollars. i have several of my colleagues the want to ask questions. we get three physicians here with us today. in the interest of time, i'm going to yield my time back. >> thank you. following through on mr. klein's question, mr. roh -- mrs. romer, d cbo score the senate at $1.60

trillion. it is not provide an employer mandate or payroll attacks. the house bill will cost about $1 trillion, largely due to the mandate to provide insurance or 88% payroll tax. how important is it that the employers continue to provide insurance along with other non providing employers? is 8% adequate or realistic? does the senate a bill to meet the president standards? >> i think you are all getting at a key issue, which is how one structures the employer shared responsibility. that is important to maintaining the system that we have, the

employer based insurance. that is certainly important. the detail are sending it will be analyzing more. i am sure that the congressional office will be analyzing it more. one issue of one to bring up, as mr. klein was talking about, slowing the growth rate of costs and our report shows that it has a beneficial effect on employment. by having a time when cost is not rising as much, gives as a period of unusually good economic performance. we certainly want to look of the totality of the plan. we think it can have some positive employee benefit. >> the omission in the senate bill of the employer mandate is not a small issue. it is a fundamental part of the president's plan. >> the president has certainly expressed the view that he does very much want to stay with in

the current employee sponsored health insurance. he won some shared -- some shared responsibility is important. >> the cost to the government of $1.60 trillion must concern the president come to. rather than have part of that cost containsgb the -- contained taken by the employer. what he has said we need to certainly make sure that anything we do does not increase the deficits and it needs to have the fundamental kind of reforms that i was talking about that will actually lower the budget deficit outside of window. that is a top priority for the president. >> thank you. >> thank you. i want to thank you for your testimony. you mentioned that you were an economist in your court to talk about the economic side. you dealt into the health care so much. questions will bounce back

and forth. we spend 18% rate gdp on health care. as an economist, how much did we spend it? >> there is no single number. you are getting at a good point. there is not some fixed amount. we should not be wasting. that is what i know. the estimate may be as much as 5% of gdp. >> it is not your testimony that the government ought to set a specific amount? is that correct? >> of course not. >> you also said that 46 million voters are uninsured. is that uninsured today? >> that is crucial. experts will tell you over a two-year period, twice that many people go through some time of lack of interest. >> are the ones that are at a sonically uninsured during the course of the last 12 months? >> that is as a point in time.

82 million over some two years period. >> a the provide the date on that. i would appreciate that. >the breakdown is helpful to fid how we get them in injured. it to be helpful to know if that lead to those folks are and why they are not insured. you also mentioned that the president's goal, and it is reiterated over and over, that if you like your current plan if you can keep it. do you know where that is in the bill? >> absolutely. things like the employer mandate is part in making sure that large employers provide health insurance. >> i am asking if an individual like their current plan and maybe they did-through their employer or maybe their plan does not doecomply with every

parameter of the draft bill, how are they going to be able to keep that? what the president is talking about maintaining what is good about the system that we have. >> that is not my question. >> you may like your plan and when the things which -- and one of the things and they do is pull the growth rate cost of your plan. what's the question is whether a patient will be able to keep their plan if they like it. what if there is an employer that are provide health coverage -- they will be fine. what it the policy that those employees and that employer light and provide for their employees does not comply with the specifics of the bill? will they be able to keep that one? >> my understanding, and i am not an expert, i think what is being planned is -- for plant in exchange to have a minimum level

of benefits. what if i were to take it in the bill it says that if a plan does not comply with the specifics that are outlined in the bill, that the employer will have to move to a different plan within five years? would that be unusual or would that seem not regis to you? >> the crucial thing is what kind of changes are we talking about. the president was saying that he wanted the american people to know that if you like what you have it will still be there. >> what if you like what you have and it does not fit with the definition in the bill? my reading is that he cannot keep it. >> the crucial thing is of the bill setting a minimum standard of what -- >> you may like the main appeal to keep it. right? >> i would have to look at the bill. >> you are talking about credibility. it is extremely important. isn't there a different way to do it? are there other ways besides what is being outlined? if you own your health insurance

policy, regardless of who pays for, with a way to accomplish it? >> we have seen a lot of people having trouble portability. the vast majority of americans have employer provided. but if an individual owns the policy could and they take it with them? >> that would seem to be. >> you did not mention a liability reform or regulatory reform. when to be able to tell the committee how much that contribute to the cost of health care in the nation? >> we have been looking at that. there are a large number of things that are behind how much health care costs are today, as they have been rising. the estimates are all over the map. it is a part of what costs are high and wide the are rising. my read is that it is not the primary reason. >> could you put a number on that as an economist?

>> i will do the research. >> thank you. >> thank you very much. i assume that there should be more wellness prevention. when you are poor, people think you are crazy to go to the doctor if you are not sick. well people could not afford to go to a doctor. more less when you were not. however, how much do you think as this moves on, the wellness, prevention, if that can be an educational part of the coverage? is there any quantifiable number that you think would show a

slowing in the increase or have you seen any leveling off by virtue of the preventive part? >> that is an excellent question. in our report, we often talk about the benefits of coverage expansion and the benefit this: the critic cost. when someone has health insurance coverage, they tend to have a relationship with a primary care physician who does to the education and the focus on one is. -- and the focus. my understanding of the literature, seems like programs in which management are things that can slow the growth rate of cost of time. the important thing is that it is not the only the queenie to do. there are other things like how we reward value over volume and changing the delivery system.

wellness is one component. >> thank you. i have had concerns as we do know, there are some in the rural areas where it is difficult. part of the district i represent, my concern continually is access to a physician or to quality care. i am wondering, i'm getting ahead of things, but how are we going to insure that in towns and districts that there will be the opportunity for wellness and quality services? we do know there is a lack of quality or lack of any positions

in general and many of the underserved districts. >> one of the very strong features of the tri-committee bill is that it does address these workforce issues. especially if we are going to move to a system or more people have coverage and more access to primary care, we need more physicians. these workforce issues are going to be important and something i know that my staff and others in the white house are thinking about. that is going to be an issue. your point about the geographical -- it is not as the numbers but the geographical to distribution -- it will be important. >> since we have other members, i will yield back. >> thank you. i enjoyed your report on the problem, but there is no descriptions.

-- there were no prescriptions. some of it seems as if you are telling up is down and down is up. medicare and medicaid is driving costs and yet we are going to increase medicaid to 133% of federal poverty level. i have an article here from a group that points out that when you have increased medicare and medicaid, for the private insurance companies, it drives the cost of. it is a hydraulic effect. he pushed down here and it pushes up here. one question i have is, how are we going to control medicaid we are increasing the reimbursement levels and we are increasing the eligibility? that is just across purposing.

secondly, next tuesday morning, i'm going to be tree lots and medicaid patients in a public hospital in louisiana. i've done for 20 years. i do not think a single one of them would say it is a patient center. i frankly did not see much over the weekend that said patients center. we are using that rhetoric. as a guy that has been spending 20 years addressing it, i've not seen it. even the advocates admit that there are a lot of obstacles to be instituted. bundling is an improvement. i wonder how we are going to save money by using the state power to drive down the provider reimbursement, which brings me back to this. it is as if you are going to drive up costs for the private insurance company, effectively gaining the system so that people migrate toward others -- that was several questions. i apologize.

>> the crucial thing that you are mentioning is something that the president is well aware of. what we are talking about in terms of expanding coverage and the reforms that we are doing like help information technology and the payment reforms, those are absolutely going to cost money. that is why he has put $948 billion in suggested savings of pay for those kind of expansion that now in the budget window. he is making the fundamental changes that will slow the growth rate of cost over time. you did mention this, accountable care organizations. one of the strength of the bill -- the pilot program. that will be a part of how we move forward on this. this is figuring out -- >> yes, we do know a couple of things that to slow the growth rate. apo's are not proven to do so. one thing and does if fha.

i have a family foundation that shows similar benefits and demographics among beneficiaries -- they have 30% lower costs in service. there is nothing in here about this. secondly, there is nothing in here about what the safeway program has, which has variable premiums for people who enroll in medicine. this would not allow that in the public auction. no one prevented the measure that has worked is making the patient a little fiscally responsible. >> i would highly recommend the volume that i have on my bedside table on budget office. there are 108 things they proposed as things that could help to slow the growth rate. what you are pointing out is that there are a range of things, the tri-committee bill has some of them in it.

other bills have mentioned some others. the important thing is, we absolutely have to take these measures and today are ones that are -- >> let me ask you. except for using power to negotiate lower rates, is there one thing in here that has proven to lower-cost? >> absolutely things that bundling, the evidence is that that has worked in other places where we are bundling. >> if you had to bet your house on that, would you bet your house on that evidence? >> it is absolutely cited in our reports. i will make sure that we track it down for you. >> thank you very much. >> dr. romer, a lot of americans are betting their house. that is their problem. it is the coverage in their house and everything they have. we are betting on fixing the problem. i want to come back to the question about the president's

commitment that if you like your plan you get to keep it. dr. prized posed an example where if a plan that an employer provides fall short of the minimum coverage that is in the house draft what would happen. the answer is that the employer would have to come up. that is true. is someone likely to like the plan? the presence and if you like your plan needed to keep it. >> i think most people like something that is better. >> let's talk about what that standard is. it is my understanding that in the house draft that the minimum coverage is based upon 70% of the actual value of the federal help employee benefit plan. that is a pretty modest number. if you think it would be likely that a plan of that -- below that number may not have access to primary care, like ob/gyn care checkups -- >> there will be limitations. >> what a fan of osama bin laden

that would have an immense copiague? -- with a plan that falls below that have an immense copiaay? how likely do think that some as catastrophic care coverage if their plan fell below? >> baraboo likely to have high out of pocket. >> i guess it is possible that someone like that kind of plan. we think the reality is that people would not something like that. let me come back to questions about employer mandates. but the mr. klein asked about this. your prediction of economic growth are based on the president's plan. is that right? >> they are based. the crucial thing is the

principal the president laid down. >> 1 principles that all employers would have some shared responsibility. >> we were focusing on slowing the growth rate of cost and how one did it. >> your predictions take into account the employer responsibility. is that correct? >> our projections are on a much broader level. they do not have those kind of details and then. they are based on -- >> that is one way that we get that curve. what happens -- i am sure you can tell us, you are an economist -- but if you run a retail store and i run a retail store. you voluntarily insure your employees and you are in excess of this standard. indeed you along. let you do what you want to. i do not. i do not provide health care to my employees. when my employees get in a motorcycle at them. i had a good the emergency room. who pays for bill?

>> it depends on whether they had private coverage. >> let's assume she is one of the uninsured. >> it to the uncompensated care. >> who pays for uncompensated care? >> taxpayers. all this that have private insurance. >> you at the retail store owner that doesn't sure your employees, you are picking of the cost for me does not? >> absolutely. >> this plan would obsolete take into account that economic issue where we are leveling the playing field. there are taxes imposed at the state and local level? >> absolutely. >> what would happen to those local taxes it this draft were enacted in people but health insurance? >> we absolutely expect that unaccommodated care would go down. the burden would go down. >> let me ask another question. how many jobs do you think it

would cost us to do nothing? i know the other side is they do not want to say that we are doing nothing. that is odd, since everyone is in favor doing something, but nothing has been done for 50 years. what would it cost to do nothing in terms of lost jobs? >> what we have numbers on what is going to cost in terms of our total standard of living. there, we have enormous numbers about how we are absolutely going to have lower standard of living. we certainly have the short-run impact on jobs. our numbers were that by not having successful reform we get numbers like we are costing ourselves maybe five and a thousand jobs but we could be having. -- 500,000 jobs that we could be having. >> i think you. i yield back. >> thank you. i want to string out exactly

what context you are here. if the administration supporting the tri-committee bill or are there other bills out there, senate bills, republicans propositions -- i'm not sure where the administration is. is this your bill? >> i am here representing the administration to tell you that health care reform is the president's number one priority and i think what i was describing was what the president sees estimate the key principles. we do know there are lots of bills. each one of them has certain strengths. we are here to help move the conversation along. >> you are not supporting this bill per say? >> we are absolutely supporting successful health-care reform, which is the number one thing on the president's agenda. >> you can correct these numbers if you will. i have seen a charts that 46 million people are uninsured.

something like nine or 10 million of those are people who are not legally in the united states of america. my question to you is, what would this plan proposed with respect to those individuals? they would have to be insured? with the government to be in a position if there low income to have to pay for that insurance? you are dealing with a situation where what do we do with somebody who should not be here to begin with? >> there is several things to point out. we mentions with dr. price above the 46 million. it is actually more like 82 million, we the people who were uninsured at this point in time. the crucial fact is that 80% of those are workers. most of those are middle-class families who go in and out of insurance. on the issue undocumented

workers, the president has said that he does not support government providing health insurance for undocumented workers. he has also talked about the importance of comprehensive immigration reform. that is something that he thinks is important. >> we should take a number away from the 46 million common terms of those of we are concerned about protecting. i'm from delaware. in my state, there is a lot of free or subsidized medical health, for federal committee health centers. there are drug programs exist throughout the country. there volunteer position programs. i read about the cancer program we have in delaware for people who were low income. the employer based clinics. we have hospital clinics. if we go to a universal system, what is going to happen to those programs? my concern is that people will say that everyone is insured now and we do not have to do these and we are going to lose a lot

from an economic point of view -- a lot of men relatively free medical health care. it had been factored into what is being done at the white house or in this legislation or anywhere else? >> we do know there is a lot of uncompensated care in the country. a lot of the end of being paid for by the government. i would think as we move from government to run programs that are providing uncompensated care, we just would be changing how they are paid for, by making these now -- by making workers now having insurance. so many these wonderful programs, i would assume they would continue. >> i wish somebody will look at that. and not the a lot of these would necessarily shift to the government. these are mostly volunteer activities by corporations or different entities were willing to help.

i'm concerned about the loss. another thing that concerns me is the whole area of prevention and wellness. i think it is in this legislation. i've not read it carefully at this time. i think we all agree it is a key to improving health care. all this in america -- has anyone looked what the cost savings can realistically be of tainted by imposed -- obtained by preventing diabetes and one is programs. it may be little bit too difficult to do. do you have an idea? >> it is something i know. it is something that is heavily studied. i will tell you about this. i was doing an interview on television. someone said, aren't you going to make people live longer? i said, yes, guilty as charged. that is one of the key issues here. we do know well and as often is

cost-effective over a range, but then people live longer. figuring out what it states in general, you are absolutely right, there is some range of this. the estimates -- like smoking sensations. that is very important. weight management. those choosing to help. if you make people live longer, and apologize for that. >> thank you. at this time, we are going. what to call mr. scott. -- at this time, i want to call mr. scott. then i'll call mr. hunter. mrs. romer is going to be allowed to leave the committee under our arrangement of getting here here today. then we will hear from our second panel. mr. scott? >> i wanted to follow-up on the