congressional statute that's been struck down, that prohibits the commercial sale of these really horrific videos about cruelty to animals. about cruelty to animals. .no carrierringconnect 1200 >> in addition to some of these once, neal should one i am really interested in. i think the court tends to say very interesting things when it gets into these questions that deal with the structure of government. i think this will be one of the

more interesting ones for five or six years. >> two cases i am involved in, i will obviously be following closely. i think the next term will be an interesting turn from the perspective of having the court look closely at the aftermath of the financial crisis. not only do you have the pcab case, but you have the jones case which will have a profound defects potentially -- profound effect mutual funds, the allegations of investment advisers charging twice as much to regular folks then they do to institutional investors for virtually the same services. and then there is a case called merck vs. reynolds which will go into the inquiry notice test,

all we're claims are made against companies for violations securities -- for violating securities laws. they will focus on the aftermath of the financial crisis, and the court will find a couple of these historic statutes in the aftermath of this very large financial meltdown that we all have. institutionally, the court, my observation is that the justices will be taking quite some time to get a sense of their new member, and chief justice roberts will be on his fifth term. that will be a significant time. this combination of feeling each other out will play itself out both in the arguments and in the opinions. justice alito's very first opinion, justice scalia slammed him for relying on legislative history. welcome to the supreme court.

it will be interesting to see what kind of reception justice sotomayor receives. >> thank you to the panel into the audience. we will see you next year. [applause] [captioning performed by national captioning institute] [captions copyright national cable satellite corp. 2009] bee

>> today in moscow, president obama and russian president medvedyev signed a new arms agreement treatment. it will replace the one that expires in december, taking the two stockpiles down to the lowest levels. they held a news conference at the kremlin. you can see it in its entirety it is o'clock eastern here on c- span.

tomorrow in moscow, president obama joins prime minister putin breakfast. later, he joins former president gorbachev. he will also meet with russian political and business leaders. on wednesday, president obama travels to italy for the g8 met with evens up through friday. then on saturday, the president flies to africa for a visit to the capital. >> next, health and human services secretary kathleen stapelias testifies before the energy and commerce committee. this hearing, chaired by henry waxman of california, is two and half hours.

>> meeting of the committee will please come to order. in february, president obama called upon the congress to enact legislation to reform america's health-care system. in april, governor kathleen sebelius sworn in as secretary of the department of health and human services. her department has the lead responsibility for improving the health of the american people. last friday, i joined with my colleagues to propose a discussion draft on health reform. this morning, we have the pleasure of hearing the secretary present the administration's views on the discussion draft. based on her contributions it today and what we will hear from the 50 stakeholders' appearing

before the health subcommittee this week, and the input from members, we will revise the discussion draft and introduce a bill for consideration by the three committees. our legislation will reduce health-care costs. it will cover all americans. it will improve the quality of care, and it will be fully paid for. the lead sponsor, the lead author will be the chairman emeritus of this committee who has faithfully carried on his father's legacy as an undisputed leader in the struggle for health reform. i want to emphasize a few important points about the discussion draft. first, it is just that -- a draft for legislation, for discussion for legislation. we are seeking input from the administration and others because we want to improve the draft before introducing legislation. second, the draft build on what

works in our uniquely american system. it builds on the employer-based system for providing health coverage to workers and their dependents. it relies on and improves medicare as the source of health coverage for the elderly and the disabled. it builds upon medicaid to extend coverage to low-income americans. third, the draft fixes what is broken. it fixes the broken individual health insurance market by creating a new insurance exchange through which uninsured americans can enroll in their choice of health care plan. those who cannot afford to purchase coverage available will receive assistance. a public opinion -- excuse me. a public auction will be available -- a public option

will be available to give consumers an alternative for health coverage. this will be self supporting, will not receive ongoing subsidies from the federal government. the public auction -- option will be complete. no one is obligated to sign up for it or provide medical services, but the public option will provide competition so we can make the markets work and keep everybody honest. the draft contains provisions to reduce or rural, racial, and its net -- ethnic disparities. the draft picks as the broken medicare/physician payment system and prevents the cuts that are scheduled during -- under current law from going into effect. it fixes the shortage of

primary-care practitioners, nurses, and other providers. finally, the draft ensures that people have a choice -- a choice of doctors. a choice of benefits packages. a choice among insurance plans. this approach builds on what works and fixes what is broken and makes sure that people have choices. it is pragmatic and it will reduce -- it will produce the results the nation's the desperately needs. lower costs, a broader coverage, better quality. today, we will continue as a journey that began 100 years ago to provide health insurance for all americans. some of our greatest presidents of the 20th century -- teddy roosevelt, franklin roosevelt, harry truman -- or advocates for health insurance for all americans. president clinton fought hard for his administration's proposal. those initiatives may have failed, but the hope that

inspired them was never defeated. the time has finally come to redeem the hope and to deliver true health reform. in conversations with colleagues and constituents, i am getting the clear sense there is a willingness to tackle this issue. to resolve the problems and bring forward more health care of better health care system for all americans. we now have the best opportunity ever to enact health reform. i am determine we will not let this opportunity slip from our grasp. i look forward to the testimony and continue to send health reform legislation to the president for his signature this year. i want to recognize for an opening statement the ranking republican member of the committee. >> thank you, mr. chairman. un die earlier this year

attended several white house health care -- you and i earlier this year attended several white house health-care summits. i said that the republicans in the house, the republicans on this committee were very ready and willing to work with the president, with you and other members of the majority, to create a new health-care system for america. there is no member of congress on either side of the aisle that is opposed to improvements or reforms of our current system. we were ready to work. you told me repeatedly that you were ready to work. myself and the other republicans. having said that, actions speak louder than words. what you and i have held several meetings, and we held one meeting with the ranking member of the subcommittee, we agreed to work together.

the brown bag lunch that was supposed to occur because of that was scheduled and rescheduled, and finally, last week, we were supposed to have had it last friday at noon. we were called the afternoon before and said that that brown bag lunch on a bipartisan basis could not be rescheduled because you were attending a press conference to reveal the democratic health care bill. that is not bipartisanship. that is not inclusiveness. it sure made me feel like the young woman who was being wooed by a young man, and the young man kept promising to take her out on the day, and he finally called corrupt and said that he was getting married to somebody else. -- and he finally called her up and said he was getting married

to somebody else. i guess there are some people that do both. [laughter] luckily, you are not one of them and i am not either. it is the way it is. we now have a bill with the secretary of human services here to probably wax eloquent in support of your bill. i have not read her testimony, but i bet it is supportive. the good news is we are going to have a series of hearings, and we will at some point in time get a markup. hope springs eternal on our side that some of our ideas, they may be included. the bill in its current form -- i have not read all 852 pages of a -- i am not thrilled about that. i have seen it summers. it is a massive government involvement in america's health care. it is usually expensive. i have seen estimates as high as $3 trillion over 10 years. i am told the word "shall" is

mentioned many times. there are 38 new mandates. dozens of new bureaucracies. i listened to your opening statement, mr. chairman, and heard you say no one has to take the government plan that does not want it. that well may be true, technically, but if you put some many mandates on private insurance that it becomes cost prohibitive, and if you raise the medicaid eligibility to 400%, there are going to be millions of americans that lose coverage because the private enterprises that offered cannot afford it and millions of americans will say why should i pay a monthly premium when i go on medicaid and pay little or nothing? the short of it is -- if your

bill were to become law, we would not have much of a private health care system in america. so, put me down as undecided, mr. chairman. we will work with you. we have a number of amendments. we have a republican alternative that is private sector-based. let's the individuals maintain their choice. we do some of the things that you do in your bill. we do have a permanent position reimbursement fix. we do have a tax credit, reimbursement tax credit for low-income americans. but the big difference between the republican bill and the democratic proposal is that on the republican side, we still believe in the marketplace. we do not have all the mandates. we do not force americans into a government plan that we think is not very good for america. with that, mr. chairman, i will

submit the rest of my statement for the record. >> thank you, mr. barton. i am is sincere when i say i want to work with you. >> thank you very much. >> i want to recognize the chairman emeritus of the committee, the champion of health care reform, the man who will be the first name on the legislation that will produce a health care reform. >> mr. chairman, thank you for holding this important hearing. thank you for your remarkable leadership while moving forward to a resolution of the health care problems we have in this country. i want you to know i am grateful and proud. i am particularly appreciative of the kind words to set about my dad. on behalf of my dad, and to thank you for your kind words in french. i also want to do something of a

personal character here, and that is to welcome the secretary sebelius to the committee. your father sat in this committee for a number of years. your father in law was in the house, as you will recall. he was a man who was much respected. you're coming is like coming home. we hope you feel that way, madam secretary. this week marks the beginning of a truly historic process. an opportunity to fulfil our moral and economic obligations to provide quality affordable health care coverage for all americans. the current system is not working. my dad started on this years ago as a matter of humanitarian concern. americans were dying for want of health care. health care was not available to most americans. today, that still is true to one

degree or another. it is now an economic necessity, something which must be done to enable the united states to continue to compete in the world marketplace. our industries are being killed by the lack of this kind of support in a fiercely competitive world economy. 47 million americans are currently without health care. 86 million will be without health care at some point during this year. more and more americans are being forced to make decisions they never should have been forced to make. do they pay their monthly premium? or do they pay utility bills, the mortgage, or food for the family? american business owners are facing a tough decision as to whether to meet the monthly payroll or to pay health

insurance contributions for their employees. if you look at american automobiles, it has $750 worth of steel and $650 worth of health care. foreign competitors do not have the problem. the federal budget can no longer sustain our current health care spending. if health care costs grow unabated, the cost to the country would be more than 20% of its gross emetic product -- gross domestic product. the discussion draft -- i stress the words discussion draft -- we are considering is a uniquely- american solution to this problem. is a pleasure to work with you, mr. chairman, on working to put this together. thank you to all the chairman of

committees to for so hard to bring together unprecedented coordination to bring forward the single discussion draft. i want to make a few things clear. the discussion draft will not create a single payer system. it will not raise your care. it will not attempt to destroy the private market system or the system of employer-sponsored health-care many americans enjoy it today. anybody who says otherwise simply has not read the bill or is not been truthful either with himself or anybody else. that being said, each of us in this room has our own vision of what i deal health care reform looks like. while the specifics may be different, we all share some common goals. first, we must pass legislation that reduces the cost of health care for families, businesses,

and government. suddenly, we must pass legislation that makes quality affordable health care available to all americans. and we must pay for this legislation and we must pass the legislation now. the choices we make of the coming months are going to be historically significant. they will rank with the passage of social security and medicare. if we are courageous and enact comprehensive health care reform, our project will meet the test of history. i will note -- as i mentioned with medicare and social security -- medicare was mentioned on the editorial page on sunday of the "new york times." if we are not courageous, we will have failed this generation and generations to come, and the country will suffer for it.

i am certain this year will pass comprehensive health care reform that will build on the existing system, keep intact to that which is working in our system and get our people the peace of mind that no matter what life changes they face, it will always have access to health insurance. the american people deserve nothing less. thank you, mr. chairman. >> thank you, mr dingell. i now want to recognize my colleague. i want by unanimous consent that all members have the opportunity to cement an opening statement for the record. >> thank you, mr. chairman. thank you for holding this hearing today in the series of panels tomorrow. i want to welcome all witnesses who are joining us, especially express my appreciation and

welcome to dr. todd williams sent -- williamson. hearing from these witnesses is important. i think we have reached consensus that reform is necessary, but we differ on the right methods are reform and the decisions that should be left to doctors and patients and not federal bureaucrats. more government is simply not the answer. the draft before us seems to think that is the answer. as far as the republican views are concerned, we have seen thus far an attempt to approach health care reform in a bipartisan fashion has resulted in what we consider to be a partisan proposal. it refuses to address the concerns of members of our side of the aisle. last friday, we received an 852-

page reform draft. that is one legislative day before the committee began hearings. we are concerned about the cost. the congressional budget office and has yet to weigh in on those costs. early analysis supports the legislation at a whopping $3.5 trillion over the next decade. we need real solutions the american family can afford. the promise of the obama administration and the leadership on the hill is that if you like what you have, then you can keep it. i believe that is simply a play on words because if this draft does what i think it will do, it will destroy that private health insurance market and will ultimately lead to what i consider to be a one size fits all government plan. if we focus on reforming the

system with the benefit of the american people in mind, and should not focus our efforts on things that will destroy the private insurance market. we should be encouraging physicians to enter into the field of medicine as demand for health care-related services continues to grow, but with the proposal before us today, which benchmarks' public plan reimbursements to medicare, that in itself continues to drive providers of the system. i believe we will fall short of the objective that all must share of having a system that encourages doctors to enter and allows everyone to gain access to health care coverage. mr. chairman, we all agree that changes to our system have the potential to yield significant savings and improvements in efficiency and delivery of care, but we must ensure that the reforms to put into place promote competition and

transparency. as we move forward, i hope we will get that cbo score. i think it is important to our deliberations. those on the other side of the aisle look for to being able to work in a bipartisan fashion as we consider the potential for amendments the will of the city suggested. thank you to our witness, our secretary, and thanks to all the witnesses on the panels that will follow. with that, i yield back. >> thank you very much, mr. deal. is my pleasure to welcome the secretary of health and seemed -- health and human services. this is the president's highest priority. this is a subject on which the secretary brings a unique breadth of experience. most recently as a two-term governor of kansas, and she served as the kansas state

insurance commissioner, exceptionally valuable experience. before that, eight years in the kansas house of representatives. madam secretary, i want to welcome you. we look forward to working with you. you're full prepared statement will be in the record. we would like to recognize you. there is a button on the base of the microphone. >> on it would be good. thank you, chairman of waxman, chairman ,dingell, ranking member barton, ranking member deal. thank you. my father did serve on this committee, and he was here when medicare was passed. i feel privileged to be part of

this historic conversation and delighted to have the chance to work with you on this critical issue. no question that you release of a draft -- a discussion draft with your colleagues from the ways and means committee's represents an historic debate. we are grateful for all the work you were about to do as we were together to, at long last, enact reform. help perform constitutes one of our most important domestic priorities, and we know the cost of doing nothing is simply too high. as the president has said, unless we fix what is broken in our current system, everyone's health care is in jeopardy. reform is not a luxury. it is a necessity. today, we have the most expensive health system in the world. we spend 50% more per person

than the average developed country, spending more on health care and housing or food. health insurance premiums have doubled since 2000, and the high cost of care is crippling businesses that are struggling to provide care to their employees and stay competitive. small businesses and their workers, the backbone of the american economy, are clearly suffering. as recently as 16 years ago, a 61% of small businesses offer health care. today, only 38% to. last week, i was meeting with business owners in new jersey. they met with me about the sacrifices they have to make in their companies to provide health benefits to their employees. even then, some of their employees cannot afford the care they need. we spend more on health care than any other nation, but we are not any help here. only three developed countries in the world have higher infant

mortality rates. our nation ranks 24th in life expectancy among developed countries. more than one-third of our citizens are obese, and we know that 75% of our health costs are spent with chronic disease. without reform, these problems only get worse. in 2008, we spent an estimated $2.4 trillion on health care. if we do nothing, by 2018, we will spend $4.4 trillion. today, we spend 3% of our gdp on health costs. during nothing, those costs to reach 30% of gdp by 2040 and 72 million americans will be uninsured. the cbo has recently estimated that by 2025, 20% of the

economic output will be in the health system, limiting our other priorities. there are many problems, but there is also a reason for optimism. across this country, there are lots of examples of hospitals and providers who are using new technology, cutting costs, improving the quality of care. two weeks ago, i was in one of the nation's first fully digital hospitals. health care providers like the mayo clinic, they have lowered costs, but more important, they have improved outcomes for their patients. community health center providers from ohio, tennessee and, pa. have outlined help help information technologies help

them save resources. our challenge is to take the best practices and spread them across the entire country. i have every confidence we can meet this challenge and achieve our goals of reducing costs for families, businesses, and government, protecting people's choices and at long last assuring affordable quality health care for all americans. and we can do it without adding to the deficit. the president is open to good ideas about how we finance health reform, but we are not open to deficit spending. health reform will be paid for, and it will be deficit neutral over 10 years. the president has already introduced his proposals that provide $950 billion over the next decade to finance health reform. many of the resources come from bringing waste of the current system and aggressively prosecuting fraud and abuse. we are currently paying for strategies that do not work,

overpaying for medicines and equipment. it is time to make better use of these dollars. we know reform can reduce costs for families, businesses, and government. as we move forward, we will be guided by simple principles. protect what works about health care and fix what is broken. we have reviewed the key features of the tri-committee draft proposal, and it is clear that you and your committee have embraced these principles. you have created an exchange that will ensure many private insurance plan options, along with the public option, a plan that promotes choice and competition. the plan makes health care affordable for all americans. it invests in prevention and wellness initiatives that prevent disease and illness and

allow americans to live longer, healthier lives, and with meaningful delivery system reforms. under the plan proposed, americans will not have to work about -- worry about being denied care. they will have it easier access to tools that will help them avoid the -- avoid disease. the medicaid reforms proposed in this bill have taken important steps to improve the critical safety net programs, making an income-based program, and approving reimbursement rates for primary care. this discussion draft represents an historic step forward. all we are examining the details, i agree with a president who says this proposal represents a major step toward our goal.

mr. chairman, i am eager to work with this committee and her colleagues in the house and across the aisle in the senate to deliver the reform so desperately need, and i appreciate the opportunity to engage in this discussion. >> thank you, secretary for your testimony. i want to start with questions. this issue of health care reform as part of the campaign that president obama waged in order to be elected president. if there is any issue, he has made this is number one domestic priority. i want to know underline, questioning you, some of the aspects he wants to accomplish and what he wants to do with this effort.

based on the president's approach, our draft, and it is just a draft, sets out a comprehensive approach. it addresses prevention and wellness, the health care at work force, quality of care, broad based shared responsibility, dealing with the costs of coverage through insurance reforms. a new exchange for people to get their insurance. affordability credits. improvements in medicaid. substantial savings and improvements in medicare. is this what the illustration is committed to? should we approach this in a more compartmentalized manner? should we approach this in a comprehensive way? >> mr. chairman, as he said, this is one of the key priorities of then it-senator barack obama and now president obama, and he believes strongly

we cannot fix the economy without fixing health care. a comprehensive approach to reform is what is required. i think that is what this legislation addresses in many of its components. there is no question you cannot do just want their -- one thing at a time. fundamentally lowering costs -- there is no question we cannot continue on the cost curve we are on right now. it is unsustainable. it will not serve anyone well, those who have health insurance now, a month, a year, two years away from not being able to afford the coverage they have. does that do not have coverage cannot access the best technology and the best medical care in the world.

we need a comprehensive approach. we need to shift the system. i think the elements that you have put forward in the discussion draft will do just that. >> undertaking this kind of comprehensive reform is pretty complicated. it is going to require an enormous amount of effort from members of congress. some of them say, well, maybe we should go slower. maybe we should do it next year. what is the ministrations view of the timetable for action -- what is the administration in's view of the timetable for action? >> i think the president feels strongly there is enormous urgency about this issue. it has to do with our economic well-being as a nation and our competitors nest as a global society. workers are less competitive

across the world because of the increasing cost of health care. the engine of our economy, the fastest-growing segment of our economy, they are often less competitive to have high quality workers because they seek to have health care provided along with their wages, and to many small employers cannot do that. -- too many small employers cannot do that. we need greater emphasis on wellness. we need a society where our children are not facing the prospect, which currently american children face, where we are seen the first generation who may live shorter lives than their parents based on the rise in diabetes. we have some challenges, mr. chairman, that cause us to enact

legislation this year, to urge the action of both the house and the senate on this important issue. it is difficult. it is complicated. if it were easy, it probably would have been done on time ago. >> let me ask you one last question because my time is almost out. we have businesses paying too much. government is paying too much. small businesses cannot afford it at all for their employees. if you are without insurance, it is impossible. the thing we need a shared responsibility for every sector, individuals, providers, government, moving forward together? and everyone has to share in the cost? no particular sector says somebody else will pay for me, but we all have to be in there and we're collectively better off as a society? >> i cannot think there's any

question that if you build on the current system, which is absolutely what the president wants to do and what the discussion draft proposes, there is a shared responsibility. over 99% of large employers provide health care coverage. a lot of small employers already do. some do not. we have had situations where some americans are left out. we need more personal responsibility, certainly, in the life choices that we may, which can help lower health costs. we need parents to get involved. we need more preventive care. there's a sense that we are in this together. this is boldly most personal issued to every american. -- this is probably most personal issued to every american. this needs to involve everyone. >> thank you. >> thank you, mr. chairman. thank you, madame secretary for

being here. you said there'd be no deficit financing as a result of this health-care reform package, if it became law. is that literally true? >> mr. chairman, i was quoting the president. the president has said consistently he will not sign the bill unless it is paid for. >> so we just want to establish on the record ride out the bad that there will be no increase in the deficit as a result of a comprehensive health care package if it does become law? that is just plain language. >> that is what the president has stated as one of his top priorities. it will be paid for. >> ok. let me walk through one part of your program. it creates a new category of coverage under medicaid. 133% of party, -- of poverty,

which will be 100% paid for by the federal government for childless adults between the ages of 19 and 64. this one provision, if i understand it correctly, could add as many as 20 million americans to the mate -- medicaid program. i do not know what the cost number is per coverage per person, so i just picked the number. bayh number is wrong. -- if my number is wrong, correct me. i said $6,000 all year. that may be too high. that is $120 billion right there per year. how you pay for that? in the bill, this is to be determined later. so give me an example of the pay for that is $120 billion a year.

>> congressman barton, the president has proposed $660 billion in savings from the current medicare/medicaid program, and in addition he has proposed revenue enhancers' -- >> that is over a 10-year time. >> yes, sir. >> $120 billion a year. >> i would start at first of all i do not know the numbers accurately. i would assume that your 20 million is within the ballpark. i can just tell you that whatever the proposal that comes forward, the president has insisted that the bill will be paid for -- >> you are a former governor, i believe. >> yes, sir.

>> kansas? >> kansas. >> the governor of kansas. this kansas have a balanced budget requirement? >> yes. >> when you were governor of kansas, by law, you had to submit paid fors when you spend money in the budget? yes, ma'am. again, my numbers may not be in the number, but they are definitely in the ballpark. if i give the president the benefit of the doubt that there are out there $600 billion over the 10-years in savings, $60 billion a year, this one expansion in medicaid is still $60 billion a year short. you are the secretary of health and human services. i assume you have had some interaction with chairman

waxman, chairman miller in providing this draft bill. you have to have some idea of how you are going to pay for it. again, i am giving you the benefit -- if the president says he can save $60 billion a year, i will stipulate he say $60 billion a year. but you need to put $60 billion more in savings or tax increases on the table. you had to do it when you were governor. >> that is true. this is a discussion draft. i can assure you at the end of the day, the bill the passes will be paid for. we will work closely with the chairman in the house and the senators on the other side to come up with strategies to do just that. >> should we tell them up front? >> we do not have a cbo score yet for this bill or the proposals in this bill -- >> but you need to put on the table where are you going to get the money.

it is not a box of chocolates. oh, there is $60 billion. mr. chairman, my time has expired. i think reestablished -- i think we have established a good point. is a good thing if we have no deficit spending. it is a bad thing if we industry with the american people about where we are going to get the money. i just pointed out one part of the bill. already, we are at least $60 billion per year short. thank you, mr. chairman. >> thank you. mr. dingell. >> thank you. madam secretary, welcome. would it be appropriate to say the tri-committee discussion

draft alliance with the health reform principles outlined earlier this year? yes or no? >> yes. >> and madame secretary, there's been quite a bit of discussion about the inclusion of a public auction in the conversation -- public option in the conversation. does president obama support this? >> yes, he does. >> madam secretary, hospitals or doctors are not required to participate in the public option? >> yes. >> premiums and co-payments under the public auction will cover the cost?

>> that is my understanding. >> the public option must in here to the same rules and regulations as other plants? " that is correct. -- >> that is correct. >> it will be administered by a separate agency than the one that runs the exchange? >> that is the way the draft is written. >> the public option will offer the same minimum benefit design is all other plans. >> yes. a level playing field. >> individuals will be permitted to apply subsidies toward both public and private plans? >> yes, sir. >> i apologize to you, madam secretary. we have all lot of business to do here. madam secretary, there has been justified concern over the consolidation of the health

insurance partners and the impact it has on health insurance claims. according to the american medical association, 94% of the insurance markets in the united states are now highly concentrated. this announced increases the amount of competition, and this is a major cause for health concerns. yes or no? >> there is a monopoly in much of the country in the private insurance market, yes. >> this is a serious concern then. how does the public plan address this concern? this is not yes or no. >> [laughter] >> [laughter] >> i think the public option uses market principles -- competition and choice -- to lower costs and provide consumers a choice of plans.

i think that the public option in much of the country -- two- thirds of my state, for example -- there would be only one choice, which is not terribly effective in terms of holding costs down and does not provide consumer choice of a side-by- side plan, which is why states and state employee plans create public options standing side-by- side. many have done that with the children's insurance program. >> madam secretary, as a former governor and former insurance commissioner, you were able to speak to this question. state insurance regulatory agents are not able to regulate except as regards solvency of the insurance companies. is that not correct? >> a survey can regulate

solvency and also have some cost regulation, but frequently if there's no choice in the market, cost regulation as almost irrelevant. >> so competition being put in the market would be the one thing that would make this system work, by having the public option there. >> again, it is a marketplace strategy, that competition is more effective than heavy-handed regulation. >> madam secretary, there are questions about whether the tri-committee proposal is a complex concept. it includes subsidies, medicare, medicaid, responsibilities for the individual and employers. will be administration be able to fully implement and administer this proposal? >> your time is expired. we do want to get the answer.

what is the answer? >> yes. >> that is it? just yes? [laughter] >> thank you. gentleman from georgia. >> thank you, mr. chairman. our state secretary made a comment during the mark above the american recovery and reinvestment act which said it is highly unlikely you will find millionaires who want to go on medicaid. one of the concerns this bill arises is whether or not we are treating low in come citizens as second-class citizens by automatically enrolling them in medicaid. my question would be this -- why you believe that a family making $29,000 a year is not as able to make choices as a family making $30,000 a year? and why would it be better to separate and automatically enroll them in medicaid as opposed to giving them a subsidy

to allow them to go into the private insurance market? >> congressman, some of those families, a limited number, are in jobs right now where they have employer-provided coverage. they certainly would not shift that coverage. a large number particularly single adults, who are at the 100% below the poverty line, who are making off been a very small amount of money, they have no coverage at all. they are uninsured and find themselves not in an ownership capacity. i think the committees look at expanding medicaid to 133% also follows the experience of many states that zebari done that. the most effective strategy to

expand coverage -- it is a larger market that often provides a benefit package that is cost-effective and, frankly, is often far less expensive than the private options that exist, which is why many states have taken the medicaid route. >> is understand the draft, it would propose that everyone under the age of 65 who is under the 133% of the federal poverty level, would be enrolled in medicaid. can you give us, first of all, how many people do you think that encompasses? and how many of those people currently have private health insurance? >> sir, i do not want to cite numbers of the top of my head, and i can easily return to those numbers. i apologize. i know there are a fairly significant number of the so- called childless adults, not

parents, typically because a number of states have taken steps for parents whose children are eligible for the program to expand coverage, because they found that an effective strategy when enrolling children. i think we are talking primarily about childless adults, often below -- i think they make less than $6,600 a year, and i can get back to you with the specific numbers. >> would you please do that? secretary, on page 73 of the bill, it provides for the automatic immelmann of individuals in the medicaid program. i want to just ask you if the citizenship and a din of the verification requirements that are -- and identity verification requirements will still be part of the enrollment processes, and

will you assure us that individuals in our country better otherwise ineligible for taxpayer report -- support will not be enrolled under this provision of this bill while you serve as our secretary? >> mr. deal, i can assure you that states now because of various federal rules requiring verification of identity and have those systems in place. we have really developed systems to verify identity of not only existing clientele, but in rolling clientele. that will certainly be in place. >> so it would not be your intention or something you would not allow to happen, that the automatic enrollment process would not overlook or override those current verification requirements? >> that is correct. >> thank you, madame secretary.

i yield back my time, mr. chairman. >> thank you. >> thank you, mr. chairman. thank you, secretary, for being with us today. i wanted to take my time just to ask about medicare and medicaid. i think there is a certain amount of confusion because obviously in this discussion, the president has stressed we can save money that will be used to pay for this plan through savings in medicare and medicaid. at the same time, the major enhancements in improvements in both programs better in the discussion draft -- there's a certain amount of confusion about that. overall, i think if you view the combination of the medicare and medicaid savings and the benefit enhancements, overall, there is a market improvement -- marked

improvement in medicare and medicaid. i wanted to ask about that. to expand the eligibility and accessibility of medicare and for enrollees, taken as a whole, how you take the benefit enhancements as improvement in the medicare program? . . .

>> coordinating post release care, actually providing incentives for follow-up care, is significant improvement. actually provides all lot better care for the patients and that would be the kind of example that a discussion draft incorporates. better quality in the long run, following best practices, and frankly, not continuing to overpay for services that have no benefits or results. >> did you want to talk about filling the doughnut hole?

that is very much on the minds of the seniors and we propose to do that. >> i think that is a huge step forward, as you saw, the chairman of aarp recently endorsed the strategy that is appearing in the house and the senate to fill the doughnut hole. it is a huge issue. as an insurance commissioner, we used to face this a chelation with citizens who had no idea and had not counted on the fact that their benefits would cease and their premiums would continue. they had not saved appropriately. this was not only a huge shock, but something that forced a lot of people to stop buying their medications and stopped following the doctor's

instructions and end up in the hospital again. this is a huge issue for seniors across this country who have benefited from lower cost of drugs, but when they hit the barrier, they are in worse shape than they were in the beginning. they have no help. >> what about medicaid? there was a major expansion in terms of increased reimbursement rates. covering people in many states that are below the 100 percent -- 1% in federal dollars. i want to stress that even though we are having savings for medicare and medicaid, we are improving the program significantly. >> there is conversation among providers in my home state that is not focused on medicare, but on medicaid.

it often reimburses -- under reimburses doctors and family care providers. i think that is a huge step forward. having a situation where, if you are an adult or a family under 33% of family, wherever you go, you would have the same benefits if you move across the state line or if you need to travel with your family elsewhere, you would have similar benefits. it would be the portability that is currently not available to all lot of people because the benefits change from state to state. that is a significant step forward. while you are discussing medicaid, i just wanted to share with the committee that my staff has told me that the number of that we have been given by cbo

for childless adults is really a $3,000 a person average cost, not $6,000 as was suggested. >> think you very much. >> i am going to now recognize mr. wood field. there is a republican motion to adjourn on the house floor. we will continue the hearing, so those that want to respond should do so. bucs mr. chairman, i think you very much. -- >> mr. chairman, i think you very much. -- i think you very much -- i thank you very much. most citizens on medicare did not receive that benefit. they were paying for those

medicines and now we are trying to fill the bill will so that they do not have to pay for that, either. as politicians, we like to expand coverage and give coverage. it sounds like we do not want anyone to pay for anything, but i know that your father was involved with medicare according to your testimony. i was looking at some of the debate when medicare was adopted in 1965 and they are making some of the same arguments that you made in your testimony. in 1965, they projected that by 1990, the cost of medicare would be $9 billion. come to find out, it was almost $200 billion. we know that health care needs to be reformed, and when you talk about it being budget neutral, we talk about it getting a lot of money in

increasing efficiencies and taking waste out of the current system and being more aggressive to stop fraud. it is so nebulous, and you are a practical person. do you honestly think that we can reform the system and save money and provide better quality health care? >> congressman, i do and i do so not because of something based on a hypothetical set chelation, but visiting help systems around this country that do just that. they have higher quality outcomes and they have used technology and the provider protocol provided to make sure that the results are better each and every time. i have seen it in systems around

the country and i am absolutely confident that we can do with throughout the united states. " i am glad you are confident, but i am really skeptical about it. when we talk about it being budget neutral, that is good for the government and the taxpayers pay for the government, but then this bill has a mandate on employers as established by the health benefits advisory council. there is a mandate and their four small business people to pay 8% of wages to provide a benefit defined by the commission that is established in this bill. so, for the small business people, if someone has wages and they are paying $500,000 a year,

that would cost -- they are making $500,000 a year, it would cost them $40,000. the fate they should be competitive and provide jobs for employees and pay this as well? >> absolutely, i am concerned about the competitiveness of our small business owners. health-care costs is one of the areas that is a huge challenge for every small-business owner. they can i get great employees without offering benefits. several things are in this bill. the discussion draft makes it clear that there will be a specific small business exemption. that will occur. >> i know that there is an exemption, but there are people who will be hit by this. >> that is ok. >> i would suggest that it would

give them a cost advantage that they do not have now. >> let me ask you one other question because my time is about to expire. one of the criticisms we always hear about the single payer system and universal health coverage in other countries is that it wrasse analyzes health care -- it rationalizes health care. the most inexpensive -- the most expensive part of health care is in love life care. i am not saying there is anything wrong with rationalizing health care, but to really get big savings, we should be rationalizing health care in the u.s.. many countries do. that is how they control costs. did you think that we should be doing that? >> absolutely not. i think that the creation of a

health exchange market place is not a single payer system. i think you'll hear from several proponents that will strongly suggest that we should be looking at a single payer system, but that is not what the chairman put forward. they put forward a plan that builds on the current system. rationing care is something that happens each and every day under our current system and it is often done by private insurers that get between a doctor and a patient and says which procedures can be paid for and what prescriptions. this is an opportunity to make sure that we have more patience centered care and that we follow the protocols that work. >> mr. markey? >> i introduced legislation with rum emanuel and congressman --

and a congressman from new jersey. the bill created a medicare pilot project focused on improving the coordination of care and reducing costs. they also need help with two or more activities of daily living such as dressing and feeding. it has been reported that 5% of medicare beneficiaries come from 43% of overall medicare spending and cms has noted that approximately 20% of beneficiaries have five or more chronic conditions that account for 66% of the program spending. could you talk about how we could focus on those medicare beneficiaries with multiple chronic diseases and how a

program like that could help to reduce the cost? >> we have not only the demonstration that you are responsible for, but a number of projects are under way to look at coordinating care for the vulnerable, high-cost individuals. they have an opportunity to do that in a home base instead of a hospital based service. it is not only better for the patient, but it may provide some enhanced cost savings. we are eager to work with you to continue to figure out better ways to not only coordinate care for individuals that suffer from various chronic diseases but also to make it a better system that would lead us to

more home care delivery. >> in terms of home-based programs for the beneficiary population, do you see a shifting in that direction to make sure that we try to reduce costs by trying to stabilize and these people at home? >> as you know, there is a lot of effort under way and a lot of it has been at the state basis. i hope that we could have a real collaborative partnership in rebalancing care, not only trying to prevent hospitalizations before they occur, but also the nursing home. the number of patients you were describing often end up in a nursing home setting because they do not have access to the wraparound services that they need. we would like to enhance that sort of home-based care that

allows people to not only be more independent, but also at a lower cost than a hospital or nursing home. >> the bill would also enable teams of primary-care doctors and other care providers to form an organization to contract with hhs as part of a three-year program. this is if they are served by these " -- of these core organizations. they can keep 80 percent of the savings with 20% of the savings return to medicare. do you think that makes any

sense to have cost savings sharing as a system that we could construct? >> i certainly support the notion of beginning to pay for outcomes. too much of the medicare system is driven by the number of times a provider touches a patient, not necessarily what happens at the end of the day. the system that you described it would not only provide for a coordinated strategy, which is what we need to occur, but also save money. it makes sense to provide those incentives to providers. >> thank you for your service and thank you for being here. >> ms. christensen? >> thank you, mr. chairman. there is some benefit to being a delegate. welcome, madam secretary.

last week, we had some very good conversations on health disparities. in reading your testimony, both in the senate and here, there was very little if any reference made to this very important issue. it leads to preventable deaths every year. hope that you will work to ensure that your entire department is aware of this situation. the office of minority health and the office of the national center for minority health will be elevated to eliminating health disparities. the bill directs that a national initiative be in place. could to discuss how you plan

to fulfill this requirement and insure that all areas be identified? how will the agency for health care quality and research be involved since they have been doing these help disparity reports? >> as i shared with you last week, i am, as a new secretary, concerned that we make sure that we do a lot more than published the reports which have alarming statistics about health disparities and, frankly, they are not getting any better. health reform is a piece of the puzzle. i do not think there is any question. having access for everyone to a higher quality care is a step in the right direction. i had a very productive meeting with a state colder rep -- with

stakeholders and assured them that we not only wanted a one time meeting, but i want an ongoing strategy. we met with our team about how it is that we are going to actually begin to close this gap because continuing the gap does not work. we are aggressively taking on not only the strategies that have been reported, but we want the new team to be focused on the issue of great concern to you and to me. >> i have another issue of great concern that relates to territories. your testimony says that this is not a luxury, but a necessity. i definitely agree with that. certain issues like equitable coverage for all americans should not be really held hostage.

we discussed that at the hearing yesterday. we have been working for years to remove the medicaid cap. while the bill does provide additional funding to the territories, it does not move us in that direction at all. so, to me, it makes it far less possible for men and women to achieve the benefits that this bill will provide for the rest of america. i would like to hear your thoughts on that. >> congressman, i would like to provide an opportunity for you to have that discussion with me and our staff and i would really like to work with you. this is a work in progress. it is a discussion draft. i would just like to work with

you to see how we can help enhance the areas that you have identified as problematic. >> thank you. >> mr. stern's? >> thank you, mr. chairman. madam secretary, i note that you said earlier that the benefit would stop and the payment continues. you understand that that is a small amount of time. i think you understand that, so it is not proper to say that their benefits stop because their benefits -- they stop for a substantial period of time, but that is dependent. >> i have two questions. the president has indicated that if you like your health care plan, you'll be able to keep your health care plan.

i have here that a group has done a study and nearly 67% of non medicare americans would lose their current coverage and be forced into a government run insurance if the plan was included. you have any evidence that if a government plan is offered at 120 million people will be able to keep their current insurance? >> it is my understanding that the study has been updated or disputed and that those numbers were significantly higher than what folks said. >> the next question is, i have a study by the age s.i. not work. june 24, 2009, they say that the bill that we are discussing

today would cost an astounding 3.5 trillion dollars. do you dispute that fact? >> i am waiting to see what they say. i do not know the figures that you just quoted. >> have you seen this report? >> no i have not. >> the president has indicated that if any bill does not control costs, that is a bill that he cannot support. the first question is, you do not agree with this report and you do not know about it. they said it would cost, if it is not three-point five or 3.2, where will you get the money to pay for this bill? >> again, i think that once the bill is scored and once the proposals are put forward, i am eager to work with the committee's in the house and the senate to identify the savings

that the president has proposed. there are other ideas that are being proposed by members of the senate and the house and we are eager. >> that will not approach 3.5 trillion dollars. $1 billion is just a pittance that the 3.5 trillion dollars that this proposal speaks about. let's not take the 3.5 trillion dollars, let's save where we are going to save money. >> to start from the premise that we cannot afford what we are doing. not doing anything is not an option. two trillion dollars a year is being spent and we have to

change what is currently happening. i think there is every evidence that the combination of health technology and beginning to pay for prevention and wellness is a huge cost saver. it is effective to have americans in healthier conditions. it is good for our businesses. it is good for our work force. >> all of the things that you suggested, both sides would agree on. the question is, how to reform that system so that there is universal access? at the same time, we do not have a government program that is not paid for with no statistics to show that it is more to save money. that could be an alternative suggestion. i just suggest that you read and

the report that came out and go back with the latest report from the group and before you come up here, you should have some answer as to how you're going to pay for this. >> thank you, mr. chairman. madam secretary, one area i have been working on with chairman waxman and senator rockefeller is legislation that would strengthen the federal health care quality infrastructure in order to identify and attract the health indicators as well as implement new signs across the states. what this bill does, is established priorities and pediatric health care is one of the first. i love this legislation has been incorporated in the discussion

draft that we are talking about today. but the draft bill also contains a provision that requires the director of the agency for health care research and quality to work with you as secretary to develop quality measures for the delivery of health care services in the united states i think this is an important requirement, but i am worried about the implications for pediatric health care quality measures because even though the discussion draft requires the measures to be designed for individuals, regardless of age, the section is funded with medicare dollars. under the previous administration, they determined it that medicare dollars could not be used for pediatric measures. what plans does he have missed -- does the administration have to address pediatric care?

>> congresswoman, i think that we are convinced that medicare can be a leader in improving quality of care for all americans. certainly, the development of quality standards is done under that umbrella. that is a huge priority and the country is moving forward. there is an effort to make sure that the pediatric standards are very much developed. >> to you think that that can be done with the medicare dollars or is that something that we will need to explore as we move forward >>? >> they are confident that we could fulfil the mandate that is

in the bill right now to develop standards. >> i know you recognize the medical establishment. children are not just a little adults. we have to develop separate standards. >> i wonder if you could talk for a minute about the administration's view on cottle 7 and the work force dollars that are included in the discussion draft. >> as you looked toward the future of a reformed health system, will -- health systems are important. they have taken a significant step in the stimulus act, beginning to fund the pipeline of critical health care workers and nurse practitioners and i

think this takes that to the next chapter, which recognizes a shift in incentives. again, with a whole series of initiatives that would provide more health care providers in other parts of the country. >> one of the provisions of was pleased to have included was the idea of although enrollment at birth for children whose parents do not have insurance plans and then continue as eligibility for children. can you comment on the administration's position? >> i think it has been shown that the enrollment efforts very from state to state -- the roman am -- of the enrollment

efforts vary from state to state. what has been proven is an easier presumptive enrollment when kids show up at the hospital. although enrollment at birth would facilitate, including the fact that children get a healthy start on life. >> thank you, very much mr. chairman. >> mr. boyer? >> madame secretary, what type of revenue enhancers' have been discussed? >> at this point, the president has proposed a return to the itemized deduction that was present in the days of ronald reagan. he feels that would be a way to raise revenue. >> $340 billion?

>> what are other ideas that have been discussed? >> that is the revenue in hansard that has been discussed. >> that is 340 billion. >> that is the revenue in hansard that the president has discussed. he has proposed over $660 billion worth of savings. we are about just under one trillion dollars. >> and we are still looking for another 200 and -- another two trillion dollars. i am not really prepared to talk about a three trillion dollar bill. >> who would that impact? >> it would impact the wealthiest americans who are currently paying a different level of tax rate on their itemized deduction than middle

income americans. >> and that would be set at what? at what adjusted gross income level would that be said? >> >> it is my understanding that it was over to -- that it was over $200,000. " what happened to the promise that he would not raise taxes on anybody that he would not raise the taxes on anybody that makes under $250,000. >> so it is okayed for him to

promise one thing to the american people and do another one. what is that what your boss is proposing? did you remind your boss and that you're the capital secretary in your about to break your promise to the american people if you do this? what i did not say that to the president. >> what did you say to the president? i told him that i was eager to help him pass health reform and that it would be paid for in the period of time that the bill proposes, over a decade. i think that is a fair promise to the american people. >> medicaid plans, when you were governor, states get a grade with regard to administration of medicaid by the states. what was your great when you were commissioner and governor? >> who is greeting me?

>> i do not know what you were talking about. i guess the people of kansas thought i got a pretty good grade because i got reelected as insurance commissioner and as governor. >> you've got a d. maybe you thought that that was good and was acceptable. at my only concern is that if you think that a d is acceptable and york live about it, >> with the gentleman yield? >> no, i am not going to yield. are we not sending a signal to the states that if the government is going to pick up additional costs, they do not have to be as cost-conscious. should i worry about that? >> i would say that the bulk of

the medicaid beneficiaries would still have a very significant state share. i do not know iof any governor n the state -- in the country that is not concerned about medicaid. >> with concern to doctors, you said that everybody will be guaranteed their choice of doctor, but when you have shifting that will occur, and that is recognized, an individual that likes going to their doctor is now has a doctor that will not participate. then they lose their choice of doctor. >> the germans time has expired. >> only if that individual chooses the public option. >> then they lose their choice of doctor. >> that is the individual's choice. doctors would not be mandated to be in the program. >> that is true with private

insurance as well? >> well, madam secretary. i just want to make one brief comment about a group of people that were discussed earlier. childless adults would be covered under medicaid in this legislation with the cost of your being asked about. it is not as if these are folks that we are not paying for already, which is most often bury expensive and inappropriate for their health needs. i think that needs to be part of the discussion. my question to you has to do with the part of the country you come from. there are barriers in rural america. i wanted to take advantage of your expertise as insurance commissioner for a state.

could you share with us some of the types of reforms that are needed to improve our current insurance market? some of the -- how will this bill address that cost savings? >> thank you, congresswoman. i think that there is no question, particularly in the small business market, and there is constant cherry picking activity is that into one of two things. -- that does one of two things. in the individual marketplace, the pre-existing condition barrier either makes insurance impossible to obtain or completely unaffordable to

obtain. it is a huge barrier to americans' access and quality health care. >> are there provisions in this legislation that you of the look -- you believe will address this customer >> absolutely. not only -- you have a couple of provisions. you would allow different oversight to medical loss ratios to eliminate overhead costs and there is a provision that would exclude insurers from denying people coverage based on a pre- existing condition and there is a much more community are rated aspect that would limit the kind of spikes in a cost of that small business owners often see that drives them out of the marketplace. >> now, to the part of my district, i represent a county in california in which one

company has more than 50% of the market. it is the only private insurer. the county also has a shortage of primary physicians because of their locality. this county also does not quite qualify for a shortage area. could you talk about your experience and that is similar and how this legislation could improve the choice of health plans in accounting such as what i have described and how we really need to attract physicians to certain areas like the one that i mentioned and many others in rural america as well as other areas in metropolitan areas. >> there is no question that the

public auction in the marketplace achieves the very goals that you have described where consumers would have a choice and there was also because competition. the initial investment began the pathway. particularly in certain areas. i think that this bill takes a bigger step forward recognizing that and loan repayment is an effective strategy. i would say that the implementation would provide for those who do not want to be isolated but are in frequent consultation with colleagues in various parts of the country and state so that they are not in

isolated practices. there are a number of features that are not only in this discussion draft, but will really help address the work force issue. >> we now go to mr. burgess. >> thank you, mr. chairman. madam secretary, i'm over in the broom closet behind the kids stable. during your -- welcome to our committee. during your confirmation hearing before the senate, i believe that the statement was made that if confirmed, i would not only be an equal partner to work with congress, but i understand bipartisanship. is that a reasonable facsimile of the testimony that day? >> yes sir. >> i know that the ranking

member has sent a letter and a follow-up. they note that despite providing technical assistance to the majority, that same courtesy had not been made available to the minority. when can we tell the senate to expect that we're going to help them with the same technical assistance to have provided to the majority on the senate side? >> it is my understanding that our staff has been in the house and the senate on a daily basis, providing information and expertise, modeling a whole

variety of situations. i am not sure specifically what was requested. that has not been provided. i know that they have been available and very present, day in and day out. >> i would like unanimous consent to make the senate letter part of the record. to follow for our committee, will that same technical expertise be made available to the minority in the house? >> as much as we can provide background information, we stand ready to do that. >> will we stand ready to access that. >> let me ask your question. in your prepared testimony, there was a discussion about the proposals to provide finance for reform. that follows the statement that they would not add to the deficit.

in the world or 96% of the people have health coverage, and i correct in presuming that -- in the world were 96% of the people have health coverage, am i correct in presuming that that funding will not necessarily need to go to the hospitals? >> there is a proposal that is part of the package that a reduction be had dissipated -- a reduction be anticipated. i do not think anybody expects someone to provide the bulk of care to people who were uninsured, but hopefully there will be differences. >> just to point out, in my home

state of texas, a significant number cannot resolve that issue. i suspect that there will be some people that will be left out of the 96% who actually have health coverage. i was glad to hear you reemphasize this morning that the president wanted to protect what works and fix what is broken. i am glad you went to omaha. i went to omaha earlier this year. they are one of the forward- looking institutions in this country and there are many others. testimony at this committee yesterday, without the ability to have the help savings account and health reimbursement account to be able to provide the correct incentives for their patience to access to preventive care that we all want people to feel that is important, without

those tools, it would be very difficult for them to operate the facility that they have today. >> >> without the help savings? >> i guess what i am getting at is, can we get a definitive answer? it appears that help savings accounts are not going to count as qualified coverage. is that correct from your reading of the bill? >> sir, i cannot -- i will go back and make absolutely sure. i know that there is no attempt to eliminate a help savings account or how they are defined. helped savings accounts would still be available to americans as they are today. >> i am not certain that that is correct under the language of the bill. the president could do a good service by instructing us to

help people avoid a penalty if they choose to get their insurance through a hell savings account. >> at a help savings account, absent another insurance policy? >> that is correct. my time is just starting. it has now gone green, yet. >> i do not want to dispute with you on that. i want to clarify that helped savings accounts are not adversely affected in the draft bill. that would be a ways of tax issue. we will get a clarification because you raise an important question. >> briefly reclaiming my time, if you look at the rate of increase, it all increases at a rate of 7.5% a year. we heard testimony that their rate of increase was about 5%

signed a year. it seems to me that if we want to figure out what works, we will look at those types of programs and give people an incentive to select healthy behaviors and make it important to them and we will find that people will do the right thing. >> mr. burgess, thank you very much >> there are other members waiting periog period >> well, m secretary. we are happy to see you here. i was pleased to see the legislation that i offered was incorporated into the draft bill today. the creation of a public health work force is a major step forward and will revolutionize public health, forever. it is a necessary step because we are staring a public health

work force prices directly in the face. in order to do this, we will need to train twice as many as we have today. >> we need to reinvest in this crucial part of our public health infrastructure so that we can take community-based action to reduce a health crisis. you are the head of the largest public health agency in the world. you probably know as well as anyone that by 2012, half of the work force will be ready to retire. in my opinion, we did a good job in managing the flu outbreak, but this has shown us how critical it is to not let our public health work force deteriorate any further. i am pleased that my piece of it

was incorporated into the draft bill. madam secretary, i want my colleagues to understand how critical the public health work force is. would you please outline, for the benefit of this committee, how your job is dependent on having a robust public health work force backing you up? >> congresswoman, thank you for your leadership in this area and your longstanding expertise and insistence that the infrastructure has to be part of this dialogue. i think you appropriately identified them. the recent situation that is still with us, the h1n1 virus, we will need a more robust infrastructure, and as you correctly point out, in many parts of the country, it is not robust enough now and we are

facing the retirement of a lot of individuals. having not only the pipeline, there are efforts to enhance, through the recovery act, the community health center aspect of the public health backbone in this country, and i think that is an important step forward. there is no question that we need not only further attention to work force issues, but further attention to quality standards in public health agencies throughout the country. i can assure you that our new leadership at the center for disease control is a huge believer that the public health infrastructure needs to be enhanced and improved and needs to be focused on and he has come

into this job with that agenda at the forefront of his priorities. it is one that i share. >> why are we facing such a crisis in public health today? that i share. >> why are we facing such a crisis in public health workforce today? i know part of it is that we need more graduates from public health programs, but i think the other part of it is that we may not have the right incentives for the graduates we do have to enter public service? >> well, i think the whole incentive system in health care is one that is on the table for review as we look at the reform agenda. how we not only attract more students to medicine in the first place, but how we attract more of the students to the appropriate shortages. >> but do you think that the

scholarship alone repayment provisions in the draft bill will help incentive to the public graduates to the public work snors. >> i don't think there's any question that those strategies have been proven to be enormously effective. students unfortunately today, are emerging with mountains of debt and often, public health officials aren't paid as handsomely as some in the private sector, so helping to retire that debt and helping to erase that debt is an enormous step to allowing students to actually make choice that is they might find more rewarding, but currently find financially out of reach. >> kwo. i thank you very much. i yield back the balance of my time. >> thank you. the gentleman from georgia, mr. gingrich. >> thank you for being with us this morning. you were asked about your grade as governor i would say your grade so far this morning has

been pretty good so hopefully you won't mind a couple of tough questions from me. in quoting in your testimony, without reform, according to the medicare actuaries we'll spends about $4.4 trillion on health care in 2018 and by 2040 health care cost also reach 40% of gdp. madam secretary these numbers are indeed, staggering and i share your concerns. however, i have another concern and i need to be reassured that you share that. the medicare trustees report that the medicare problem will be insolvent 2016, receive health care from a government payor and your testimony focuses almost exclusively on the private sectk health car care -- private sector companies. given that 45% of all americans

get their health care from a government program, and the fact that your department oversees the largest government program tasked with insurance of quality health care for our seniors is available both today and in the future, shouldn't entitlement reform be an integral part of this legislation? >> yes, sir. i think it definitely should and that's why i'm confident that not only a number of the proposals to enhance quality for seniors are important and we talked a bit about closing the donut hole which is a huge issue. but also, the savings that are proposed by the president will enhance if lifetime of the medicare program that you've just cited. and, also, lower premium rates. premium rates for the seniors paying them so it has a win-win situation and it helps to pay for a longer life of the program

that's so important to millions of americans. >> let me reclaim my time since its so limited. i would have to tell you i think that's nibbling around the edges when the latest medicare trustee report says by 2083 we'll have 37.8 trillion dollars worth of unfunded liability in the medicare program. you state that since 2000, the year 2000, private health insurance premiums have almost doubled growing three times faster than wages. madam secretary, do you know what percentage medicare part b premiums have increased since 2000? you just referenced that a second ago? let me tell you if you don't have it on the tip 06 your tongue, they have more than doubled. 111%. that's how much medicare part b premiums have gone up since 2000. so i would suggest to you that the parody between medicare part b increases and insurance premium private insurance

premium increases suggest that high health care costs are rampant and they are integrated. so it's not just private but it's public as well. so we need both private insurance reform and medicare reform. simply turning the system over to the government, i think, will not solve this problem and without addressing medicare reform, we'll leave many seniors without quality health care coverage. let me real quickly, if i might, mr. chairman, secretary, you quote your testimony -- in your testimony that reform will guarantee choice of doctors and health plans. no american should be forced to give up the doctor they trust or the plan they like. if you like your current health care, indeed you can keep it. do i take it from your testimony that you mean all americans will be able to keep the health plan that they like, including the 11 million seniors who get their medicare from medicare advantage? >> well, sir, i

i would hope police -- definitely hope so. there are no enhanced benefits and are being paid about 40% higher of a rate that other programs. as you know, as the center for medicaid services has proposed, there should be fewer plans this year because of the proliferation of plants and the fact that consumers often did not choose them. we have some plans that have fewer than 100 people choosing them and that is not a cost- effective way to run a system. the doctors and the networks will remain available. >> the gentleman's time has expired. >> i appreciate your patience. >> next, we have the gentleman from ohio, mr. space.

>> thank you mr. chairman. as a native ohioan, i want to thank you as well. there are so many different areas worthy of discussion that it is difficult for me to define one to ask you about. given the rural nature of my district, and ohio, generally, and given the special challenges that those in rural america face when accessing health care, the barriers that we of got, and given that one of those challenges happens to be attracting and retaining sufficient work force, specifically primary-care doctors, and some adolescents specialists, what, in your

assessment, did the president's initiatives and what does this bill do with respect to attracting and retaining quality work force in those areas where it has been a problem? . . step in the right which is on the horizon and certainly an important component of health i.t. is a huge step forward. a lot of providers in kansas

and, i am sure, ohio, are concerned about their isolation and want to make sure they're able to access colleagues and consultation. i think the steps that are included in this legislation that pay for student loans and to encourage additional incentives for primary care and family care doctors also enhance the work force in their role as where it -- as well as the urban areas. >> and i just have a couple more minutes. i want to just make a comment as a follow-up. you mentioned telemedicine and i guess i want to take this opportunity to explain to you as a member of the administration, just how important it is to access broad band and high speed internet for those area that is can access. this bridging the dij tackle divide is so very important in so many areas including accessing quality health care. one other area i wanted to bring up has to do with some of the

geographic despairities pertaining to chronic disease. coming from appalachia, one of the things we see, for example, is a higher rate than average or normal in diabetes incidents. how do we make wellness and prevention programs address these specific regional despairities when it comes to chronic diseases like diabetes? >> well, there is a new grant that we just made available which actually focuses specifically on areas with the highest rates of diabetes and chronic disease in terms of providing incentives and providing additional resources to not only coordinate care, but do much more effective monitoring of conditions. i think that there's no question that preventative care at a much

earlier stage helps, but also what helps to prevent hospitalizations, amputations and a variety 06 things is to make sure that that those suffering from diabetes actually are staying on an appropriate regime and that monitoring is what the grant is designed to do. i think we're trying to follow some best practices which have proven to be very effective and my guess is your area is likely to be, unfortunately, rising high on the list of an area that's likely to be one of the -- i think there are 133 communitieses that will have additional resources to focus on this effort. >> thank you, madam secretary and i yield back my time. >> thank you. mr. walden? >> thank you, mr. chairman. madam secretary thanks for being here today and the work that you're doing. i have some questions. like many of my colleagues i'm just starting to look through discussion draft that's out and

i know that you've undoubtedly played a role in working with some members of the committee on the. so if you can help me with some of these things. is it true under the bill an employer could be subject to 8% tax even if they offer a worker an employer-sponsored health care policy? >> yes, i think that's accurate that there are some ways, if it isn't determined to be credible coverage, that you could have the pay or play provision. >> if i'm reading it correctly, is it true that if the employee decided to go with eoh through their own plan, employer could still end up having to pay oh foe they went through the exchange, i guess it is. tell me how that process works. an employee could refuse the plan from the employer, correct? >> i must confess --

>> the people behind you are shaking their head, "yes." >> i am not familiar with that specific provision. i'd be glad to get back -- if you want to give me the questions, i will immediately respond. i'm just not -- >> my understanding is that an employer could offer an employee employer-sponsored health coverage and the worker could turn it down and enroll in the exchange plan. the employer would still be liable for the 8% tax even though providing the employer-sponsored care would have been cheaper. that's what i understand. if you could take a look at that. >> i definitely will. >> is it true in order for an employer to avoid paying the 8% tax the employer has to offer a plan that the new commissioner deems to be qualified? >> that is correct. >> can an employer require an employee to accept the employer provided health care coverage in. >> can you require an employee to accept it? i don't know, again, thousand

provisions are drafted. i'm not aware of any mandatory in a private insurance market, how you mandate that anyone accept a plan. but i haven't read the outline of the bill, sorry. >> do you know if these provisions, are states and federal governments considered employees under this draft? >> state and federal government? >> mr. walden can i just -- >> i'm not trying to stop you, but, i mean, it's the draft -- discussion draft is put together by the members and i don't know that she can necessarily be the person to comment on what's in it. but i mean, if you want to continue -- >> well, yeah, we are on my time near. >> i'll give you extra time. but i want you to understand to that he didn't ask her here to comment on the provisions of the draft, per se. >> i thought earlier she was indicating that the administration support this is draft, did concepts in this

draft, is that not true. >> i said we support principle that pronted the draft. i'm sorry. the draft came out on friday and i have -- i didn't write the draft and i'm not intimately familiar, but i'd be happy to answer questions if you have them for me. >> i don't want to stop you -- >> i'm reclaiming my time if i could. so you haven't read this draft either, then? >> i have read it. i don't have it memorized. i appreciate that. >> you're ahead of me. i haven't read it fully. but i also know the way this committee has been operating of late it moves rather rapidly so i doubt we'll have the chance to ask you these questions before we have to vote on this. so that's why i'm -- i don't mean to be disrespectful. i know others on the committee have asked you a pretty specific set of yes and no questions. >> i'm just trying to be honest with you. if i don't know the answer i'm happy to get it for you i just -- >> let me go to another point. that was a comment you made

about medicare and part d. in this, i don't think, is necessarily in the draft. do you know what the medicare part b premium was in 2000? i'm not going the play a got who game. medicare part d for divine was $29, which was 30% lower than the original projected when we passed medicare part d in 2003. i understand you issued a report yesterday showing that employer-sponsored premiums for health care doubled between, i think it's 2000 and 2008, for health insurance? medicare part b premiums have more than doubled. 110% increase in the same time span. i think what a lot of people are asking me about when i was home in arlington and fossil and out in my district they're saying, if medicare is going broke by 2017, and we're going to just

expand and add all these people into a government-run system and we can't get access to providers now, when the government runs the system, which you know is a big deal in rural areas, they're saying, how does the new government-run plan going to hold down costs? and how is it going to expand? how are we going to pay for this is the underlying issue here. the estimates they are just saying, you talked about health insurance could cost us, you know or health coverage, $4 trillion. this plan alone, i think, some estimates are that. so people at home are really struggling with the dollar amounts here. >> congressman, the plan, again, that at least the payments side that the administration has put forward not only saves dollars through medicare but helps to expand the life expectancy of the medicare trust fund and

lower overall costs in the part b premium for the beneficiaries who are currently paying, as you say, higher costs. i'm a believer that medicare has to get at the front of the lower cost-higher quality care for the beneficiaries of the system and that we can be not only innovative but help to drive best practices which exist now in various parts of the country, to scale. so that's really one of the intents of the new program moving forward. >> i appreciate that and i'll close with this. i spent five years on a small community hospital board. and it seemed like medicare gave us the most headaches, not the least reimbursement been second to least, reimbursement and there was an enormous cost shift going on when the federal government was involved and now you have the access issue trying to get physicians that will take medicare patients. i don't want to see us create a

government-run system that mirrors one that's not sustainable right now. and you know as well as i do, some of the goofy rules in medicare that drive seniors to the hospital to get, you know, an injection when they should be able to get it at home, telemedicine is a great thing but if you're a provider and you're on the other end of telemedicine you don't get reimbursed under medicare so there's a disincentive, irrespective of this debate, that we could do to improve medicare. >> thanks for your generosity on time. >> let me remind mens. we mentioned this earlier but i wanted you to know that the secretary has to leave at 12:00. now, of course, we'll have written questions for many members including those that have already spoken and those who have not to follow-up and she'll get back to us. >> mr. chairman? >> yes. >> could we ask the secretary if show could have those answers back by july 6th?

i think that would give about a week? >> normally we submit the questions within ten days. so that would -- i'm triing to figure in out here. if you all agree to sends her questions within ten days, then i think she has to have at least, i don't know, july 6th is kind of early, isn't it? >> mr. chairman, if they have specific questions if we can just address our question to her and not get a response but get the response that -- >> she has about ten minutes left or five minutes left. i have mr. engel is next. i'm not putting a timetable on when you get back to us with the written and i do not want to run out of

time. >> i would like to be on that list for questions. >> let me explain. anyone can submit questions. >> i think on something this important that we do not have the opportunity to ask questions -- >> i do not know what to tell you. i do not want to waste the time we have remaining. >> you raise holy hell if they did not stay here for every question. >> there is not much i can do. you are next. >> thank you very much, mr. chairman, madam secretary. welcome. i heard your opening statement. i was delighted president obama selected you and i think you are doing a great job. i want to call two things to your attention, two priorities of mine. i was pleased to see that my

legislation, the early treatment for hiv act, which i introduced with speaker pelosi was included in the house reform draft. etha, in conjunction with the proposals for the medicaid program including up to 133% of the poverty level is a significant step to ensuring the people with hiv. it addresses a cruel irony in the medicaid system. people must become disabled by aids before they can receive access to medicaid. this is care that could that prevented their becoming so in the first place. medicaid will not help you unless you have dates. full-blown aids and as you know, if someone tests positive to hiv, it could be a number of years before they have full-blown aids so it makes much

more sense to help those people once they test positive to stave off the full-blown aids and it's an irony that you couldn't do it. what etha does is gives states option do provide people living with hiv access to medicaid before they become disabled. president obama repeatedly in his quest for president said he supports it. when he was in the senate he co-sponsored the bill. i want to ask you if i continue to count on the administration to continue to support etha and will you work with the states to take up this option if it's included in the final reform package? >> yes. >> thank you. that's the answer i was looking for. >> and secondly, the second priority is home infusion. we know that some delivery system changes need to be part of our health reform package and this legislation, the second piece, addresses an anomaly in

the medicare program that forces patient into hospitals and nursing homes to receive their multiweek infusion therapy when the same care could be delivered safely in the patient's home where the patient prefers to be without standing results and lower cost and virtually no risk of health care acquired infections. so i believe that it makes no sense that medicare pays for all costs associated with infusion therapy when it's far more costly in a nursing home setting that won't pay for home infusion. for decades private health insurance has covered home infusion therapy used extensively by medicare advantage plan. medicaid programs cover it. but medicare fee service stand as loan in the failure to cover the services, equipment and supplies needed for home infusion therapy. so my bill which is the medicare home infusion therapy coverage act, i've introduced with 92

members of congress. i've introduced it with my republican colleague, tim murphy and 20 members of the energy and committee are sponsored. can i have your commitment that your staff will work with me and chairm chairmanman's staff to work with us on this. >> we'll certainly look forward to working with you and see what can can be done about this area. >> i thank you and i'm turning back my time, minute and 17 seconds. i want it dooley noted to give someone else a chance. >> duly noted. thank you mr. chairman and med dam secretary thank you very much for taking your time to be here. i understand you have to go to the white house for a taping and i would hope that -- >> with the attorney general. >> sorry, i was misinformed. but i would certainly hope that you will be able to return and answer the questions that those

on the committee have about the health care plan. could you give us a commitment to answer these before the markup? >> let me -- i'm not going to take away from your time and ill you an extra minute or so. i know that members are interested in getting timely responses, but we're not -- we don't have the opportunity at this point to say that the secretary is going to come back so what i'll ask is that members submit their questions as quickly as possible and i'd ask the secretary to respond to those questions as quickly as possible. >> will the gentleman yield? >> i want to get through this. ms. blackburn' -- are you telling the witness not to answer the question? >> parliamentary inquiry. are you telling the witness not to answer >> i thought i said the opposite, which is that -- >> no, you didn't, you told her not to answer. let her answer the question. >> i would like to reclaim my time, mr. chairman, as soon as you finish. >> what i'm saying is we're not

asking the secretary to come back at this time. >> mr. chairman -- point of order, the secretary is hear to speak on the single most important piece of legislation, most far reaching piece of legislation in my 15 years in the united states congress. there are at least four members here, at least four, maybe five or more, who have not had an opportunity to question her. we fully understand her schedule. she has important things to do. that's perfectly all right. it would be unreasonable for this committee given the scope of legislation that is moving to ask the secretary to come back sometime before this bill moves to full committee. >> what i'm saying to you, and i will repeat again is the following. the secretary is here to give the administration's response to the discussion draft. i am not asking her to commit at this time to come back. first of all i don't know her

schedule. i don't know whether that's possible. miss blackburn can ask, but i don't want her to feel she has to mitt. >> point of order, mr. chairman. >> i think we're on my point of order. >> when she's done we're going to have to ask the secretary to leave because she has to leave. so i'll go back to miss blackburn. we'll start the clock again. it's the gentlewoman's time. >> thank you, mr. chairman and madame secretary. i hope we'll be able to resolve this. when my constituents talk about the issue they are fearful of what may be included in this plan. and coming from tennessee and you having been a governor, i think you can understand that. and when they hear remarks about it being deficit neutral or -- yes, deficit neutral, not increasing the debt, you've made statements that it would be paid

for, you've talked about reducing the itemized deduction. my constituents are very, very concerned about how this would be paid for. the other members of this committee have constituents who are equally concerned about this. of course, our concern in tennessee is in the problem that existed with care. i know governors have many times gone to school on what happened with ten care, and you set us an example of what they did not want to do i would like to have a response here. i do have some questions. on what you would see as the lessons learned and what you would not want to do that was from the template. what were the lessons you learned? do you realize that you can't provide gold-plated all health care for free for everybody?

do you realize that a public option which is government-run, government financed, does not work in competition with a private option. that's one question i have. the second is medicare advantage. i know you have a heart for dealing with health care for seniors. i appreciate that. my constituents, i have 56,000 seniors in tennessee on medicare advantage. they very much want to keep those options. i would like to hear from you what you envision a medicare advantage program looking like once the obama plan goes into place. how you see that being delivered, what you think the options are going to be. it is of concern the options are going to be restricted. when members of this committee sit here, when we hear from

constituents the panic that they feel, especially from seniors who say, look, i've paid. >> what's going on with the mike? do we know? >> my mike is not being touched. >> now it's okay. >> okay. but seniors are very fearful that they have paid into a system -- this was a part of their retirement security, a part of their savings, if you will. because it was money that the government took first right of refusal on their paychecks. took that money out. and now you've got somebody in their 70s, they've got doctors's set, medicare advantage set. they have their system in place. and they are seeing this savings devalued.

finding out now it's going to be a one size fits all program. this is a great concern to all of them. your responses to what medicare advantage would look like would be appreciated. >> congresswoman i would be happy to answer both of those questions. i can't do it now in person as you said earlier. you wanted to address the question and have me respond. i will do that promptly. >> thank you. i appreciate that. at this time i will yield the balance of my time mr. chairman -- >> i couldn't hear her? mr. pitt. >> thank you. section 222 of the bill states an amount for purposes of starting up the government government plan. that is to be applied in the text of the bill. do you have any idea how much it will cost you to start up this government-run plan? >> no, sir, doi not.

>> you mentioned the president's repeated promise that the health reform bill will be neutral. are there any other deal breakers? does the legislation have to include a government plan? does it have to include an individual mandate? does it have to include an employer mandate? can it increase taxes on families making under $250,000 per year, for example? >> i think the president's principles are that the plan needs to lower costs for everyone. needs to improve quality of care, needs to provide coverage for all americans. and around those principles that he -- and be paid for within the period of time. those are the fundamental principles he's ar the ticklated. during the course of the discussion various proposals on some of the areas.

i misspoke to the congressman earlier. st proposal he had for the itemized deduction return is for families making 250 o$250 or mo $250,000 or more. i was corrected, and i'm happy to provide the additional information. >> the gentlewoman's time has expired. now, i'm just going to repeat -- i know you have to leave. members will get back to as quickly as possible with written questions. we would ask the madame secretary to respond as quickly as possible. >> very quickly. >> thank you so much for being here today. we appreciate your time. thank you. now let me explain. we are going to adjourn the full committee, and then the subcommittee reconvenes, the health sub committee reconvenes at 1:00. and we have three panels for the rest of the day.

mr. chairman -- >> mr. diehl. >> mr. chairman, with all do respect to the secretary. this was billed as a legislative hearing on a draft. >> yes. >> we have heard the secretary say she did not participate in the draft preparation, nor has she apparently as she said had the opportunity to read it. one of the situations we all labor on in this time frame. i would simply urge you to urge our full chairman of the full committee that it would be mandated that she return to answer questions when we move to a legislative proposal. we're talking about a draft. hear we be allowed the opportunity to answer -- to ask and to have answered questions. you made the statement she was speaking on behalf oaf the obama

administration as it relates to the draft. i think there are specifics that we should have the opportunity to ask specifics about. i would urge you to urge our chairman toe ask her to return to this committee. i think it is due diligence for all of us to have the opportunity to explore these questions in person with her. >> well, let me just say, i can't make that commitment, mr. diehl. for various reasons. a part of it is the fact that we're -- you know we have a draft. obviously changes based on your input. we really asked her here today to comment on what the administration thought about the draft. the bill is never going to be exactly what the president wants. i just can't make the commitment. i appreciate your asking. >> you were saying you can't commit to ask?

>> i can't commit -- >> his request was that you ask -- >> she's been here. she's testified. you can ask her questions. i'm going to leave it at that. we're going to adjourn. >> object! >> subcommittee hearing at 1:00. >> there are 12 republicans that have not had a chance to speak and ask our questions. >> members were told that she was going to leave at 12:00. >> we understand that. we're simply asking she comes back. >> i can't make that -- >> you're refusing to ask a question. >> i can't make that commitment. we're going to adjourn the committee at this time. >> can you at least commit to ask the chairman? >> that's it? >> gentlemen, look. i'm going to certainly express your views. but i can't commit the secretary to anything at this time. >> request a recorded vote on a motion to adjourn.

>> you can make the request, sure. all those in favor? on the motion to adjourn. let me just ask parliamentary point of view. >> we already have a motion before us, a motion to adjourn. the chairman has entered that motion. >> i think what we'll do at this time -- we had a vote and it was defeated to adjourn. so at this time we're just going to recess. >> we asked for a recorded vote. we asked for a recorded vote.

>> coming up on c-span radio, a live look -- a look at the life of robert mcnamara and conversations with president johnson tonight at 8:00 p.m. eastern on c-span radio. over on c-span2, prime time begins with telecommunications technologies including gary lock tonight at 8:00 eastern on c- span2. >> how will c-span funded? >> the government.

>> private benefactors. >> i do not know. >> it is not public. >> donations. >> me, my tax dollars. >> how? 30 years ago, cable companies created c-span as a public service. no government mandate or money. >> the senate judiciary committee hearings on the nomination of judge sonja -- sonia sotomayor start on the 13th. remarks about her. it is about 10 minutes.

the presiding officer: the senator from arizona. mr. kyl: mr. president, i ask unanimous consent that further proceedings under the quorum call be dispensed with. the presiding officer: without objection. mr. kyl: we've herpd debate centered >> we have heard some debate centered on whether it is appropriate for judges to consider foreign law and public attitudes when interpreting u.s. constitution and laws. the american people through their elected representatives make their lost through which we are covering. as james madison said in the federalist 49, the people are the only fountain of power and it is understand the several branches of government hold their power.

mr. president, judges have the responsibility to faithfully interpret the constitution and the laws that have been adopted during our processes. judges do not make a lot. the growing idea of using foreign lot to interpret our own law as it is troubling and problematic for two reasons. first, as chief justice john roberts pointed out in his confirmation hearing, it is contrary to the principles of democracy. they are not accountable to the american electorate. using foreign law, even as a thumb on the scale, helps decide key constitutional issues and the values american expressions through the democratic process. an analogy would be to allow non-americans to vote in our elections, devaluing the votes of americans. secondly, if it were not

inconsistent, its use would free judges to enact their personal preferences under the cloak of legitimacy. if they want to find the legislative enactment consistent with his or her preferred outcome, he or she can find it in the loss -- the laws of member states. as we soon began to consider judge sotomayor's nomination, we deserve to know where she stands on this issue of using foreign law to interpret the u.s. constitution. although we do have some materials waiting on certain documents, for example, in response to the senate judiciary committee questionnaire she identified 200 public speeches or remark she has given.

we have not received a draft board description for more than 100 of them. these include four occasions in which he publicly spoke on the issue of foreign law. on one of these occasions she participated in a panel discussion with foreign judges. her judiciary committee questionnaire -- she said she spoke on the permissible uses of the international law by american courts. she participated in a roundtable discussion in the university law school on the dynamic relations between international and national tribunals. with hearings scheduled to begin in a couple of weeks, getting this information is critical to our understanding of her judicial philosophy. the most notable of the materials we have is a 22-minute speech she gave to the aclu of pr on 2009 entitled "have

federal judges look to international and for an law under article 6 of the constitution." we began to see how foreign law could shaper jurisprudence in the future. her views were not casual observations but directed to this topic. in this speech, she says "international law and foreign law will be important in how we think about the unsettled issues in our own legal system. it is my hope that justice everywhere will do so because within the american legal system we command law and interpret it as best we can and we should look to see what anyone has said to see if it has persuasive value." what on earth does this have to do with judging? asked what court anyone else has said to see if it has persuasive value? how about using the traditional law as of tradition -- of

judicial construction and common law heritage? she revealed she believes a foreign law is a source for good ideas that can set our creative juices flowing, in her words. onta citing an anti-trust case orate commerce at dispute or an indian law case it does not require creative juices. indeed, it could interfere with the specific rules of construction or application of precedent. judge sutta mysore's says that not considering foreign law would be asking -- this judge says that not considering foreign law would be like being close minded. what is close minded about requiring american judges interpret our law sn constitution? that is what they take their oath of office to do. and she has said that appellate courts is where policy is made. when you combine the notions

with a view that for a lot is a creator of ideas, you open the door to the worst form of judicial activism, one complete lee untethered to american legal principles. judges do not have the responsibility of finding new good ideas that would make new good policy. that is for our elected representatives. the ideas expressed by judge sotomayor threaten to undermine our system that has served us well for centuries. she went on in the same aclu speech to criticize two sitting justices and her views with those of justice ginsburg, who endorsed foreign law at a symposium in ohio state university. judge sotomayor stated that the nature of the criticism comes from a misunderstanding of the use of that concept of using

foreign law and that understanding is endorsed by some of our own supreme court justices. but justice scalia and justice thomas everett extensively criticizing the use of foreign and international law in decisions. she continues, i share the ideas of justice ginsberg in thinking that courts should be more open to discussing foreign cases and by international cases that we are going to lose -- that we're not going to lose influence and the world. she believes foreign opinions can add to the knowledge relevant to the solution of the question. she is right. mr. president, judge sotomayor's rationale so that the united states is not lose influence in the world is absolutely irrelevant to the role of judges in america. it is the province of the president and legislative bodies to make policy and manage foreign affairs.

in defending the supreme court's use of law, she made an astonishing argument -- courts were just using that law to help us understand what that concept cement to other countries and to help our understanding of our own constitutional rights which fall into the mainstream of human thinking. the mainstream of human thinking. the words of our constitution are not intended to reflect the mainstream of human thinking. think about the mainstream public opinion in europe, asia, africa, or south asia at the end of the 18th century. even today we doubt we would be satisfied being governed by the thinking of other governments such as china, the muslim world, and the dozens of autocracies around the world. as i noted, in my remarks related to views on foreign

policy, if the founding fathers had been given to trans nationalism, america would not be the leading light it is today, nor would it be a leader in convincing other nations to have free speech, a symbol, and have other political freedoms. do we really want judges to look to the law of foreign countries and decide if our most treasured constitutional provisions, such as the second amendment -- i do not. the american people share my view. judicial activism is not a popular concept. based on this one speech, i believe it is fair to ask what else she has said on this subject. there are other speeches that we do not have. the nominee should find the speeches or ask whether there are other records, for example,

a transcript, tapes, press accounts that would indicate whether her april 28 speech is indicative to her approach to judging. as we begin to consider the nomination of judge sotomayor, we will need this information to evaluate her qualifications, especially as it relates to her view of whether foreign law is appropriate to interpreting the u.s. constitution. >> tonight on c-span radio, and look back at the life that -- the life of robert mcnamara through conversations with president johnson tonight at 8:00 p.m. eastern on c-span radio. >> the legal times hosted a discussion on the 2008-2009 supreme court term which you can see in its entirety tonight at 9:45 on c-span2.

>> i thought my clients had a very sympathetic free-speech claim. they were very sincere. at the end of the day they wanted to express their own religious views in a park that was already home to different religious views in the form of the 10 commandments monument. while these seven asterisms were certainly unfamiliar to most people and struck people legitimately as foreign, there is nothing offensive about them on their face. it is a contradiction in terms. they were mainstream, new-age religious tenants. emerson and thoreau but in new- religion guard. there was nothing outrageous, nothing hateful, and nothing offensive about the speech that they wanted to engage in in this park -- except -- and this was

the crux of the case -- that their proposed monument would have been placed close to the 10 commandments monument. it might have conveyed the idea that the 10 commandments were not a singular or only religious truth. and i think people were deeply and genuinely offended by that implicit message. some people found it quite literally blasphemous to put a different religious monuments so close to the -- so close to the 10 commandments monument, which raised a fairly compelling set a free-speech questions. over the last 25 years or so, there has been a consistent move to open in the public square to religious views and speech, and i think that is to the good, but it raises difficult questions like, whose religious speech will be included? if you want to bring your religious views out of your community and into the public square and the public

marketplace of ideas, do you have to be prepared for the give-and-take of that marketplace of ideas? do you have to be prepared for dissenting more different viewpoints expressed as well? when you think about the case that way, it does present this compelling free-speech claim. it is not without problems, no question. monuments are different from other forms of speech and maybe the government needs more latitude in regulating monuments, but there was something sympathetic there, i thought, which leads to the question of, how did we lose this case 9-0? this was a 9-0 case. i think the problem was the court did not think about it as a free-speech case. they thought about it as establishment clause. that was what was planned as strategically and it made that -- it made it very hard for us. the liberal justices who should have been sympathetic were concerned about calling a

monument in a public park, even if it had been privately erected like the 10 commandments monument, about calling that private speech which protected but makes it harder to challenge it under the establishment clause. to assure that is conveying a government message and not just a private message. the justices who should have been our allies were against us because they were very worried that our free speech position would insulate meant to -- would insulate religious monuments. the conservative justices had this mirror image problem. on the one hand, they did not like our free speech claim. they saw it as an end run against prior establishment clause cases that had included the 10 commandments monuments. they thought those cases had already approved a right of singular or preferred access for the 10 commandments, not equal access where everyone gets to put up a monument. they were worried if we won the

cities would take down their monuments before they would open their parks to a bunch of religious monuments. on the other hand, these justices were aware as for the liberal justices that once you call an arguably religious argument government speech, you make it much more amenable to establishment clause challenge. i think what is most interesting about the opinion in this case is how justice alito, who was the author, tries to thread the needle and to call the model government speech but at the same time to try to minimize the establishment clause exposure. for that kind of monument. again, this kind of shadow establishment clause is where this case is being fought. for us, as a strategic question, we knew we were losing going in.

how did we want to lose? they love the idea of express our ideas in the park. if they could not do that, the second choice was losing in a way that would be helpful under the establishment clause, specifically, losing with the ruling that we got -- that any monument in a public park is going to be recently seen as conveying a governmental message and government speech. in that sense, to bring you to closure, this was a huge victory for us, a 9-0 loss -- we will get it next time i do think where this case will mob -- will matter most is free speech -- we will not see something like this under free speech. monuments are different under the free-speech clause. where this case matters is under the establishment clause. and quite possibly in the case next term, the salazar vs. buono

case, which are -- which involves a christian cross erected by a private corporate -- a private party. i think it will be very interesting in that case to see how this plays out and how successful justice alito was in planting the seeds of an establishment clause defense in cases like that. >> ok. i wanted to ask you about your transition from a private attorney to government attorney and a different pressures and expectations that involves. also, if you could talk about the voting rights case. certainly during des arc -- the early oral argument and seen the court was ready to declare the law unconstitutional, but it did not turn out that way. what are your thoughts? >> but we start by thanking you for hosting this event.

my transition was pretty rough. it is an enormous privilege to represent the government of the united states. with that privilege comes responsibilities. one is the responsibility not to make any news. sorry to disappoint you, but i will avoid trying to make news here today. when i got to the department on january 21, it was in this time of transition in the government in terms of the executive branch. if the solicitor general's office is a little different than other parts of the government. one thing -- it is just the structure of the office. there are three other deputies to know a heck of a lot more about supreme court law than i do. then there is the solicitor general. that is different from the office of legal counsel were all the deputies are political

deputies in change from one administration to the next. there is continuity in our office and there is a premium placed on stability and positions that we take from one administration to the next. that creates no doubt, no amount -- and untold amount of frustration on the part of activists in the party and otherwise. i think it serves the government quite well. after all, we are not simply the administration's lawyers. that means something -- that means we defend all laws of congress that was passed and enacted into law. that is not to say we will not ever change our position or think about stuff in a new way. i think one example and an interesting case is the fourth amendment case involving the strip search of a 13-year-old girl. traditionally, the justice department -- we take our responsibility to our prosecutors more seriously than

virtually anything else, and we generally do not -- we do not side on the side saying there is a fourth amendment violation, but in this case, there is only one other example in memory in which the government has come in and said there was the fourth amendment violation. what we are geared is that her rights had been violated, her fourth amendment rights, but that there was a qualified immunity defense available to those officials and ultimately that is what the supreme court concluded. a-one. for me, it has been an enormous personal change. when i did cases before, coming into the government, i did cases with students, one of my former students spend four years working on hamdan with me. she was one of a team that were writing these drafts. it was a ragtag group of people.

things like that. they come to our office, which was amazing, 16 attorneys, four deputies, a staff of 20 paralegals and so on. the quality of the work product is literally breathtaking. i remember my first week in there, we got an assignment, a high sensitivity. i said to one of my assistants, could you look at this? on monday i had a memo that was better than anything i could of britain. that is an enormous shift. they do that in this office with a budget of $10.4 million for the entire year. we participate in 50 supreme court cases and review every decision made in the united states by the u.s. government. there is an enormous amount of work that is done all for that

amount of money. when i was doing cases last year privately, i was in a case where one area -- where one person spent $10 million on one case. we do that for the entire year. quite remarkable. in your opening remarks we talked about the timing. when i was teaching here i did have the ability to just think big thoughts were small thoughts, as they may be, and practice my arguments. i practiced hamdan 15 times. the inquests case i did 8 moots or something like that. my dna argument which was march 2, i think i got able to read the brief about one week before the argument and have the customary two weeks in the office right after i got to read the briefs. it is a very different pace in

that office. it is remarkable how quickly you are out there and arguing. it is nothing like i ever thought before i got in. one other thing i will talk about -- maybe i will do the voting rights in the next segment -- i do want to talk for a moment about the difference in the transitional difference between being a private lender again, particularly one going against the door for a man, and one on the -- a private litigant particularly one going against the government and being on the other side. watch what you did -- i adore gordon, greg. i have enormous respect for how you conducted your self possessed areas i am sure this happen to your -- for how you conduct yourself. i am sure this has happened to you, you have all the time to these cases where there is no

money involved. the media -- these are all things i have dealt with. i am sure you have had these experiences. what to do is to perform made audible service in making us all more honest as government officials. i think it is enormously powerful, this great thing about our country. we allow people private litigants, a little utility districts, fourth grade educated people to come in and challenge the most powerful people people. i remember when judge robarts was at his confirmation hearing to be the chief justice of the u.s. and he said the great thing about the supreme court is on the one side of the courtroom is this little guy, on one side you have this big fancy corporation with all the law firms. on the on -- on the other side you have just got the little guy with the argument. if the little guy has a good

argument, then the supreme court -- he can win. that is what he showed. >> the legal times hosted a discussion on the 2008-2009 supreme court term. you can see it in its entirety tonight at 9:00 p.m. eastern on c-span2. .