not need americans or nato or anyone else there on the ground in order to ensure that international terrorist groups cannot launch from there and also that they can provide for their own people's basic security and economic host: needs we have been speaking jonathon morgenstein of thrid way. we appreciate all of your calls this mine. tomorrow's guests include joan from "usa today," longtime reporter about the supreme court. she will give us a good preview about the hearings that begin tomorrow ford judge sonia sotomayor. we begin at 10:00 a.m. eastern with those hearings. so, we will see you back here

tomorrow for more of "washington journal." [captioning performed by national captioning institute] [captions copyright national cable satellite corp. 2009] . .

>> welcome to "newsmakers" on c-span. the debate is fully engaged this week. our two dwests bring to the debate their perspective as practicing physicians. first is congressman michael burgess of texas. he is a member of the energy and commerce subcommittee on health. also with us is congressman bill cassdi, republican of louisiana, and a member of the education and labor committee. thanks to you for being here as well. let me introduce our two reporters. steven is a staff writer, and

carey covers health care. >> thank you for joining us. i want you to think about health care and in that sort of real world, not an ideal world but a real world given a democratic congress, a democratic president. what kind of bill could you support given the construct that you're in politically in the democratic congress. is there any kind of bill that you could support? that ungs your colleagues would agree? >> i certainly haven't seen it yet and i don't know that i've thought it through from that context. clearly, there's some common ground. and when we've had -- westbound several hearings on our subcommittee and there are areas of broad agreement. but the distances and exist and the moving parts, the things about the government one plan, mandates, those are going to be very difficult to overcome from

my perspective. it doesn't mean that we don't work. and in fact early this year and right after the swearing in, i went to the chairman of my committee and said i didn't give up a 25-year medical career to sit on the sidelines when we have this debate. and i was very anxious to work with the majority. i was thanked very kindly for showing up, and that was the last i heard of that. so i still stand ready. but to this day, outside of a brief invitation to the white house last march, which really didn't turn out much of anything, there really has been very little willingness to include those on our side of the dais, and honestly i understand the political calculation. there's no need to include us. they've got problems to solve within the majority itself. and there's really no need to try to bring any republicans along because they have the numbers without us and their onf job right now is to solve the problems they've got within

their own caucus. >> is that to say you think there's no scenario understood where democrats are going with health care where you are? that there's no common ground in that way that you can in this environment you can -- >> on the house side it will be difficult. i have watched some of the act tivelt on the senate side. last fall i was doing some work for senator mccain. senator baucus had the big complication over the library of congress. i thought that was the blueprint for legislation. terribly surprised that there wasn't a bill that came out after the election or before christmas or after christmas or before the inauguration or after the inauguration. and really it was late in june before we began to finally see the structure of whaff some of these bills were going to look like. we were roundly criticized for not having a republican bill but honestly there wasn't a democrat bill during those times either.

very surprised that the president didn't have some specific proposals. i mean, i heard all kinds of specific on the campaign trail on the last fall. and very surprised that there was not a more structured offering from the white house to the congressional committees as this congress came together. >> you're asking a question that i can take one of two ways, and i'm going to take it the way i wish to. if you're saying there's this huge current of a public option, higher taxes, bigger bureaucracy, in d.c. no, i can't support that. on the other hand, if you look at their stated goals, which is to control costs, increase access, improve quality, make it patient cent rick, if you take those goals there's an incredible amount of common ground. at the beginning you said real world medicine. i am working in a public hospital treating the uninsured. if we take a patient cent rick

response, not a bureaucracy but a patient centric response, hsaless decrease one type of family with benefits compared to the same type of family with fee for service benefits. h.s.a.s can decrease costs by 30%. so if they -- i'd like to say with the common ground of the goals maybe there is room for final compromise, because frankly i think a patient e centered approach is the only way to get to those common goals. and since there's a limit on the number of patient centered approaches, i'd like to think there's a convergence of ideas. >> i was wondering, you spoke about the fact that the numbers aren't there for republicans. but democrats are taking some fire, some heat from fir fiscally conservative colleagues, the blue dogs, and that has caused a delay in terms of the markup, in revealing language. and what i'm wondering, what

effect does that have on getting something that's more likely you can accept? >> that's the chapter that is yet to be written. i made some comments last night that here we are on literally the eve of the markup and i've got no bill. presumably this is going to be an 800-1200 bill. it's going to take time to go through it and understand all the moveling parts. we're supposed to mark it up last week, or we were told that. we didn't have access to the bill. and there was a question whether or not we would have access to the bill before the markup. and that's still an open question even though the date of the markup now may have slipped and may be delayed. that's a pretty tall order to say we're going to be able to go through that involved structurally, that piece of legislation in a day or two or three. i think you referenced in some earlier discussions how the senate health committee has been in markup for weeks. we should be in markup for

weeks. we shouldn't try to ram this thing through just so we can say we've got a house bill. here, senate, you go deal with your part and we'll come together later that's just not the way to do something like this. i think back 1965 when lyndon johnson, texas president signed medicare and wouldn't -- if the folks who voted for that medicare bill back in 1965 could have seen the looked into the future and seen the unfunded liability that we are leaving now to the next generation of americans, do you think they'd try to do some things a little differently? i believe they would. we're there now. and to look over now the next election and let's look over into the next generation and see what we're putting in place and what we're leaving for the folks that are going to come after us. and they want us to do our job. yeah, there's some pressure to get something done. but they want us to do our job.

the american people want us to do our job. >> if you look at some of the reasons why things are coming up a little bit, for example, businesses become very nervous. now, the head of the c.e.o. of verizon, who is the head of the health committee of the business roundtable, came and spoke to the republican caucus and said we want reform but we don't want a public health option. we don't want a public health option because no government program is ever required accountability from patients. the only way to control costs is patient centric. so the business folks are looking at these discounts the government is getting as part of pharmaceutical or hospital concessions and they're scrasm scratching their heads and saying who is going to pay that. it's like a tube of tooth paste. you skis it here and it wideance here. they are come congress back to

congress sayings, listen, we want reform, we want it to be patient centric, allow us to demand accountability. but don't squeeze the cost out to us for superficial savings to the government plan. >> it seems as if the blue dogs have a lot of the same fiscal concerns that many of you do. what are the chances of working with them to try to more moderate the language? >> of course, i'm not in leadership, i'm a freshman. on the other hand, i'm working on going to a committee hearing and a democrat grabs my lapel and says, we don't like this. we just signed off on this letter. is there common ground? i'm in committee and another i think a new democrat comes up, can you believe this bill? they're going to mandate something we don't know the cost for. so i think the very fact that they're approaching someone as junior as me suggests that they are looking for something across the aisle to moderate

the very, full, extreme of what's being presented to them. >> we get very wrapped up in tactics in washington. but i want to go back to your description because you're a proponent of health savings accounts. how would they work for the very poor? >> it's very interesting you ask that. one thing that is totally lacking here is an understanding of how patients think. i work in the hospital, the uninsured. and they want a plan in which you're going to log on the internet? i'm slapping my knee because many of my patients don't have computers, they don't have land lines, they're not going to be down loading pdfs. the way it works in the netherlands, they allow any ten people to come together to purchase insurance. now, within poor folk, my patient population, if you will, there's always one person who is a clerkle worker, always one person who can log on at

work and download stuff. typically a female, very detail oriented. she would then become the advisor for the other nine. they could get a credit. there's something called conseerge medicine in which you prepay a physician to take care of your primary and preventive services needs. this is already being done. it's not theatrical like an accountable care organization. there's organization that is do this. let me give you a scenario. the clerkle worker gets ten of her friends, maybe her entire church. they prepay that physician has to manage their costs. now, they're paying o 50 a month. but if they don't like that physician they can transfer to another. and so, therefore, the physician is incentivized to take care of them. and the way it works out in the west coast is they provide labs, son generics, x-rays, the

whole thing. >> where do they get the $50 a month? >> i do think there could be a credit given to the folks who are below a certain income level to fund that patient directed health spending account that they could then move. the advantage of this program is you're cutting off the administrative costs of billing the insurance. 40% of a practicing physician's cost is related to billing insurance companies. if all of a sudden you're just getting pre-paid $50 a month, that is where you remove 40% of the cost. so, therefore, that's how you fund this, through the savings of the administrative costs. >> i wanted to ask you about the public option. you were here in 2003 for the medicare vote. there was a trig anywhere that bill. you supported that bill as far as i can tell. i'm just wondering, given the discussion last week from the white house, saying that there

is still an option on the table for them srks that something you could support? >> yes. but i think the current majority demonstrated their complete disdain for a trigger. and when the trigger for medicare spending was in fact triggered last year, what did they do but came to if floor and said we table the resolution or table the motion to do something. that's the action that was required by the trigger being tripped. so they've already demonstrated disdain for that type of activity. i don't know that i would like to that to be treated any differently. certainly the track record is not great. i just also want to comment on the issue of a consumer directed health plan for people who are in lower health care groups. in 2005 when republicans were in charge we passed the availability of what were called health opportunity accounts, essentially an hsa for patients on medicaid. it wasn't a requirement but states could be allowed the flexibility to set up an account for their medicaid

population. they would place dollars into the account over which the patient would have discretionary control for health care expenditures. if they were not all used, a portion would stay with the patient. i know from my experience in practice, when i first started up i would see patients who were on medicaid who would have a tough time paying their medical bills. but it wasn't always going to be like that. they would get a job and the next thing you know they were on a reliable health insurance. but to allow them to begin to build toward that in those years while they were just getting started and they relied on a program like medicaid, a very powerful tool to put in the hands of people. and then the other aspect of things, you look at the rate of growth of the cost of regular indemty insurance, the high option p.p.o., about 7% a year. medicare and medicaid are growing. consumer directed health care plans are growing at 2.5% a

year. if we really want to find out what works, which is what the president said in march, why not look at the lesson that's already being learned. and the beauty is the government doesn't have to ration. we don't have the put caps on anything. the patient makes those decisions and they get to vote with their feet. if they don't like the way they're being treated in one practice, they go to another. i built a practice, i understand the thing that is are involved there. you open early, you stay late. you keep the customers satisfied, you take good care of your patients. but you also provide that extra level of service. there is no incentive to provide that extra level of service in what's being described as this public option or the government plan that's in the bill. >> i just want to get back in the public plan but from a slightly different angle on this in terms of the give and take that we might see next week with the markups. many democrats have said that they hope to get doctors on board with some sort of a public option by in turn

promising to change doctor reimbursement rates under medicare. given your experience, i want to get both of your perspective on this idea of adjusting the sustainable growth rate in return for getting support for public option. >> if indeed that is what medicine is going to see on the table, they need to be certain, absolutely certain that they've got a lockdown, nailed down, rock solid deal. because anything that we've seen so far is a far cry from that. in the president's budget he said he was going to pay for the replacement of the sgr over the next ten years. what happened in ten years? it fell off a big cliff and you're going to get a huge pay cut. i will tell you my history of six or seven years here in congress is we don't deal with those things until the 111thth hour. replacing that, that is no compromise at all. that doesn't alleviate the

burden for people who don't understand what the we talk about, we say sustainable growth rate formula. doctors who participate in medicare look at radio reduction in reimbursement every year, have for the past years going forward into the future are looking at a 30% reduction in medicare reimbursement. it's unsustainable. and not having the -- not being able to depend upon what the future is going to look like has been had an effect on how do you go to the banker and borrow money, and say i'm going to expand my practice? the banker says, it looks like you're going to be making less money each year. i don't think i'm going to make you that loan. this has a terribly pernicious effect on keeping physicians in practice and allowing physicians to build their practice. the far better way to do this would be for us to bite the bullet. the formula is scored by the

congressional budget office as costing $300 billion to buy out of. so $30 billion a year out of ten years. the reality is the money has already been spent. there is no money in the federal treasury gathering interest. congress has already come in and said, doctor, we're going to pay you at least what we paid you last year. so there is no money that has to be paid out. it is a bookkeeping adjustment that needs to be made and congress needs to make that bookkeeping adjustment and then pay doctors based on a cost of living adjustment just as they do drug companies, hospitals. >> you -- >> other than this system they're using now. >> i know we're almost out of time. >> the one thing i want to say is it almost proves the point. if you look at every government run health system it overpromises and underfunds. to medicare is projected to go bankrupt in 1e7?

1el8. going bankrupt. and so the very fact that we have to fix something which by the way already underpays relative to the private sector shifting cost to the privately insured shows that the president agrees with me. government traditionally is overpromised and underfunded. and yet we're to believe the health plan will not do the same. it is a triumph of hope over experience. and our experience tells us it's not the case. and, by the way, the savings according to the gu rues behind the public helleds plan, the way they're supposed to get savings is by paying providers less. so he's kind of going cross purposes. we're going to bride you into accepting it by paying you more. there's an internal contradiction there which can't be resolved. >> similar to the contradiction, if you like what you have, you can keep it. and the one we won't accept is a sfattuss quo.

there's no way to have both of those realities exist at the same time. >> you could possibly begin a markup next week in energy and commerce. in the health education and labor committee. on the senate side, the republicans have put up, offered a number of amendments. they've gotten a few passed. can you give us any sort of hint as to the republican strategy in that markup? >> within my auches, within my personal office identify been developing amendments for the past several weeks and recognizing the log jam that's in the counsel's office that actually writes the language. we've been stock piling these amendments for some time. so we've got 50 ready to go. there's probably three times that many that are other members of the committee have prepared. so we're probably somewhere close to 200 amendments, which is why -- >> just from you? >> no. just from our committee. 50 then another 150 that are out there, and more being written every day.

there are some that i recognize that i'm going to need some help with and i've reached out to democrats, and sat down and said here's a good idea. what do you think? or you co-sponsored this when i introduced this bill last year. would you consider perhaps you offering the amendment and maybe it would be looked on more favorably when we do the committee markup. if the track record with cap and trade is to be any model for us, we will have no republican amendments accepted during our markup in energy and commerce. and it's a shame because there will be some good ideas that are out there. so, yeah, we're trying to work with the other side where we can. certainly i'm going to be proactive and prepared, have the multiple copies of the amendments that are required on the table the morning we start so we don't get caught in a procedural motion that will then disallow the amendments. >> i just want, looking forward, what do you think of the prospects, really, of

getting something done and to the floor by the august recess? as the house leadership says they want to go, especially given all the concerns, financial, procedural and what not? >> i think one you're looking into a crystal bawl and it's hard to say. i think the whole deadline is being driven by political purposes. tom daschle said that the reason the clinton health care plan failed and everybody went home on the august break and heard an earful and said, i can't vote for this. and it's too bad. a political process is driving something which covers 15%. i do think the american people are smarter than they are presumed to be and they're letting their representatives know now, which is why we're seeing this fractionation of the democratic caucus, they know now they want something different than we're hearing about. so it may be they're figuring up the scheme and they're moving up the pressure. >> i would believe that the speaker of the house has the ability to get her side to pass

something before the august recess, or the august recess will be delayed. the reason the time line exists, dr. cassidy alluded, we all remember bill clinton's beautiful speech the evening of september 23, 2003, not a dry eye when he finished and everyone left convinced that now is the time that this was going to be done. and it turned out it was too late and members were already worried about their next reelection even though it was a year away. the other thing pushing this is the instructions called reconciliation instruction that is passed in the senate budget. my understanding is that will allow them to pass this out of the senate with 50 vets rather than the required 60 can to cut off debate. but that ability to use reconciliation disappears about the middle of october. so that's a ral strong driver on the senate side to get something done before they lose the advantage and reconciliation. >> a colleague of mine of time

magazine asked an interesting question in one of her pieces this week. sit riskier to push health reform right now, or is it riskier to be seen as having stopped it? >> i think that what is most important is getting it right. and in the netherlands it got to ten years to get to sophisticated thinking and yet we're supposed to do it by the august recess? what i will tell my constituents is that i'm fighting for patient centered care andly vote for something that does that. and it's more important to me to get it right. otherwise we're going to have unfunded liability that will swamp our country's economy. it's more important to get it right. >> and one of the big lies is we are only dealing with a ten-year budgetary window. but if you peel back the curtain and look at the next ten years, the costs absolutely explode. some of the maneuvers that will being done to hold down acceptance for the first five years and some of the language

i've seen, and that's pulled away after five years where everyone will be driven into the public option. and the cost for that plan will sky robert. it is -- we're not doing a service to anyone by rushing this through without having fully evaluated the consequences of our actions. >> i want to close with you, as a freshman member of congress, a physician who came here wanting to be engaged in health care debate, can you tell people watching what the experience of actually trying to legislate an important issue like health care has been for you? >> i think most of my colleagues are well meaning people who desire the best for their district and their country it's been great to see that. i've been very disappointed in the deliberative process where a small group of people go out and then bring what they have decided to the rest of the group. it would be better to allow

everyone to channel their wisdom into that product. but so far we've not done that. >> we'll be back to talk to both of you about the debate and the prospects for passage this month. >> we just heard two republican members of the house of representatives and their challenges and ideas for health care reform. help us understand, because so much of this is really behind closed doors. help us understand how this will move forward and ultimately what you think the outcome will be. >> i think from this point forward, four weeks are on the calendar to the august recess and wevering has to work perfectly for the next four weeks if they hope to get it done on time if the house is going to finish and when the senate is going to finish. they don't have any room for

error. they did for a long time and they're really going to have to get everything right for the next four weeks. and things haven't been going that well lately. >> in what way? >> just this week, you saw an unexpected event for the senate democratic leadership stepping in and saying we don't want the biggest piece of the financing for the project plan right now, which is taxing health benefits. had to tell max baucus to come back with something different. that set tpwhem back a week. that was unexpected. so those kinds of challenges just friday in the house this past week with thursday and friday different members just speaking up and saying i don't like it. those were unexpected. we expect that had generally but you don't plan on that kind of stuff. and i think we're going to see more of that >> it certainly is worrisome. as in 1993, is the 19194 when the thought there was a bill and it all started to fall apart too late to make a difference. it certainly seems like h there's a concern here that