country's highest court, the supreme court, on c-span. . . >> thanks to both of you for being here. >> thank you for joining us. i want you to think about health care in a real world, not an ideal world. given the democratic congress and president, what kind of bill could you support, given the

construct of the democratic congress? is there any kind of bill that either of you could support, that you think your democratic colleagues would agree with you on? >> i certainly have not seen it yet, and i do not know if i have thought it through from that context. clearly there is some common ground. we have had several hearings on this in our subcommittee, and there is some broad agreement, but the distances that exist and the moving parts you are talking about, the things about the government run plan and mandates, those will be very difficult to overcome from my perspective. it does not mean that they do not work. i went to the chairman of my committee and said i did not give up a 25-year medical career to come and sit on the sidelines while we had this debate. i was very eager to work with the majority. i was thanks very timely for showing up and for my willingness to serve, and that

was the last i have heard of it. i still stand ready, but to this day, outside of a brief invitation from the white house last march, which really did not turn out to be much of anything, there has been very little willingness to include those on our side of the dais, and i understand the political calculation. there is no need to include us. dicthere is no need to bring any republicans alone, because they have the numbers without us. their job right now is to solve the problems they have within their own caucus. >> is that to say that you think that at this point there is no scenario under which the direction democrats are going with health care, there is no common ground in this environment? >> on the house side, it will be difficult. i have watched some of the activity on the senate side.

last fall i was doing some work for senator mccain. it was interesting when senator baucus had the convocation at the library of congress. i thought that was the blueprint for legislation. i am terribly surprised there was not a bill that came out after the election or before christmas or after christmas, or before or after the inauguration. it was late in june before we began to finally see the structure of what some of these bills would look like. we were roundly criticized in the spring for not having a republican bill, but honestly, there's not a democrat bill during those times either. i am very surprised that the president did not have some specific proposals. i have heard all kinds of specifics on the campaign trail last fall. i am very surprised to read not a more structured offering from the white house to the congressional committees as this congress came together.

>> you are asking a question that i can take one of two ways. if you are saying there is a huge current of a public auction, higher taxes, bigger bureaucracy, i cannot support that. on the other hand, if you look at their stated goals, to control costs, increase access, improve quality and make it patient centric, there is 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 paycheck -- patient centric response, for example, employing hsa's, they will decrease benefits. held savings accounts can decrease costs by 30%. i would like to say with a common ground of the goals,

maybe there is room for final compromise, because i think a patient centered approach is the only way to get to those common goals. since there is a limit on the number of patient-centered approach is, i think there can be a convergence of ideas. >> he spoke about the fact that the numbers are not there for republicans. democrats are taking some heat from their fiscally conservative colleagues on the democratic side, the blue dogs. that has caused a delay in terms of the mark up. what effect the thing that has on getting something that is more likely what you can accept? >> obviously that is the chapter that is yet to be written. i made some comments on the house for managing the house floor, and here we are on the eve of the market, and we have no bill. this will take some time to go through it and understand all

the moving parts. we are supposed to market up next week, or last night we were told we would market up next week, and we did not have access to the bill. there was a question as to whether we would have access before the market up. the date may have slipped and may be delayed. that is a tall order to say we will be able to go through that involved structured, that involved piece of legislation in a day or two or three. i think you referenced in some earlier discussions held the senate health committee has been marked up for weeks. we should be in marked up for weeks. we should not try to ram this thing through at the 11th-hour just so we can say we have a house bill. you vote on your part and we will come together later. that is not the way to do something like this. in 1965 lyndon johnson signed medicare. if the folks who voted for that

medicare bill back in 1965 could have seen -- looked into the future and seen the unfunded liability we are leaving now to the next generation of americans, do you think might have tried to do some things differently? i believe that they would. we are kind of a the same promontory right now. to look over not the next election or even next presidential election, let's look over into the next generation and see what we are putting in place and what we are leaving for the folks who will come after us. they want us to do our job. there is 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 going up a little, for example, business is becoming nervous. the ceo of verizon came and spoke to a republican caucus and said we want reform, but we do

not want a public health option. that is because no government program has ever required accountability from patients. the only way to control costs is patient-centered. the business folks are looking at these discounts the government is getting as part of pharmaceuticals concessions or hospital concessions and they are scratching their head and saying, who is going to pay for those discounts? healthcare spends like a tube of toothpaste. you squeeze it here for the government and it widens here for business. business knows that they are coming back to congress saying listen, we want reform. we wanted to be patient- centered. allow us to demand accountability, but it is a tube of toothpaste. did not squeeze the cost out to us for a superficial savings to the government. >> it seems like the blue dogs have the same visceral concerns as you have regarding this bill.

what do you see it as the chances of working with them to moderate the language? >> i am not in leadership. i am not a freshman. i am walking down and going into a committee hearing and a democrat revs my lapel and says listen, i do not like this. is there, ground? i am in committee and another democrat comes up to me and says, can you believe this bill? there are going to mandate something we do not know the cost for. the fact that they are approaching someone as jr as me suggest that they are looking for something across the aisle to moderate the very extreme of what has been presented. >> we get very wrapped up in tactics in washington. you are a proponent of health savings accounts. how would they work for the very poor? >> it is very interesting you ask that. one thing that is totally

lacking is an understanding of how patients think. i work in a hospital with the uninsured. i am slapping money because many of my patients do not have computers. they do not have clan lines and they will not be downloading pdf's. that is not real world. the way to work for the less insured and uninsured, they allowed any 10 people to come together to purchase insurance. my patient population always has one person who is a clerical worker who can log on at work and download things. typically it is a female, very detail oriented. she would then become the advisor for the other nine, and they would move as a group. they can get a credit to fund their hsa. there is something called patient directed health spending in which you prepay a position to take care of your primary and

preventive services needs. this is already being done. it is not theoretical like an account of their organization. there are organizations that do this. let me give you a scenario. the clerical worker gets 10 of her friends, maybe her entire church, to sign up with a particular physician. they prepay. that position has to manage their costs. they are paying $50 a month, but if they do not like that physician, they can transfer to another. therefore, the physicians are incentivized to take care of them. on the west coast, they provide basic labs, some generics, x- rays, the whole thing to keep the patient group happy. i do think there could be a credit given to the folks who are below a certain income level to find that patient directed health spending account that they could then move. the advantage of the program is you are cutting out the administrative costs and billing insurance.

40% of a practicing physicians cost is related to billing insurance companies. if you are just getting prepaid $50 a month, that is where you remove 40% of the cost. therefore, that is how you find this, with the savings and the administrative costs. >> i wanted to ask you about the public auction. you were here in 2003 for the medicare vote on the prescription drug program. there's a trigger in that bill. you supported that bill, as far as i can tell. given the discussion last week, rahm emanuel sang a trigger is still an option on the table for them -- is that something you could support? >> the current majority demonstrated their complete disdain for a trigger. when the trigger for medicare spending was triggered, what did they do but come to the floor and say they table the revolution -- the resolution.

they have already demonstrated distain for that type of activity. i do not know that i would look to that to be treated any differently in this new plan. the track record is not great. i also want to comment on the issue of consumer directed health care plans for people in lower income groups. in 2005 when republicans were in charge, we passed the availability of health opportunity counts, essentially countshsa port people on -- essentially an sha for folks on medicare. they would have discretionary control for health care expenditures. they were not used by the end of the year, a portion would stay with the patient and accumulate over time. from my experience, when i started out, i would seek patients who were on medicaid who would have a tough time paying their medical -- paying

medical bills. to allow them to begin to build toward that, in the years while they were just getting started, and they relied on a program like medicaid, it is a very powerful tool to put in the hands of people. you look at the rate of growth the cost of regular indemnity insurance, it is about 7.5% a year. medicaid and medicare are growing at 7.4% 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 is already being learned by this consumer directed health plans? the beauty of it is, the government does not have to ration. the patient makes those decisions and they get to vote with their feet. if they do not like the way they are being treated in one

practice, the gut to another. i built a practice when i was much younger. -- they go to another. you open early and stay late. you keep the customer satisfied and take good care of your patients, but you also provide the extra level of service. there is no incentive to write that extra level of service in what is being described as a public auction that is republic option that is in the bill. >> in terms of the give-and-take that we might see next week with the markups and negotiations, many democrats have said that they hope to get doctors on board with some sort of public auction by promising to change dr. reimbursement rates under medicare. given your experience, i want to get your perspective on this idea of adjusting the sustainable growth rate in return for getting support for a public auction. >> if indeed that is what medicine is going to see on the table, they need to be certain,

absolutely certain, that they haven't nailed down in a rock- solid -- that they have id nail down in a rock-solid deal. the president said he would play if we do pay for the replacement over the next 10 years. you'll get a huge pay cut if congress does not deal with it. my history is that we do not deal with those things until the 11th hour when we have to. replacing the sustainable growth rate formula with a target growth rate formula, that is no compromise at all. that does not alleviate the burden. for people who did not understand what we are talking about, doctors who participate in medicare look at a reduction in reimbursement every year and half for the past five or six years. going forward into the future, they are looking at a 30% reduction in medicare reimbursement. it is unsustainable.

not being able to depend on what the future will look like in those medicare reimbursements has an effect on how you build your practice. how do you go to the banker and borrow money to expand to practice and hire another partner? the banker says it looks like you will be making less money each year, so i will not make you that long. this has a terribly pernicious effect on keeping positions in practice and allowing them to build a practice and bring other doctors in. a far better way to do this would be for us to by the bullet. the sustainable growth rate formula is costing him $300 billion a year to buy out of. the reality is, the money has already been spent. congress has already come in every year and said we will pay doctors at least what we paid last year. there is no money that actually

has to be paid out. it is a bookkeeping adjustment that has to be made, and congress needs to make that adjustment and then paid doctors based on a cost-of-living adjustment just as they do drug companies, hospitals, and all the other players. >> we have about seven minutes left. >> one thing i want to say is, i always say to folks, if you look at every government run health system, it over promises and under funds. medicare is projected to go bankrupt in 2018. the very fact that we have to fix something, which by the way, already underpaid relative to the private sector, shifting costs to the privately insured, shows that the president agrees with me. government traditionally has over promised an underfunded. yet suddenly we are to believe

that the -- it is a triumph of hope over experience. by the way, according to the brewer is under public health plan, the way they are supposed to get savings and the public health insurance plan is by paying providers less. he is going cross purposes. we will drive you into accepting it by paying more. there is an internal contradiction there. >> similar to the contradiction, if you like what you have, you can keep it, and the one thing we will not accept is the status quo. you cannot have both of those exist at the same time. >> you cannot begin the market next week. on the senate side, the republicans have offered a number of amendments and gotten a few past. can you give us any sort of hint

as to the republican strategy in that markup next week? >> within my personal office, i've been developing eminence for the past several weeks, recognizing the logjam in the office that ashley writes the language. we have been stockpiling these amendments -- that actually writes the language. we have been stockpiling these amendments for some time. we are probably somewhere close to 200 amendments just from our committee. 50 from me and the other 150 that are out there, and more are being written every day. i recognize i will need help with some of them, and i reached out to democrats and sat down and said here is a good idea, what do you think? would you consider 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 a model for us, we will have no republican amendments except during our markup in energy and commerce. it is a shame, because there will be some good ideas out there. we are trying to work with the other side where we can. i will be proactive and prepared. we do not want to get caught in a procedural motion that will disallow the amendments. >> looking forward, what do you think of the prospects of getting something done and to the floor by the august recess, as the house leadership says they want to do, given all the concerns? >> we are not looking into a crystal ball. it is hard to say. tom daschle said the reason the

clinton health plan failed is because everybody went home on the august break, heard an earful from their constituents, and said they could not vote for it. it is too bad. a political process is driving something that covers 17%. i cannot look into a crystal ball and say it will go this way or that. i think the american people are smarter than they are presumed to be, and they are letting their representatives know now that we want something that is different from what we are hearing about. it may be that they have figured out the scheme and are moving up the pressure. >> i am relieved 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 excess, we all remember bill clinton's beautiful speech that he gave to the joint session of the house on the evening of september 3 -- september 23, 2003. everyone left convinced that this was the time that it would

be done. turned out that september 23 was too late, and members were already word about their next reelection, even though it was over a year away. the other thing pushing this is the reconciliation instructions that passed in the senate budget. it will allow them to pass it out of this in senate with 50 votes rather than the 60. that ability to use reconciliation disappears in the middle of october. that is a strong driver on the senate side to get something done before they lose the advantage and reconciliation. >> a colleague of mine asked an interesting question this week. is it riskier to push health reform right now, or is it riskier to be seen as having stopped it? >> what is most important is getting it right. in the netherlands it has taken 10 years to get to some sophisticated thinking about where the netherlands should be.

and yet we are supposed to do it by the august recess? i tell my constituents i am fighting for patients' care, and i've been is more important to me that we get it right. otherwise we will have unfunded accrued liability 30 years from now that will swap our country's liability. >> one of the big lies in his argument is that we are already dealing with a 10 year budgetary window. if you peel back the curtain, the cost actually explode. maneuvers that are being done to hold down acceptance of the public auction for the first five years, and some of the language i have seen, everyone will actually be driven into the public auction -- the public option, and the costs will skyrocket. we are not doing a service to anyone by rushing this through and not fully evaluating the consequences of our actions. >> congressman curtis has been

asked this for a while. as a freshman, can you tell people watching what the experience of trying to legislate an important issue like health care has been for you? >> most of my colleagues are well meaning people who desire the best for the district and the country. it has been great to see it. i have been disappointed in the delivered to a process where a small group of people go in a back room and come out and show what they have decided and agreed upon. frankly, our american people would be better served if we were able to channel their ideas and wisdom into the final product, but somehow we are not trusting that. it is a very small group, and that is disappointing. >> thank you all for being here. when we come back, we will talk about the debate and the prospects. that me reintroduce our to reporters. a staff writer for "congress

now," and health care reporter for "the politico." help us understand, because so much of this is behind closed doors, how this will move forward and told me what you think the outcome will be. >> from this point forward, for weeks or on the calendar before the august recess, and everything has to work perfectly if they hope to get it done on time. they just cannot have any room for error. they did for a long time, and they are really going to have to get everything right for the next four weeks. things have not been going that well lately. this week, you saw an unexpected event with the senate democratic leadership stepping in and saying we do not want the biggest piece of the financing for this plan right now, taxing health benefits. that had to tell max baucus to

go back to the table and come back with something entirely different. that set them back a week. that was not expected a week ago. those kinds of challenges this past week, different members speaking up and saying they did not like it. we expected that generally, but you do not plan on that kind of stuff. i think we will see more of that. >> in 1993 and 1994 there was the thought that there was a bill or something in place, then it started to fall apart too late to make a difference. it seems like there is a concern that in meet -- and moving fast to meet a deadline, there are a lot of gaps in the plan, substantially as well as cost wise. as a result, you have a lot of different factions dropping out of this. you have more liberal democrats who have concerns with the public auction. you have fiscally conservative democrats with a concern that there is a public auction.

republicans are concerned that they have not been involved at all -- a public auction. --. option. it does have to be a perfect shot at it, but everyone wanted. it is not just posturing on anyone's side. both parties want to do something. they have different ideas as to how to do it. >> on that point, senate majority leader and harry reid and the president and speaker pelosi are determined to get something done. the flip side to people having concern that this can happen is the fact that they are determined to make it happen. from talking to people, the threat of keeping the senate's in session is not a fake.

if they have to, that will keep the senate around for an extra week of it means getting the bill passed. >> what does this say for the strategy of the white house to not drop a piece of legislation and let both houses debate that, but let it foment up from the congress itself? >> it is difficult, because the last time they dropped the legislation, it was a terrible failure for them. this time, they chose an approach that thought would be more effective. the problem is, when you get into the details of any sort of plan, people will start to pick at it and have concerns about it. the thing is, people understand this has to happen now. the timing of things with the next election coming up, this is one of the best opportunities they will have. there is a great amount determination to get it done, even if it means pushing into the august recess. >> are