it has been rammed through. . . >> good afternoon, and congressman john shadegg. i have been working on health care since i got here in 1995. it is one of my passions. i am pleased that the nation is now focused on health care reform. i believe it is something that desperately needs to occur. i am pleased to add to be joined here by a number of my republican colleagues were going

to speak on this bill and give you their view of why it is the right way to go. i believe we have the ranking member of the commerce committee, mr. barton here who will speak. we also have marcia blackburn, phil from georgia, and i believe we will be joined by robb bishop of utah. we are announcing the introduction of the improving health care for all americans act. the improving health care for all americans act takes a radically different approach than the bill that you have heard about and is seen in discussion drafts of from the majority party. this bill reforms health care from the bottom up. it reforms health care by empower individuals and putting them under control of their own health care. there is some key legislation i

will highlight very quickly. i will then be happy to take any questions. the bottom line is, this reformer's health care from the bottom up, it does so by empower individuals and puts the patients first. this legislation is patient focused. i would begin asking you, when was the last time that when putting the government in control of something resulted in net costing less? the think the answer is, when you put the government in control of something, it always costs more. the democrats are proposing to put the government in control of health care. we believe that means it will cost more. at this bill -- this bill puts people in charge. the first provision of the bill says, if you like you have, you can keep it. that is what 83% -- that is because 83% of current americans like their health care. most americans get their health care from their employer.

this empowers them to say, i want to keep my current health- care and the exclusion from income taxes that make that health care possible. if you like it, you can keep it. second, it covers every single american and gives every american choice and coverage. what that means is that every american that does not have a health care plan and every american that has health care falling from their employer and does not like that plan can go out and acquire their own health care plan on the same tax advantaged basis that employers get. what that means is that if you pay income taxes, you'll be able to go out and buy health care plan and get a direct offset from your income taxes. it means others will the government side and that will let you buy your own health care. every american gets choice and coverage. third, it provides americans and

group plan choices for every american. right now, you could only get into a plan -- a group plan if you have employer provided coverage. if he did not have employer provided coverage, you cannot get a group plan. this bill says -- and by the way, what that means is, if you do not have a plan, you buy into the individual market which is phenomenally expensive. this bill says, to all small lawyers and individuals are not part of a group plan already, they can join a new mechanism that says that groups like churches, alumni associations, trade associations, and other civic groups can sponsor a health care plan the you can pick. i want to take my employer's plan, are what the plan offered

by the daughters of the american revolution. i can't take my employer's plan, or the rotary international sponsored plan. there are many more group plans for you to pick from, giving you much more choice. fourth, pre-existing conditions are covered, and chronic illnesses are covered at affordable rates. that is done through both insurance pools and higher -- no american who becomes sick should have their income threatened or lose the ability to acquire health care at reasonable cost because they became sick or had a chronic condition. those people will be able to buy health care at a cost equal to what every other american lives. that cost is borne by all americans. the mechanism for controlling costs in this bill is from the bottom up, not the top down. it creates patient choice and

does not expand the government. there are other things i could say about it. i am joined by a distinguished group who care about health care reform. let me begin with mr. martin. >> one of the first tenants of medicine is to do no harm. i think our friends in the democratic side it would be well to consider that as they unveil their latest version of their health-care proposal later this afternoon. the proposal as we expected to be and as it was last week would destroy the private insurance health-care market in america. it would do it within five to 10 years because of the mandates and taxes and penalties. this bill that is being unveiled today it takes a different approach. it uses the power of the marketplace and of the individual making free choices

to provide access to more americans through the arrangements that the congressman has alluded to, which i think is very important. and also providing a tax credit for individuals who do not work where they can get insurance. they can join one of these pools. there are too big problems in the health-care industry today. one is access. the democrats tried to provide access with government mandates and the government plans. we're taking a different approach through individual choice and pulling, things like that. the other problem is cost containment. the polls show the cost containment is a bigger issue among most americans that access is. while this bill doesn't directly handle the cost issue,

the other alternatives we're going to put out later this week does that through transparency and individual choice. we have a basic balance point in the debate. you believe in the power of individuals and the power of market, or do believe in the power of bureaucracy and government. today, we're saying that we believe in the power of the individual. i'm glad to be a part of this press conference. i will say one more thing. the democrat bill, if it is what it is -- if it is what we think is going to be, it is almost by definition a nonstarter. because it is not only one bridge too far, it is several bridges too far. just the gargantuan size of the loan is going to make it very difficult for a political body to digest.

>> the state of tennessee has been through this issue already. >> thank you so much. thank you for your leadership on the issue, and think you for the work you have put into this on behalf of not only the republicans in our conference, but the american people. my state of tennessee has been through this. we had the test case for hillary clinton health care which went into place in 1994 in our state. i can tell you from the experience that we had, the initial cost estimates are nothing compared to what the final cost turns out to be. as the congressman said, when have you ever the government come in and work with an industry or takeover industry or takeover delivering services and then up costing less? that also applies to health care. the test case out there has

ended up being what our democrat governor called a disaster. i would just highlight that with all of you. the $1 trillion price tag on the democrat's 1200 page bill would be simply a down payment. i appreciate the fact that the congressman has brought forward a bill that works with market forces in order to allow a choice and options and retain ownership of not only your health insurance, but also your health care decisions. not by the government, but by the individual. i am pleased that we're bringing this bill forward today, her and look forward to continuing to work with our ranking member and with the other members of the committee as we address this issue on behalf of the american people. >> one of the veterans of the struggle is a member of the dr.'s healthcare caucus.

>> i appreciate the opportunity to be with you and talk about improving health care for all americans. let me make the analogy here. what the democrats in the senate and house appeared to be doing is trying to build a a 10,000 square foot house on three stories, but they don't have the money to really build a good house. so they're cutting corners here and there, and they will end up with a 10,000 square foot house on a shaky foundation, may be a leaky roof. they can't he did, they can't collect, and it will eventually come crashing down because of the tremendous cost. not just the $1 trillion to $3 trillion, but what the congressman has done here, he has worked on this issue for so

long. i was elected in 2002 with some of my colleagues here on the dye is. i thought i would have all the -- it did not take me long that people like joe barton you have worked on health care for years and know what they speak of. this bill is maybe a 4000 square foot house on one story, but is built strong with a good foundation. it protects and gives them that coverage that they need right now. it stopped the hemorrhaging, if you will. from this, we can go on and to do things like electronic medical records, and insurance reform in regard to rejecting people who have been in a plan for years and lose their jobs.

guaranteed accessibility there in addition to the pools that the congressman was talking about. i am proud to support this legislation. it is simple, it is common sense, and it will work. >> we're joined by robb bishop of utah. >> like the humorous p.j. o'rourke said, if you think health care costs are high now, wait until it is free. our entire life is based on options. how i choose i scream when i get 31 flavors from which to pick. there 54 different kinds of egoo waffles. -- eggo waffles. the idea of a government plan that will tell us how to do things, when to do things and will supersede a bureaucracy,

decisions made by a patient and doctor is ludicrous. this is based on giving people choices and options, dealing with it on a realistic basis. i am very proud of what the representative and others have done on this bill, to give is a very good and very solid starting point. >> thank you, i have known of drawn out for between 25 and 30 years. this issue, i suggest that not only has he understood the significance of the issue, but it was becoming a great consideration for the american people. i believe that his solution is a hopeful one. in about one hour, we're going to see a very different idea put forward by democrats. it is going to be along the same lines that we have seen the last

six months. we have seen a government takeover of banking, of the car industry, we have seen a $700 billion stimulus plan. we have seen it passed to the house, a cap and tax increase that is the largest in the history of the human species. it represents a different world view that what america was founded on so long ago. it seems like the highway of history has been littered with the wreckage of socialist ideas that somehow believe that they can lower prices better than free markets. it has never worked. i would offer only one example from recent history that would be the most apropos thing i can think of. there was a time when government essentially had somewhat control of the telephony of our telephone companies. there was weight -- there was great outcry among liberals

because it wasn't working. government wasn't doing a good job offering phone service. the operator was always somebody with you when you talked to her. it would not give you the time of day because it was essentially government run. if you calculate what the costs today would be permitted, it would be 3000 -- at $3 a minute. free markets and free people doing the best things that they know how to do -- because of that, we now have fallen so we can talk to anybody on the planet with. we can pull website. long distance is 3 cents a minute. unless we're able to catalyze innovation, even in the market system, if we have the

innovations that i think america can come up with and they will only exist in our private system that will completely be eradicated, there is open my mind. with that, i think john for what he has done. i think he is on the right track, and i support his efforts. >> and finally, one of the great young leaders on our side, a gentleman that has done more to carry this issue forward than any of us, i am pleased to have dr. burgess. >> trend was talking about the telephones, i remembered if people would mind vacating the lines so i could call in for my patients. i really like this bill. i like the emphasis it puts on where the rubber meets the road on health care. that is patient dr. interaction.

if you think about how our how -- if you think about how our government has the audacity to wants to own their own insurance policy, someone wants to have a longitudinal relationship with their insurance outside of their place of employment. yes, they can do it, but it will cost significantly more than someone who purchases insurance through their work place. i like the way that this bill puts the responsibility, really gives the dollars to the patient and allows them to direct where it is going nothing that we have looked at in the other proposals that are coming out this afternoon really do anything to limit the volume of health purchases except for perhaps putting some caps on physical therapy and radiology. otherwise, we don't address the volume cited all. we will have to address the

volume side runt -- one day. we of criticism that is too big to fail with the government run system. if you give that purchasing power to the individual, i know from personal experience, you make much wiser decisions about how those health care dollars are spent. in 1996 and 1997, i wanted to be the first one on the new medical savings accounts. when those were first introduced, we were only going to have 750,000 of them. i was fearful that i would arrive to see the last one snapped up before i could get there. only 30,000 of them were purchased. it was an excellent idea, not just because i have got to put money away in a medical ira if you will, but that by, not someone at the end of the other line was able to decide where i went for my care and when i went for my care.

i directed those dollars. it lists -- it puts a lot of power and the individual. >> i know you have any questions you want ask, but very quickly, i just want to make two quick points. if you hold that sign up right there, many of us republicans are saying that we support legislation that says if you like it, you can keep it. the president has been saying if you like it, you can keep it. the president isn't talking to people drafting the house bill. this is a section of the draft. it makes it clear that your plan will disappear. some plans will disappear. by the end of the five-year period, a group health plan must meet the minimum benefit requirements under section 121.

the create a new health care advisory board. that health care of advisory board is empowered to prescribe minimum benefit requirements for every plan in america. the chance to your employer's plan they have right now will meet with their prescribed, i suggest are zero. in five years, your plan is gone. the second point goes to the broader issue. i suggest that most americans worry about one thing more than any other. cancer. it is a huge issue. before we embrace a health care reform, we ought to know the facts about cancer. hear those facts. the five-year survival rate for prostate cancer in the united states beat canada. it trounces europe. it crushes england. if you have prostate cancer, or

if you might someday get it, before you let the democrats adopt a plan that looks like canada europe, or england, you better ask how that will put you in a better place. let's talk about a more serious one. every husband and america worries about his wife getting breast cancer, and every woman is concerned about breast cancer. hear the facts. breast cancer, a five-year survival rates. better than canada, significantly better than europe, even more significantly better than england. do we really want to go to the kind of system? with that, we will be glad answer any questions. >> the democrat proposal has a $540 billion tax increase in order to pay for it. i asked whether that would hurt

small businesses. he city could not think of any -- he said he could not think of any. is it going to hurt job growth and recovery? >> i will be my answer in one class -- one sentence. absolutely, unquestionably. nobody could believe otherwise. >> so many of these small businesses filed as so proprietaries. they are paying at the same individual tax rate that once the president obama lets the bush tax cuts expire in 2011 and out on the surcharge, you're talking about a marginal rate of up to 42% or higher. that is going to be hit right on the backs of so many of these small businesses who create most

of the jobs. they're obviously not creating too many under the economic stimulus bill. i think we lost 500,000 last month. to put this on the back of that is absolutely unconscionable. >> from a business perspective, to suggest that this won't have a profound impact on jobs is ridiculous. this will be too big raw -- the coup de gras. >> how many will be ensured if this comes? how much will it cost to subsidize the people that will have to -- that described as a potential policy? where that money come from? >> we have not had the bills scored. i do not have an analysis of what impact it would have on the

uninsured except that it provides coverage to every single american. so presumably, all those responsible, when offered a chance to pick up a policy will take it. it also is pretty evident that many of the uninsured in america are uninsured because of the cost. when i introduced my bill that allowed people to buy insurance across state lines, it was believed that it would significantly reduce costs and would allow 17 million americans to pick up coverage. this bill, because it creates these new groups that you can join will have an even more dramatic impact on cost. though i don't have an estimate, i estimate it would eliminate half of the uninsured in america today. of course, it has the potential for eliminating all of them. we believe that the competition fostered by the bill will bring

down costs significantly. i have not they will have its cord. i am not in a position to get its court. we believe there are substantial savings to be achieved when you add levels of competition in this bill and give people many more choices. >> they said the same thing. the default system in the mountain -- there were so many more choices. we may special provisions. they have better telephone service than ever could have had by the government. >> the congressman is correct that it had not been scored. if you were reasonably good in elementary school math, you can make an approximation. if you assume that 20 million people who don't have health insurance take it, and they take maximum advantage of the tax credit, that right there would

be about $100 billion give or take. the assumption is, you are not going to have 20 million who do not have any insurance at all jump on this tax credit. you'd probably take about half of that in which it would be about $50 billion a year. the one thing that we can say with some authority is that it is going to be way less than the democratic plan because there is a huge government bureaucracy and all these mandates. their average cost -- i can't remember what the kennedy plan scored per person. it was pushing 2 trillion dollars. i want to say $20,000 a person

per year. if i'm wrong, you tell me. but is not going to be more than $5,000 per person per year. that is if you all go to the individual insurance market. if these small businesses joined the group tools, they're not going to pay that much per person. they're going to get a group rate. it is indefensible costs. it is two or three times less expensive than the democratic plan >-- >> most of that is going to be -- it lets them keep that care and keep their current exclusion. that is the 3%. thank you all very much.

>> on tomorrow morning's "washington journal." we will talk about federal bailouts for financial-services companies. then, a supporter of sonia sotomayor's supreme court nomination. and senate judiciary -- [no audio]

on tomorrow morning's "washington journal." we will talk about financial services companies. then, a supporter of sonia sotomayor's supreme court nomination. in the senate judiciary member charles grassley will the cuts the confirmation hearing. "washington journal" begins at 7:00 a.m. eastern on c-span. >> live coverage for supreme court justice nominee sonia sotomayor continues this week on c-span 3, c-span radio, and on

the web at c-span.org. coming this fall, tore the home of america's highest court. the supreme court. on c-span. >> president obama said today that he expects unemployment in the u.s. to continue rising over the next few months. those comments came during a meeting with the prime minister of the netherlands in the note -- in the oval office. the president also talked about the war in afghanistan. this is 15 minutes. wvw6ñj-wóñd?íwé i am very pleased to have prime minister here, and his delegation. we're about to celebrate the 400 th anniversary of henry hudson

exploring manhattan. he helped lay the groundwork for the united states. it will be an incredible celebration that we're all looking forward to. the united states and the netherlands have maintained an extraordinarily close friendship for many years now. i wanted to express to the prime minister, both the american people's appreciation for that friendship in general, and our admiration for some of the specific international obligations that the netherlands has taken on at a leadership that has taken on. we discussed the critical role that the netherlands has played in afghanistan. they're part of the operation there. the dutch military has been one

of the most outstanding military is there -- militaries there, not only in a military capacity, but also and the culture of politics. the review that we conducted in afghanistan that emphasized the three d's of development, diplomacy, and our ability to deploy troops effectively was really adopted from some strategies that had already been pursued effectively by the netherlands. we discussed a range of international issues that we have been working together on. i extended my personal invitation to the prime minister to participate in the next lg-20 summit in pittsburgh.

the only as the netherlands one of the world's largest economies and most active internationally, but the prime minister has very specific expertise and experience in working with a whole range of world leaders. i think his contribution will be greatly appreciated. we discussed the issue of guantanamo, and the importance of european countries working with us to assist in that process. we are grateful for the encouragement we received there. and we had discussed the issue of climate change. obviously, the netherlands has a lot of experience in dealing with the battle against rising notions. -- rising oceans. they'll also taken terrific

strides on issues of clean energy. we think we can get some good advice there in terms of how we can work together. overall, we're thankful that this partnership is strong and will continue to grow. we're grateful to the dutch people for their extraordinary contributions to international peace and security. i look forward to seeing you in pittsburgh. >> mr. president, i want to thank you very much for receiving us in the oval office. we have had a good meeting, and you have already referred to the fact that we have been friends for centuries. the united states and the netherlands -- henry hudson arrived on the harbor, and we share the same values. we talk about freedom, human rights, we talk about our common

responsibilities. we talk about democracy. and we both act worldwide. when he started as president, you brought the message of hope and hope for a new future. we admire you for that. we want to thank you for taking on the responsibilities domestically and internationally. we have met four times, and we have talked about important issues of today. we're both convinced that we are talking about not only the financial crisis, but also about the issue of energy, climate change. the copenhagen summit must be successful. it is important that we will have a very successful meeting. all to thank you very much for the invitation to be there. i am convinced that we can only solve the problems when we are working together. we also spoke about the issue of

health and the health system. in my country, we have had a lot of discussions. i know it is here in the united states now, but we also talked about the important issue of invasion. -- the issue of innovation. we talked about the role of the private sector, social responsibility. i'm convinced that we have so many things in common, that we can work together. you already mentioned work and afghanistan. we are faced with the importance of working together. i wish you all the best with your responsibilities. it is not an easy time to be president, but you have shown your commitment to change things. i am convinced that we work together in the interest of the people worldwide and in the

united states and of my people of then -- of the netherlands. >> representing the united states, sam young. >> [unintelligible] >> well, i think is fair to say that i want to loosen up my arm a little bit. my general strategy the last time i threw a pitch was that the american league championship series. i want to keep a high. there was no kaukauna, i do not know how fast it went. if it exceeded 30 miles per hour, i would be surprised. it didn't clear the plate. with respect to the employment

issue, i obviously do not have a crystal ball. we have looked at a lot of the economic data that is coming out right now. as i have said repeatedly, we have seen some stabilization in the financial markets. that is good. it means that companies can borrow and banks are starting to lend again. small businesses that might have worried a couple of months ago about closing doors are not able to get a little more financing. it means they're less likely to lay off workers. that is on the positive side. what will also seen is that historically, even after we start moving into recovery, hiring typically lags for some time after that. that has been the historic norm.

this has been more severe recession that we have seen since the great depression, so how employment numbers are going to respond is not yet clear. my expectation is that we will probably continue to see unemployment take up for several months. the challenge for this administration is to make sure that even as we are stabilizing the financial system, will understand the most important thing is, are people able to find good jobs? we had a problem even before this recession. even during times of economic growth where the pace of job growth, wage growth, and income growth was not moving as quickly as overall economic growth. the last recession that we had, the recovery was turned into a jobless recovery. we cannot repeat that approach. that is why when i talk about things like health care reform

or revamping how we approach energy and investing in a clean energy, when i talk about improving our education system as i discussed it today, those foundations are so critical because we have got to find new models of economic growth in times when consumers are not going to be spending as much as they were. that drives a lot of economic growth over the last several months. michigan is obviously a state that has been better during this recession and in that year's leading up to this recession. we're pleased to see that gm and chrysler have gotten out of bankruptcy. they have an opportunity to compete internationally had it not an -- it to compete internationally. had it not been for the steps we had taken, i believe it would have been far worse. we have made investments that

early on allowed us -- to allow the state to lay off fewer teachers, fewer cops, fewer firefighters. those were all jobs it would of been lost in the absence of a recovery package. it is still not enough. i would argue that the single biggest challenge that not just united states faces, but countries in europe and all around the world is, how we generate enough jobs with rages -- with wages that keep up with population growth. unless we are investing in energy, infrastructure, innovation, science, development, and eliminating the drag of the health-care system, i think we will have a very difficult time generating jobs. if we make those investments, have confidence that we will be able to do so.

>> mr. obama, you mentioned critical roles. how important is it [unintelligible] >> i think dutch troops have been some of the most effective troops in isec. i recognize that participation in the coalition -can be controversial. it is never set -- is never easy sending our finest men and women into the field of battle. what i shared was that the hope was that even after next summer, there be the ability for the dutch to continue to apply the leadership and the experience that they have been able to accumulate over these past years. i think that all of us want to

see an effective exit strategy where the afghan army, the afghan police, the afghan accords, the afghan government will take more responsibility for their own security. if we can get through a successful election in september and we continue to apply the trading approach to the afghan security forces, and we combine it with the much more effective approach to economic developments inside afghanistan, my hope is that we will be able to begin transitioning to a different phase in afghanistan. the one thing i want to emphasize is that the issue in afghanistan is not simply an american issue. it is a worldwide issue. the vulnerability to terrorist attack in europe are at least as

high as they are here in the united states. if you look at how our car is operating, they consider the west to be one undifferentiated set of countries. they will exploit whatever weaknesses are there. i think we have a comment dressed in dealing with this as effectively as possible. i am grateful to the prime minister and the dutch people for their extraordinary contributions. >> we're following the 3 d approach. the fence, diplomacy, and development. the review of the american administration says that we are of the same mind. [unintelligible] is also good underlined that the methods will not turn its back on people. we feel a responsibility.

that is also a way of talking about this issue. i'll also like to underline what you said about economic issues. last year, we talked about the financial crisis, and financial architecture. it is important that we are developing the same strategies. the idea is enough for the question of implementation. his work is extremely important. after a financial crisis, it is a matter of creating jobs. it is also linked to the people -- to the issue of confidence. we're working together to give hope to people. if people are losing their jobs and we are rare of the fact that we have to change things, that

is my message. >> thank you, everybody. >> on monday, but -- members of parliament questioned -- had questions about the war in afghanistan. from london, this is one hour. [captioning performed by national captioning institute] [captions copyright national cable satellite corp. 2009] >> order, order. >> question no. one, please. >> mr. speaker, with permission, can i start by paying tribute to the 15 brave men and women who have tragically lost their lives in afghanistan over the last 10 days. we have now lost 184 lives in this conflict. each one is a terrible loss. this last week has been a hard week for those serving.

the result is incredible in the face of these tough times. in the face of heavy resistance, they are making progress. i would urge colleagues on both sides of the house took give their support. mr. speaker, progress is being made, but the insurgency remains resilient. a majority of people can go about their daily lives, but in certain areas in the south and east, significant security challenges remain. british, afghan, and american troops are currently engaged in major offensive operations to secure key population centers up to the afghan presidential elections. >> i joined in that paying tribute to the service personnel that have lost their lives in recent days.

the have died serving their country. some of the greatest security threats are service personnel face in afghanistan are on the ground. can the secretary explain why he believes that the current level of provisions and support is sufficient, particularly in the context of recent changes in policy and approach of operations that put our troops and their lives at greater risk? >> we have, as we have said repeatedly, see a huge uplifting. over the last two years, and 84% increase, and there will be more by the end of the year. we will get the chanuk out in 2010. the issue that the hon.

gentleman raises is the problem that changes the way in which the operations are being conducted. it leads to more ground operations, and these cannot be conducted from helicopters. we have troops at the moment involves who are clearing clomp -- compounds and taking on the taliban in one of their areas. there has been hand-to-hand fighting resorted to in some of the deaths that we have experienced sadly over the last week or so. this cannot be conducted from inside a highly armored vehicle. it cannot be conducted from a helicopter. >> may i put it to my hon. friend that tragic that these death star, and wally must do as much as we can to minimize casualties, it is irresponsible and dishonest to pretend that if

only the government had provided this piece of equipment or that piece of equipment, all of these lives could have been saved. it only serves to ups that unnecessarily the grieving relatives of this country. >> what hon. friend is right. we have lost five people in the area conducting a security -- these are vital, and are done from time to time. there is a pretty well plan so you can conduct those patrols on foot. we lost a member having just dismantled having from the most heavily armored vehicle that we have got in the theater. our troops have to get out in order to engage with the people and in order to deal with the insurgency.

they have to take those risks. -understand that. i think that the british public understands that. i would appeal that members of the house [no audio] we cannot remove risk from this kind of operation. >> i agree with what the secretary of state has just said. when the chancellor has said over the weekend that the treasury would ensure that the ministry of defence was not short of money, what did he mean, and what new actions will secretary of state be taking to take him up on his promise? >> he meant, for example, that we are lifting -- the treasury

has lifted the ceiling that was announced in december of 635 million pounds in order that we get the latest capability to deal with the -- everything we need we will present. we will make sure that we get what is needed in order to keep our troops as safe as we can. add a time where we are involved in the most serious operations in the theater, not only us, but the americans as well. people contrast the equipment we have with the americans. our colleagues have lost more people than we have ourselves despite the great adventure in. >> i was very struck talking to ordinary soldiers that they were

forming a view that we're losing the battle of hearts and minds. we are seen as a force liberating to being an occupying force. vital to winning, however you define winning, is keeping the support of the afghan people. >> absolutely. i have not come across that opinion and would not deny that there will be afghans who hold that view. but my friend is absolutely right. this operation will not be won by killing caliban -- taliban, it will be won by protecting the people. we except that the afghan government is on their side. it is the absolute priority of the new commander general and

the instructions he has been given. >> mr. speaker, if we're told as burnout that the province contains terrorists, on what basis would it be hoped that a shot would not be fired? is this not the beginning of a really serious misreading at the situation that is still continuing today at which our armed forces are paying a heavy price? >> in never was said that there was hope of their not being a shot fired. what we said was, remember i was sitting in that chair over there. it was said by the secretary of state then that we would be happy if not a shot would be fired. he was responding to a question. he would not have been putting

the brigade into a theater of work they thought that they would not be a little bit of trouble in the area. >> confirm what the defense secretary has just said. and can i tell my hon. friend that he has just misled the house. i never, at any stage expressed the expectation, promised, or pledge that we would leave afghanistan without firing a shot. i did however insist that we would not be aggressors. we did not seek work. it we did not go there as part of an invasion. for our part, we would be happy to leave without firing a bullet. it was in that sense that it was said. i would be extremely obliged i could be confirmed again from the front bench, and the hon. members could stop the misrepresentation of what was

said when we went in. >> that is my memory of what i heard at the time. i have heard various forms of it ever since. that is what i recall him saying at the time. >> no one denies that these dangerous operations -- it is not a solis of the responsibility to do everything in our power to minimize casualties. isn't the fundamental problem for the government of fact that when there is no comprehensive strategy to deal with the military, political, economic -- until a comprehensive strategy is agreed and implemented, we will continue to struggle with afghanistan. >> i would say two things to the hon. gentleman. i keep hearing there is the strategy now. if people want to disagree with the strategy, fair enough. please do not deny that there is

one. the strategy is about building up afghan capability both in a security and an area in the government as well so they can get to a point where they're able to defend their own country from the insurgency, and they can provide the basics for their own people. it would be a long time before they could do that. afghan tax revenues doubled in the last year. they would be dependent on the international donations for some rigid for a long time yet. there is a strategy. the second thing i would say is, let's not pretend that the existence of a strategy is going to get us out of a situation where our people are having to take on a very ingrained insurgency right in the heartland where they know how important it is that they maintain control of those central belts.

and our people are going in there and clearing them. that is why they're fighting. they know how important it is for them to hang on. sadly, we have lost some people. they have lost a lot of people. >> can i very gently say that he is doing his best to respond to the points made. there is a balance. i am keen to get in as many colleagues as possible. david crosby. >> we're at war in afghanistan. if we don't work together and political partnership, we will certainly lose the argument. does he agree with me that any attempt to play politics while our troops are laying down their lives is beneath contempt? >> i agree with my hon. friend.

we're making progress. we're going forward. these operations that are currently being conducted at our at our instigation. these are offensive operations to clear the taliban of very important area. .

>> i think the honorable gentleman is right. the military side of things can go as well as it likes, but unless we can make progress in these other strands, then all will be for naught and there isn't a single member of our armed forces who doesn't understand that right down the chaven command. we have an election on the 20th of august. it's important that that's a credible election, that that goes on to improve governance, that it goes on to continue to provide better for the afghan people and that it goes on not from a position of weakness but from a position of strength to hold out the hand to those parts of the insurgency that are prepared to come across and to give up the armed struggle and involve themselves in politics. >> tom watson? >> it is a very great shame that we are currently engaged in an unseemly media row about

air lift in afghanistan much the defense world will know what that's about and the defense world will expect my right honorable friend to commit in future to put pressure on the chancellor to maintain funding for defense and to expect the front bench opposite to commit the current shadow chancellor to end his shameful refusal to not commit to even existing defense spending. >> we need to maintain our support for our armed forces in the field. we need to do that through the core defense budget, we need to do it through the u.o.r. process as well. we need to continue to get more protective vehicles, more homenters in the field as soon as possible and i assure you i will do everything i can to bring those dates as far ford

as pac bell -- 307b89 >> the mr. liam fox. >> can i add my condolences to the families of the service men killed this past week? every single death is a strategy -- tragedy and our thoughts and prayers are with all the families involved. when the government cut the helicopter budget in 2004 by $$1.2 million pounds was it a mistake? >> we have made great strides to increase helicopter availability and capability with a large degree of success over the last two years in afghanistan. there are now 60% more helicopter frames, 84% more helicopter hours and there is yet the merlin to be moved into theater, and enhancements are possible to both lynx and

chinook that would make them a better helicopter more capable of dealing with a very difficult theater. >> mr. speaker, people in this country understand the security need for our mission in afghanistan. they understand that in wars there are casualties and fatalities. what they don't understand is why we're not doing everything we can to reduce the risk to our forces. we need more and better armored vehicles but if we cannot move our forces by air they are more vulnerable on the ground. as the former cheeve the defense have said, of course they need more helicopters. if there had been more it is very likely fewer soldiers would have been killed by roadside bombs. so why is it that american forces have eight times as many helicopters for the number of personnel? how on earth did we get into such an unacceptable position? who is to blame and how are we going to get out of it?

>> i've heard the honorable gentleman over a period of time and have yet to hear how he thinks we can get more helicopters into theater. what he's saying from the dispatch box that we ought to get as many helicopters into theater as quickly as possible. yet i have heard him say nothing that indicates that he could do it any quicker than we are planning to do. indeed, i understand on the radio this morning he said, and it's true, we should look to our allies. we are part of a coalition. and so for anybody to suggest that we ought to be down on the fact that our american allies are in helmand assisting, it's a nonsense. he cannot do the impossible. we will do everything there is possible in order to enhance the whole of protective capability in helmand province. >> question two? >> we have a contract with e.d.s.

e.d.s. in their turn has set up a consortium called atlas consisting of themselves, of fujitsu, general dynamics u.k., of e.a.d.s. and of lodgica. beyond that there is a range of sub contractors with defined tasks, sometimes for limetded --ly. ed periods of time -- >> order. >> can i just say to the secretary of state that he does need to address the house as a whole so that everybody can hear? i think he's finished his initial answer. mr. david taylor? >> the delayed agreement and signoff on stage three is for the benighted project that's already tripled in cost. why are civil servants and politicians so obsessed with outsourcing public sector i.t. contracts when the logic and economics of extra costs and

complexity point in precisely the opposite direction? >> i think my honorable friend is actually factually wrong on a number of those points. the budgeted costs certainly haven't increased 300% as he is suggesting. there's been a much morely. ed increasing -- increase of 180 million pounds out of the 7.1 billion but i have to say to my honorable friend, first of all this project is going to save money in relation to legacy methods of fulfilling the same role. that is very important. second, it's an absolutely essential part of modern warfare that we do have effective, secure communications linking all aspects of our armed forced at home and abroad in theaters. it's part of the network capability to which we're committed >> mr. speaker a pilotment oring scheme is in place at

chatwick garrison designed to help them transition to and cope with civilian life. in addition to the normal support given when leaving service, the pilot program gives additional guidance and support and encouragement for six months. >> on the subject of p.a.c., the subject was told that 48% of raw marines and soldiers receive only a five-day pretraining for afghanistan. >> can i assure the right honorable gentleman that everything is done to ensure our service personnel do receive adequate training both before they leave for theater and during theater as well. the safety and security of our service men is our highest priority. >> thank you, mr. speaker.

thement oring service must also be available for those young men who don't make it through the initial training. professor kapoor published his study about the 230,000 young people who left the service over a 10-year period and found that those most vulnerable, particularly to suicide, were young people who hadn't finished initial training or served only for a very short period. can we be assured that within the mentoring service there will be a focus on advising young men especially of the need to seek help, advice, and support should they suffer any mental health problems? >> certainly through our recruitment and training procedures we to seek to assure that all the promote advice and training is available. and this pilot scheme is targeting those service personnel who leave early who are deemed to be vulnerable. the initial indications are

that it is proving successful. i think we need to get to the end of the pilot scheme and see how and in what way that could be rolled forward. >> mr. speaker, the estimated cost of operations in afghanistan for this financial year is 3.5 billion pounds. as recently published for the first time, the main estimates, the cost of military operations is dependent on a number of variable factors which are difficult to predict including changes to operational tempo and the actions in theater at the time. we do not therefore attempt to project costs for the subsequent years. >> given the events at chancellor sledge over the weekend how did the secretary of state or minister at this. funding operational requirements given in those future years his ministry will have to be paying back every

penny they spend on operational requirements? isn't that a case of robbing the future to pay for the military today? >> well, we haven't gone over those liments and therefore there is no need for a repayment. i've just announced to the house that those liments, that 635 million pound limit --ly. -- limit has just been raised. i think there is some indication the chancellor is trying to assist. >> thank you, mr. speaker. but in assessing those costs does the minister acknowledge there is real, understandable doubts about -- amongst the powerbomb -- public, not about being in affsaffs but whether they have the right amount of equipment to do their tasks? >> i think -- i mean the number of troops and the costs of the

afghan mission have gone up considerably after the lost -- last three years. all i can say is that i get the opportunity many others in the house don't get to do, go out to theater on a regular basis. i hear repeatedly that the kit and equipment that they have has been improved massively over the last couple years. >> there are merlin helicopters and lynx mark 9's currently being prepared for use in afghanistan. but can he tell us what further steps beyond these are being considered by the department to ensure that the helicopter needs in afghanistan are met in the future? >> we are planning a spend of about six billion pounds on helicopters over the coming years. what we need to do is to try to make sure that we spend that as wisely as we can to ensure that we have no capability gap,

particularly when our people are involved in the operations that they are today. >> mr. speaker, it's difficult to anticipate the costs but air lift is clearly one of the areas where we have constraints. given that currently germany provides 70% of i.s.a. capacity, is he in discussions with them? >> we encourage our nato allies to do the absolute maximum. there are, there is little doubt that we are pulling our weight in the afghan theater. there is little doubt that the operation is absolutely vital to our safety back here in the united kingdom and to nato's credibility. so we hope and we press all the time for our allies to do whatever they can in order to

ensure success. >> nadeanedories? >> mr. speaker. >> thank you. 0.1% of course regular service personnel ever discharged for mental health reasons for whatever reasons but the mental health undertaking studied funding for mental health disorders for both service and in the veteran community. the results of this will be available at the beginning of next year. in addition, evaluation of the six community based u.h.s. community pilot schemes will help define the level of need for support in the communities. >> nadine dories. >> mental health issues are as

distressing as any physical dibblet. but only 70% of current g.p.'s are even aware of the government mental health program. >> can i address the -- well, actually the number of serts suffering are very small but each is a personal tragedy for the individuals. can i say what we're doing is on two levels. one is the small pilots. in addition, working with the department of health to look into the veterans tracking system. but if she or any other members would like to visit one of the mental health pilots or the center at thompson hospital i would be -- be quite willing to arrange them. sflm my honorable friend is aware it can take up to 1 years

for an ex-service person before they often report and present themselves for treatment at a mental health program. what can we do amongst the military to take away this altitude that presenting yourself for some sort of mental health treatment is some way a disgrace? every member of the military service have -- should present very many -- themselves and have a check before they go into civilian life. >> my honorable friend raises a very important point. unfortunately men, particularly young men are terrible at recognizing issues in mental health. i think the issue around trim which is a system of self-assessment pioneered by the royal marines is actually making sure that mental health is not a stigma people should be ashamed of reporting. i think working with certainly veterans' organizations and the

n.h.s. and the six pilots, i think we can certainly make sure the help is there for westerns -- veterans whenever ment at -- mental health issues affect veterans. >> the u.s. has put in place hay comprehensive health screening for operation at military. our government has not. you could be forgiven for supposing that british combat stress and american combat stress are completely different disorders. can the minister say how much we have spent on p.t.s.d., why clinical awareness of it continues to flatline and why there is no mental health screening for our returning veterans? >> well, i don't accept that there is no screening for returning veterans. but one thing is does indicate is that mental health screening predeployment is not effective and actually causes more problems than you solve in the

actual population you are talking about and that goes right back to the second world war. in terms of ptsd, it is a small number that present. in terms of 9 numbers that present inspect u.s., there are question marks about the way the operational temper is different in the u.s. from ours and the surgeon general and counterpart are looking at the issue. just recently a team was over from the u.s. to look at the way we're treating mental health in the armed forces in our veterans community. >> speaker, the government is committed to the current nuclear deterrent. good sprog being made in completing the actions set out in the 2006 white paper, the future of the u.k.'s nuclear deterrent. >> but tony blair told this

house in december 2006 that britain could maintain its minimum strategic deterrent whiles. reducing from 200 to 160 war heads. less than three years later the current prime minister seems to be offering to reduce this figure below 6 -- 160 warheads. how can he do this while still maintaining a minimum level of deterrence. >> the prime minister also made it very clear he was committed to main taping the nuclear deterrent. we need to try to make an appropriate contribution to any multilateral nuclear proposition that is made. but we have to at the tame -- same time ensure that we have a credible nuclear deterrent and this government in its entirety, not only the defense team, is committed to doing that. >> jim devine? >> thank you, mr. speaker. recognizing the meeting that

president obama had last week with the president of russia where he committed to reducing 500 nuclear warheads each isn't it about time the department of public safety tried it? >> no, it's not. if my honorable friend wants to look at the record since we same -- came into power he will see we've made significant reductions to our demovieable nuclear capability. we have made a significant contribution to the reduction of nuclear weapons. we will obviously seek to be constructive in any propositions going forward but we will be constructive within the parameters of maintaining the british nuclear deterrent. >> thank you, mr. speaker. can the secretary of state confirm that any future nuclear deterrent which involved reliance on nuclear armed cruise missiles as some

recommend, would that be compatible with the provisions of the 1987 intermediate range nuclear forces treaty? >> well, as the honorable gentleman knows, we looked at different methods of maintaining the nuclear deterrent during the white paper process and we decided for very good reasons i think of invulnerability to stick with the ballistic missile system based on submarines and that is what we intend to do. >> jeremy corbin. >> does the secretary scrve doctor of state really think it's a very good idea to commit ourselves to the expenditure of 186 billions ahead of the treaty next year and when sharing the aspiration of a nuclear free world? wouldn't a better choice be to

not replace trident? >> my honorable friend's views are well known and have been consistent over views -- years. i'm glad to see that they changed but he will know that i disagree with him, have done in the past and still do. >> angela watkins. >> number eight, mr. speaker the >> we keep our prords under constant review and are introducing further improvements at the present time. >> i think -- thank the minister for his answer but the main investment decisions on the new satellite navigation terminals were made in 2001 on the acquisition of -- introduction of smart acquisition. yet those are the very ones that have suffered the greatest slippage in 2007 and wait to -- 2008. why? >> we keep it under constant

review and one of. improvements which we are introducing say rather more robust attitude towards failure and i think the honorable lady will see the results of that before too long. >> procuring the right of -- kind of daily equipment is important for troops but it could also be important for daily workers. tell -- can the minister tell us what the prospect is for early 2010 to ensure our forces of the most up to date equipment possible? >> well, we issued just a week ago draft invitations to tender for two very important land vehicle projects. one is the scout and the other is the warrior upgrade and i remain hopeful we may be able to sign contracts frr -- for those vehicles early next year,

following the tender and the evaluation of the bids. >> angus mcneil? >> good procurement of course depends on the best test centers. there's no other political party supporting the government's pondering of cutting 125 jobs at the head of the company. if they abolish those jobs, this golf. will not be forgiven in scotland if they to. there is no question of degrading our testing facilities. the question is whether or not it can be more efficient to control all those from one single place which modern i.t. makes feasible and it would be irresponsible not to look at that. i've had a number of representatives from scotland whom i greatly respect. we won't be taking any decisions until the review is

completed. >> two years ago the current secretary of state said that all six ex-danish merlin helicopters would be operational by 2008. yet it now seems they will not be available until the end of this year at the earliest. given the widespread criticism of the government's failure to provide sufficient helicopters, how does the minister justify yet another 12-month delay in another critical program in? i don't accept that we've failed in producing helicopter capability in afghanistan. my right honorable friend has set out some of the figures. an 80% increase in availability of the helicopters over the last two and a half years, helicopter hours and we have an enormous program of procurement of new helicopters. the danish merlins. the -- i'm coming to that in a second -- the merlins which are coming back from iraq and being fitted for theater entry standard for afghanistan.

there is the prospect of the eight mark three chinooks which will be available for operations again by the end of this year. there is the up-engining, the re-engining of the lynx helicopters. there is the prospect of wildcat, which is currently being manufactured. i think that's a very good record. so far as the merlins from denmark are concerned they are being upgrade -- graded for theater entry standard as rapidly as possible and i can't force through these procedures faster than the experts are able to deliver them. it's a very dangerous thing to do. >> we currently expect initial gait way. >> givingen that a number of people, including retired military officers and former defense academics are now saying trident is both irrelevant and unaffordable will he defer the initial gate

process he's talking about and the hundreds of monies -- millions of pounds of cost it would commit us to until a further report? >> the answer is no. >> andrew mckinley? not here. mr. allen reid? >> number 11. >> mr. speaker, the available resources for defense expenditure were set during the spending rounds. the most recent comprehensive spending review set in the department's budget for 2008-2011. the department's exsenditure plans after 2008-2011 are not yet agreed. we review the allocation during

regular expenditure rounds. >> i think the secretary of state for that answer. recently we found that the carriers were going to have to require an extra billion pounds. can the secretary tell us is the government fully committed in all circumstances to trident and to new aircraft carriers and if it is, what is the strategy for ensuring that over the next 20 years the government will be able to provide the resources required so that our troops are fully equipped for all the challenges they face? >> yes, there seems to be a little contradiction between he and his honorable friend who sat right next door to him. but that's not unusual as the honorable gentleman opposite points out. we are committed, you know, as i've just said, to trident and also to the coors. -- carriers.

there has been an increase in the program costs of carriers as the honorable gentleman talks about. but we are committed to both projects. >> number 12, mr. speaker. >> the effectiveness of our spending on defense procurement is being enhanced all the time. ever since the reforms of smart acquisition, smart procure metropolitan at the beginning of the history this government i think their effectiveness has been very good by international standards. as i've already explained we are considering further improvement at the current moment. >> but what estimate has this department made of the additional costs of core budget for kit and equipment levels be at planned useage in afghanistan? >> we are looking at this issue at the present time and don't have a firm response. it is a complicated calculation, which the

honorable gentleman probably accepts. >> in which they are engaged either at home or abroad. >> can i place on record my own thanks to his ministerial colleagues for the courtesy in replacing the nimrod plans. but can i ask that that be properly assessed before any final decisions are made about the efficacy of the other bits? i thank my honorable friend, who i know is hugely interested in this and has expressed his interest over some time.

we are ready to receive a nimrod-based bid from b.a. systems. we wrote to them the 15th of june asking if they wished to make an unsolicited bid and haven't yet received a response. if they make a bid, i assure my right honorable friend they will be considered effectively. but they don't have forever to do so. we need to consider the decision by round about the end of the year. >> the secretary of state said earlier that building up -- strategy in afghanistan was about building up afghan capability so they can defend their own country. i'm sure we all agree with that. the strategy when i was there seemed to be deploying troops by day and withdrawing to defensive positions by night the could the secretary of

state say whether he thinks the strategy is working? it's really not meanting to critical. >> can i say to the honorable gentleman i believe the strategy and the tactics are working but we are facing an extraordinarily difficult set of challenges. and the point he highlights of increasing the capacity of the afghan forced is absolutely clear. in the meantime we're right to pursue the approach we are, which is bit by bit taking back, reclaiming ground from the taliban so that we can spread the authority of the afghan national government and the army. >> 15 u.k. casualties in 15 -- 10 days is a tragedy but it's truly desperate when a political leader exploits such for -- a since seer apology for

such a nakedly obvious attempt. >> my honorable friend must accept we all need to try to make the maximum contribution to maintaining the cross-party support that our operations in afghanistan have enjoyed over the yards and we -- years and we shouldn't allow any tensions that may have been over the last few days to be against that. i was in afghanistan and i was enormously pleased to say to troops in theater that they do enjoy cross-party support in this house for what they do out there. let's all try to do everything we can to make that a reality. >> nadine dories. >> thanks, speaker. i wonder how many troops the minister believes we need on the ground in afghanistan in

order to achieve our objective? does he believe the chief of staff, the man who knows what is happening in afghanistan knows or a man in a westminster office? >> can i thank the honorable lady, and we have rightly increased our troop nubbeds from five and a half,000 to nine,000. that was the right thing to do. but we're part of a multinational coalition and the idea that we alone are responsible for facing up to that challenge is fundamentally wrong. >> john robinson. >> thank you, mr. speaker the i asked the parliamentary undersecretary of defense about the mask probably and he said at that time the most important thing was to carry out the contracts and get that up and running. now that we've got the steel company, i thank him, assist not clear we're looking at the mask project for the next step

in years to come? >> we are looking at the mars project but i don't want my honorable friend to be under any illusion. where we build war fighting vessels like the cost, then we have made a strategic decision as part of the defensive strategy that, to make sure those ships are built in this country. where we are talking about logistic support ships or tankers that doesn't apply. we need to get the best value for money so it would be quite wrong to say that those ships are being reserved for the ship yards in the clyde or elsewhere in the united kingdom. doesn't mean british ship yards wouldn't be most welcome to bid for them. we would be delighted if they win on the basis of best value for the money. >> mr. speaker, i've just returned from a visit to

afghanistan. i have nothing but praise for our forces working in helmand province but i think this government should hang its head in shame for sending our troops out with not enough heavy lifters and helicopters. what is the actual plan for reconstruction and development? i asked a series of senior officers and not one of them had any idea what was going to happen once the actual bullets stopped flying. i urge the minister to look into this. >> order, order! topical questions need to be brief as do the answers. minister in? can i say to the honorable gentleman, the shadow secretary of state confirmed in his view that no amount of helicopters tragically would have saved the lives lost last week and i think we ought to discuss the discussion on the bgs -- basis of that national fact. in terms of national -- nation

building and reconstruction we are committed. the police, the courts, the judicial system, the army to spread the afghan golf. that is the right approach. >> when the bullets stop flying, the hated karzai police will move back in with their dreadful record of exploitation of the population, extortion of robbery, of drug use and drug trafficking and worst of all the practice of the sexual exploitation of young boys. how is this a way to win hearts and minds? >> my honorable friend has strong views that he's expressed over a period of time. let's not deny that we have anything other than a perfect situation in afghanistan. we have to strive to improve that. but when one looks at some of the abuses that were perpetrated under the taliban

regime when they were in power, they were utterly appalling and pretty comprehensive and they still are in those areas where the taliban has sway. so my honorable friend so i would have thought temper his views with regard to the karzai government. >> alan reid? >> the government in its disposal of the matter with the -- with the twin aims of obtaining money and helping stimulate the local economy, can the minister update me on progress there and what consideration has been given to the possibility of a community buyout? >> like any other surface lands deal, it's to get maximum value for money in that site. as it is the case when i last wrote to him it's to ensure also that we have community

buy-in. i'm happy to meet with him and local authorities to ensure how we can have maximum benefit from that disposal of that site. >> my honorable friends will be very aware the british public understands very well the level of occasional -- casualties being taken in this offensive. what they have less feel for are the losses being taken by our allies, the afghans and audio -- others and indeed by the taliban. are this estimates available? >> i can't give precise figures. however, i think my honorable friend is right, there have been casualties across the coalition equally significant to the numbers that we have lost. what i think that undermines is that we are at -- underlines is that we are at a critical phase of this campaign. we are harming the taliban. that is why they are fighting as strongly as they are and we need to keep pursuing that strategy to assure we actually succeed.

>> mr. speaker, we've seen today how pressed the infantry is in afghanistan. does the government agree that to keep a world-class army in tip-top condition in these very difficult theaters requires some very difficult expenditure decisions and maybe that that -- we have to cancel or postpone big-ticket items elsewhere. would the government therefore bring forward its expenditure review on defense and not postpone until the election? >> there say very acute dilemma between giving the required priority to the operations that we're involved in now, difficult as they are, as the honorable gentleman says, and trying to make sure that we have at built to respond to the many threats that we may well do, we may well face in the

coming years. that is quite probably the -- properly the province of a strategic defense review. i think his party is committed to having one in 2010 as are the liberal democrats, as are we. >> my honorable friend, victory in -- could my honorable friend define what victory in afghanistan would mean? >> the strategy is about ensuring that this country is safe and in order for that to happen we need to have sufficient capacity. within the afghan national army, the police and the government so that the government of afghanistan can secure the situation in the country for themselves. >> does the chair share my disappointment that we seem to be lose the argument about trident sure -- purely because of the financial bill? and wouldn't it be better if we started an open debate about the alternatives, the strategy,

the options a -- as my honorable friend suggested so that we can have a debate and people will then start to understand why we need this? >> i think the debate has already started and, you know, he knows there is quite a debate raging within his own party about the future of the trident nuclear weapon with the defense team having one view, the treasury team appearing, you know, to have another. i mean there is a need for a debate on defense across the peaks, which is why i asked the other week for a green paper on defense capability and i would hope i would be able to conduct that in a cross-party manner and that we will get as many people involved in that process as possible and to it in a nonpartisan way. would the secretary of state confirm that he will not cut any reg i aments of the

infantry so that we may have enough boots on the ground to do the job? >> there are no plans to cut any reg i aments of infantry the >> is not one of the greatest threats to the security of afghanistan the inexcess -- incompetents ant abject failure of the reconstruction projects which are adding intolerable burdens to our security forces? >> can i say to the honorable lady there are health centers reopened, schools rebuilt, there are girls that are in school, that simply was not the case in 2001. yes, we face significant challenges but you think honorable members in the house deny the reality if -- underestimate the progress made if they deny that reality the >> will he guarantee there will

be no further delays in the construction of carriers? >> the carriers are proceeding really -- well. the first ca carrier had the first steel cut last week. it was a great privilege to be there and see the exemplar in the ship yards and i have no reason to believe there will be any delay in that program. we have reprofiled that program to align it better with the instruction of the aircraft that are going to fly off the two new carriers. >> can i put it to the secretary of state that with the appointment of the supreme commander in afghanistan under president obama, the americans and british are in fact embarked on a new strategy of which panther's claw is part of that strategy but won't we know in just a few short months whether we are able to win the hearts and minds of the

ordinary afghan and if not won't we have to rethink again what we are doing in afghanistan? >> well, general mcchrystal is involved in an initial review of the situation in afghanistan, a 60-day review. we are and will be completely plugged into that process. we will want to see the findings he has but the -- of course the election process that will follow very soon thereafter is of massive and vital importance and this is a particularly crucial time. the honorable gentleman is absolutely right, for the future of afghanistan and therefore for the future of our involvement in that country. [captioning performed by national captioning institute] [captions copyright national cable satellite corp. 2009] >> president obama today announced a series of measures

to expand community cols. the president spoke at macon community college in warren, michigan are for a half hour. >> hello, michigan! thank you. thank you so much. first of all, give joe a big round of applause for the wonderful instruction. -- introduction. we've got some special guests here tonight. if everybody has chairs, go ahead and use them. feel free. we've got some special guests here today that i just want to acknowledge. all of you are special, but these folks i want to make sure you have a chance to see them. first of all, one of the best governors in the country. please give jennifer granholm a big round of applause. lieutenant governor john cherry.

one of my favorite people, former colleague of mine, still just a fighter on behalf of working families each and every day, senator debby stabenow. you got speaker of the house andy dillon in the house? we've got a lot of other local elected officials and i just want to thank them. a couple of people who are missing, carl levin, who is doing great work. he's in the senate right now fighting on behalf of a bill to make sure that we're not loading up a bunch of necessary defense spending with unnecessary defense spending. he's the point person on it. the only reason he's not here is because he is working alongside the administration to get this bill done.

please give him a big round of applause. >> congressman sandy leveane also working hard on your behalf each and every day, but is not here today. i want to go ahead and acknowledge the new mayor, mayor dave bing. great ball player. my game's a little like dave bing's. exempt i don't have the jump shot or the speed or the ball handling skills. or the endurance. also don't have the afro. don't think i forgot that, dave. i remember. i remember that. i also want to acknowledge that we've got the executive director of the white house council on auto communities and workers who's working hard, has a direct line to me each and

every day, he's traveling constantly back here. ed montgomery. please give ed a big round of applause. and the chairman of the grand traverse band of ottawa and chippewa indian tribes, derrick bailey is here. please give derrick a big round of applause. and finally the president of the college where we are here, jim jacobs. give jim jacobs a big round of applause. and those of you who i have missed, you know how grateful i am that you're here and thank you all. it is wonderful to be back at macomb. it was terrific visiting this campus as a candidate but i have to admit it's even better visiting as a president. this is a place where anyone, anyone with a desire to learn

and to grow, to take their career to a new level or start a new career altogether, has the opportunity to pursue their dream. right here at macomb. this is a place where people of all ages and all backgrounds, even in the face of obstacles, even in the face of very difficult personal challenges, can take a chance on a brighter future for themselves and their families. they're folks like joe who just told us his story. when joe lost his job he decided to take advantage of assistance for displaced workers. he earned his associate's degree here at macomb and with a pretty impressive g.p.a., i might add and with the help of that degree joe found a job working for the henry ford west bloomfield hospital as a maintenance worker using the skills and talent he brought to make a fresh start.

workers like kelly como -- raise your hand. there's kelly right there. kelly is a u.a.w. worger at a ford plant if sterling heights, michigan. . she used to drive a forklift, right? but then she decided to train here at macomb for a job that required new skills. now she's an apprentice pipe fitter. it's a telling example that even as this painful reduction continues in our auto industry, people are seeking out training for new jobs. community colleges are an essential part of our recovery in the present and our prosperity in the future. since this recession began, 20 months ago, 6.5 million americans have lost their jobs. and i don't have to tell you

michigan in particular has been hard-hit. now, i -- you know, the statistics are daunting. the whole country now, the unemployment rate is approaching 10% here in michigan. it's about five points higher, new reports are coming out and we're going to see continuing job loss even as the economy is beginning to stabilize. those aren't abstractions. those are extraordinary hardships, tough times for families and individuals who have worked hard all their lives and have done the right thing all their lives. if you haven't lost a job, chances are you know somebody who has. a family member, a neighbor, a friend, a co-worker. and you know that as difficult as the financial struggle can be, the sense of loss is about

more than just a paycheck because most of us define ourselves by the work we do. that's part of what it means to be an american. we take pride in work. that sense that you're contributing, supporting your family, meeting your responsibilities. people need work, not just for income but because it makes you part of that fabric of the community that's so important. and so when you lose your job and when entire communities are losing thousands of jobs, that's a heavy burden. that's a heavy weight. now, my administration has a job to do as well. that job is to get this economy back on its feet. that's my job. and it's a job i gladly accept.

i love these folks who helped get us in this mess and suddenly say well, this is obama's economy. that's fine, give it to me. my job is to solve problems, not to stand on the sidelines and carp and gripe. so -- so i welcome the job. i want the responsibility. and i know that let's just take an example. many question our efforts to help save g.m. and chrysler from collapse earlier this year. their feeling was these companies were driben to the brink by poor management decisions over a long period of time and like any business they should be held accountable for those decisions. i agreed that they should be held accountable, but i also recognized the historic significance and economic prominence of these companies in communities all across

michigan and all across the country. i thought about the hundreds of thousands of americans whose livelihoods are still connected to the american auto industry and the impact on an already struggling economy, especially right here in michigan. so i said that if chrysler and g.m. were willing to fundamentally restructure their businesses and make the hard choices necessary to become competitive now and in the future it was a process worth supporting. now, today, after a painful period of soul-searching and sacrifice, both g.m. and chrysler have emerged from bankruptcy. remember folks said there was no way they could do it? they've gotten it done already in record time far faster than anybody thought possible. they've got a leaner structure, new management and a viable

vision of how to compete and win in the 21st century. and those sacrifices were shared among all the stakeholders, workers and management, creditors and shareholders, retirees and communities. and together they've made the rebirth of chrisler and g.m. possible. it was the right thing to do. but even with this positive news, the hard truth is that some of the jobs that have been lost in the auto industry and elsewhere won't be coming back. they're the casualties of a changing economy, in some cases just increased productivity in the plants themselves means that some jobs aren't going to return. and that only underscores the importance of generating new businesses and new industries to replace the ones that we've lost. and of preparing our workers to fill the jobs they create. for even before this recession hit we were faced with an economy that was simply not

creating or sustaining enough new well-paying jobs. now is the time to change all that. what we face is far more than a passing crisis. this is a transformative moment. and in this moment we must do what other generations have done. it's not the time to shrink from the challenges we face and put off tough decisions. that's what washington has done for decades and it's exactly why i ran for. to change that mindset. -- ran for president to change that mindset. now ap the time to build a firmer, stronger foundation for growth that will not only withstand future economic storms but that will help us thrive and compete in a global economy. to build that foundation we have to slow the growth of health care costs that are

driving us into debt. we're going to have to do that and there's going to be a major debate over the next three weeks, and don't be fooled by folks trying to scare you saying we can't change the health care system. we have no choice but to change the health care system because right now it's broken for too many americans. we're going to have to make tough choices necessary to bring down deficits. but don't let folks fool you -- the best way to start bringing down deficits is to get control of our health care costs, which is why we need reform. now's the time to create the jobs of the future, by growing industries, including a new, clean energy economy and jennifer granholm has been all on top of this as the governor of michigan. she has been bringing clean

energy jobs right here to michigan and we've got to support her in that effort. i want michigan to build windmills and wind turbines and solar panels and biofuel plants and energy efficient light bulbs and weatherize all the buildings because michigan, you know bad weather. so you can be all on top be weatherizing. you need to weatherize. i know about that in chicago too. but we also have to ensure that we're educating and preparing our people for the new jobs of the 21st century. we've got to prepare our people with the skills they need to compete in this global economy. time and again, when we've placed our bets for the future

on education, we have prospered as a result. by tapping the incredible innovative and general erative -- generative potential of a skilled workforce. that's what happened when president lincoln signed the legislation creating the land grant colleges, which not only transformed education but our entire economy. .

we have begun to take steps to achieve this goal. already we have increased pell grants by $500. we have created a $2,500 tax credit for four years of college tuition we have simplified applications and make sure aid is not based on an income of a dog you just lost. -- of a job that you just lost. it is beginning to help soldiers coming home from i iraq and afghanistan to begin a new life. the recovery plan has helped close state budget shortfalls which put enormous pressure on public universities and community colleges. it makes historic investments in

clusters and facilities all across america. -- in classrooms and facilities all across america. with taken steps of your building the foundation for a 21st education century. it allows to debut china and india and everybody else around the world. today i'm announcing the most significant thing on reaching the goal of having the highest college graduation rate of any nation in the world. we are going to achieve this in the next 10-years. it is called the american graduation initiative. it will reform and strengthen community colleges like this one from coast to coast so they get the resources that students in schools and need and the results workers and businesses demand. we seek to help and additional 5

million americans earn degrees and certificates within the next decade. 5 million. not since the passage of the original g.i. bill and the work of president truman, which held double the number committee college and increased enrollment, have we taken such a historic step on behalf of community colleges in america. we have a paid for this plan. we this is not adding to the deficit. we are paying by ending the wasteful subsidies to provide the banks and private lenders to pursue the loans. that will save tens of billions of dollars over the next 10 does years. instead of lining the pockets of special interest, at this time

the money went to the interest of higher education in america. that is what my administration is committed to doing. i know that for a long time there were politicians that state college as a cure all. it is not. we know that. i cannot tell you how many workers that have been laid off. they ask about training in basic training for what? i & the frustration that a lot of people have, especially if the training is not specified for specific jobs the drought there. we know that in the coming years, a judge requiring an associate degree are estimated to grow twice as fast as jobs requiring no college degree. we will not fill those jobs or even keep those jobs here in america without the training offered by community colleges.

that is why i want to applaud him for the no governor left behind program. it is providing up to two years of free tuition. the rest of the country should learn from the effort. this is train to become a medical technician or a health i t worker or a nurse. 59% of all new nurses come from community colleges. this is training to install solar panels. it is developing a smarter electricity grid. this is the education that more and more americans are using to improve their skills and broaden their horizons. many young people are spending money by spending two years community college by heading to a 4 year college.

more workers that have lost their jobs fear losing their jobs are seeking an end to at schools like this one. community colleges are under increasing pressure of a cap enrollments to cut costs. this is in addition to the challenges they face in the best of challenges. the schools receive far less fundings per student than typical for year colleges. community colleges are an undervalued asset. that is not right or smart. that is why i have asked joe biden is a community college and to cater for more than 16 years to promote community colleges and help us make community colleges strong. that is why we are putting in place this american graduation initiative. let me describe for you the

specifics of what we will do. number one, we will offer competitive grants, is challenging community colleges to perceive innovated strategy's in exchange for federal funding. we will fund programs that connect students looking for jobs with businesses as are looking to hire. we will challenge the schools to find new and better way to help students get on the basis that math and science. -- the basics like math and science. they will match curricula with the need of the world. yser -- these some examples of what is possible. we as seen cisco working with him in the colleges to prepare them for jobs ranging from work in broadband to help i.t. the most successful community colleges are those the partner with the private sector. we want to encourage more companies to work with schools to build these types of relationships, that way when they go through a program they

know there is a job at the end of the training. we will create a new research center with a simple mission, to measure what works and what does not. all too often we do not know what happened on some walks out of a classroom and on to the factory floor or into the library or laboratory or office. businesses often cannot be sure what a degree is really worth. schools themselves not have the facts to make informed the choices about which programs achieve results. this is important not just for businesses, but for students and workers as well. the decree has to mean something. and they have to know that when they get the degree it will help them advance their goals.

if there was to train for a home a profession, it means that they need to be ready and the businesses are ready to hire pre . we want to promote funding for completion of programs. more than half of all students to enter committee colleges to earn an associate degree are transferred to a four year school to earn a bachelor's degree to help them reach their goals. that is not just wasteful, it is its strategy -- tragic for the students. they have often taken of debt. it is a disaster for our economy. programs that track student progress inside and out of the cluster as well weenie. but pumaybe it becomes too difft

for parents to be away from home. maybe it is too expensive for a waiter to miss a shift. maybe a young student is not sure if her education will lead to employment. we need to figure out solutions for these and the challenges. facing these impediments should not prevent you from reaching your potential. that is a big chunk of this first part of this. the second part -- we will back $10 billion in loans to renovate and rebuild college classrooms and buildings all across the country. all too often community colleges are treated like the step tired -- like a stepchild of education systems.

schools are often years behind the facilities. that is a mistake. it is one that we will help correct. through this fund, schools will have the chance to borrow at a more affordable rates to modernize facilities and they will be building on the recovery plan that is already helping to renovate plans, including community colleges all across the country. not only does this improve the schools and the training that is provided, guess what? you also have to hire workers to do the work on those schools. that means we are putting to people to work in michigan right here right now. number three, even as the repair of bricks and mortar, we have an opportunity to build a new virtual and a structure to complement community colleges. we are good to support the creation of a new online open

source clearing house of courses. community colleges and offer more classes without building more classrooms. this will make a big difference, especially for rural campuses. they had struggled to attract senses -- students and faculty. and will make it possible for professors to complement his lecture with an on-line exercise of first union and of the way from her family still keep up with her coursework. we do not know where i will be, but we want to try. there is the possibility that on an education can provide, especially for people who are already in the work force, the chance to upgrade their skills without having to quit their job. let me say this. the road to recovery and

prosperity is going to be hard. it was never going to be -- when i was sworn in, we are seeing 700 jobs lost that month. then we had the same amount lost for two more six -- 42 for 2 more consecutive months. we will get to the job -- part 4 reaction creating jobs. this will take time. -- where we are actually creating jobs. this will take time. there will be setbacks. i am confident that we will meet these challenges. that is what we have always done. that is what america does. we do about the business of solving our problems. that is what we see on display right here. that is what i have seen a colleges and universities all across this country.

at every juncture in our history, when we have been challenged, we have been resilient and industrious and we have a can do american spirit that has allowed us to 60. that is what we can and must do. we must leave something better behind, two foundation on which our children and grandchildren can prosper and take responsibility for their future. just as the students of this cooler taking responsibility for theirs. i am absolutely confident that if i have your help the we can make it happen. we are going to see a stronger, more prosperous michigan in the years to come. thank you very much. god bless you. god bless the united states of america. ♪

[captioning performed by national captioning institute] [captions copyright national cable satellite corp. 2009] >> up next, the senate health committee works on a comprehensive health-care bill. house democrat introduced their health care legislation. vader, the confirmation hearings for sonia sotomayor war. -- sonia sotomayor.

>> we will talk about federal bailout for financial-services companies. then a supporter of sonia sotomayor's nomination, wade henderson. senate judiciary committee charles grassley will discuss sonia sotomayor's confirmation hearing. this begins a 7:00 a.m. eastern on c-span. >> this weekend, the nation's governors take on critical issues facing their states. live coverage of the governor summer meeting, saturday, sunday, and monday on c-span. >> the senate health committee held its 12 legislative market session on a comprehensive health-care bill. this three hour portion begins with senator tom harkin who is sitting in as chairman.

>> the senate committee will come to order. our chairman, senator dodd, has to chair a banking committee and until 10:30. i guess we do have a quorum of eight. we are ready to proceed. did we have a pending amendment? but i do not think so. >> know, we do not have a pending mmm. we are open for business. >> i haven't an amendment. the first, i would like to ask. i am% from last night's

activities that a chairman and you intend to complete our work today. is that correct? >> in my conversations with senator dodd, he wanted to go through the day and see we could finish. but i wonder if we had the cost estimates from cbo for the amendments that we have adopted. >> we do not. i am told we do not. that is a very simple answer. >> i would hope that we would try to achieve that goal before we vot4e final passage. >> that is fair enough. anyway, the defense build on the floor. maybe in this amendment that i have a we will take more time than that.

and maybe i could schedule a time later on today to try to have this amendment up. it is on malpractice. thank the chairmen for the courtesy. what i interest in the concern, but on the issue of cbo scores, i asked to find out how many times to get passed a bill without a ceo score and it is quite lengthy -- cbo score and it is quite lengthy. in the hundred and ninth congress, 2006, the cbo score was released may 3. that was on the modernization and portability act. whenever had a cbo -- we never

had a cbo score on that. no child left behind marked up on march 7 reported without cbo score. 952, the public safety corporation act of 2001, cbo score released september 24. it goes on and on and on. >> by thank you, but those are interesting -- those bills and no comparison to what we are considering here. none whatsoever. the chairmen knows that full well. if you want to go ahead, you have the votes, to pass disavows

having it, fine. you have the votes. you can do it. let's not in the past three passed bills that are minor in comparison to the cost of this gargantuan effort that there is any comparison between those situations. if you want to go ahead and have the final vote, i guess you can. i do not think it makes for a fair deal for the taxpayers. the budget deficit already is $1.10 trillion. we are talking about $1 trillion cost of this legislation. i guess we will try to take our case to the american people, that this kind of way of doing business is not fair to them, because they are the ones who are paying for this. i would strenuously object final passage of this bill until we know what the cost is. i do not think that is really a

big demand. i didn't think my constituents in arizona feel so either. but the debate is just how much something costs and whether we need a cbo score. it had pet bills in the past at all cost money. -- we have passed bills that all cost money. it is a matter of how much money is. i did not know what the cutoff point is right now. the cbo will score the bill. before i go to the floor we will definitely have a score for this bill. >> the senator from arizona may have objected had he been on the committee at the time.

there is a huge difference in the range of cost we are talking about. we've covered a lot of different amendments. i do not know the we know where we stand on this. >> we do have scores on the covers title -- everything but the follow on biologics. >> i understand we have an amendment that is already been adopted. the murray amendment passewill probably be adopted. i think i have made my point. did not want to hold of the proceedings. i thank you. >> could i comment?

>> just on the operations of the cbo, i found conversation interesting. what i found in likening was when they talk about just the physical and mechanical difficulties of doing this scoring. i think with the senator from arizona what is reasonable, rational, and required will me go to the floor. the cbo is not like a group of people sitting in a room with a super computer with a well established methodology before arriving at this that they just turned out. to think that they can do this amendment by amendment is really based on their own conversations to us, and reasonable. they are working seven days a

week to try to give us the kind of rational analysis that senator mccain and i would both like to have. they talk about it at both the physical, mathematical, and technological limits of their ability to function. they are also not only getting their requests, there began to request from the finance committee. they are also getting requests from the house. is that right? >> yes, i can personally attest that it e-mails from them all around the clock. they are working about as hard as human beings can work. >> i hope that the in began after learned we need to upgrade them technologically. as we go to the floor, there has to be an analysis. i would hope that even both committees to come together for discussion and someone to see

the consequences of what we have done, which has in the adjustments that are required. the chairmen will pass out our bill to the finance committee. there has to be treaty negotiations windows would to give the finance committee and cbo the opportunity to truly give us totality of what we have done. am i correct? >> that is absolutely correct. >> we just need to have reasonable expectations of their ability to function in a way that continues to give that a very responsible information that we still rely on. thank you. >> senator mikulski made the idea that i was going to make. the important thing is what cbo's if you is of the combined product from the two committees before we go to the floor.

i believe that is the key issue. we will just have to see what each committee reports and then see what the leadership and the leadership of the two committees can agree upon by way of combined bill. >> senator enzi. >> i'm sorry. >> thank you. i have an amendment this morning. this is numbers 215. >> rakowski to 15. >> the legislation that we have allows of the secretary to enter negotiations that limits the rate for the public plan to no higher than the average rates paid by private insurance --

ensures within the plan. if we are to remove this paragraph and require that the rate be on par with the private insurers in each metropolitan area, it will usher at a minimum what you have is a floor embarrassment that will not be left to the private insurers. -- is a floor minimum of one of the lead to the private insurers. it can be at medicare rates set significantly less in what the private insurer rates are. to ensure access to care for these patients, a government raid need to be negotiated with providers and on par with the private insurance rates within a metropolitan area. what we currently have is a mechanism that says the price ceiling, so you cannot see the average private rate. we do not have a price floor.

the reality is that as it is drafted, it will allow the government to reimburse at the lowest rate, which likely will, without regard to what the private insurer is paying for the medicare is paying 20% less than private insurers on average. under this language, they can set the rate to be a medicare or medicaid rates. you have a situation where you are telling the medical providers what the rate of reimbursement will be. we are not saying exactly what your rate will be, what we are doing is giving the authority to the secretary. if you go back to the cbo letter that we all read, it provides the provisions regarding a public plan did not have a substantial effect on cost at that because the public plan would pay providers rates comparable to privately

negotiated rates and thus would not project premiums lower. unless we pay less than the private rate, there will not be in the savings. it is important that we ensure that the secretary not set the rate so low that providers will not participate in the government's plan. i think we've all had discussions about what is happening with this bill, fast tracking the health care bill would affect the entire country, 17% of the economy. within this provision, we are not spelling out to the medical providers what their rate of reimbursement will be. i have talked on just about every issue and i come back to whether not reach really provide for access to individuals, particularly with medicare.

i've spoken about the challenges that medicare enrollees in alaska face. i have a map. you all have received a copy of it on the table. what did speaks to is that this is not just an alaska problem when we are talking about access to care for medical -- medicare enrollees. this is a steady for machen 2006. you have alaska. you have nevada, oregon, new mexico, who are really very compromise in terms of their ability to access to primary care providers. it is not just those five. if you have washington state, oklahoma, and california has significantly reduced access to medicare providers. we need to be very cautious as

we look at those policies that would hold back even further on access to medicare providers. we are creating a new government insurance program with the rates better very likely to be set below the government rates and our cbo report provides that the government program will not pay anything unless we reduce the reimbursement rate for medical services to less than private health insurance reimbursement. probably for those that are seeking specialty care, and those medicare recipients are being taken care of. they are fine. when they need preventive care. when they cannot get the screenings that they need, the examinations, because they cannot have access because there are no providers available, this is a problem.

if we are really seeking to reduce our costs, which i think we all are, we need to ensure their primary care services are increased and truly more readily available. the concerns i have expressed earlier, that we have a proposal here where we are bringing the inadequacies of the current medicare program with regard to primary care, bringing those into a government-run program. what my amendment does is requires that the rate to be on par with the private insurance to make sure at a minimum there is a rate floor and that the reimbursement will not be less than a primary insurers. the secretary must work with rural and frontier provided to ensure that their part of the government provider's network in these areas. this is to ensure, when we are talking up the issues in rural

america, the rural communities are not left out when secretary is looking to establish these rate for providers and the communities. i think the amendment is one that makes sense. as the last is severely limited when it comes to access the alas that is severely limited when it comes to access. -- alaska is severely limited when it comes to access. so are other parts of the country. >> let me give my initial reaction to the mmm. i think there are two separate amendments in here. subsection a is 1 and section b is another. subsection b i agree with and support. i think we should adopt it. i would be glad to support that part of senator mikulskowski

s mmm. 's amendment. i do not support section eight. it would get rid of one of the things we are trying to accomplish. that is to provide some real competition i have passed out -- this is a chart that shows the market share of the two largest health plans by state, 2006. you can see in alaska 80%-100% of all the market is controlled by the two largest health care plans. in my state, it is a 50%-69%. in alabama, it is also 80%-100%. you can just look at the map

there and see what the extent of the concentration is. my support for a public auction -- option is premised on the idea that people should have choices, particularly in states where are their -- where there are just a couple of the health plans that dominate the market. i do not want the secretary to negotiate the reimbursement rates the way the bill now reads. as i understand it, the reimbursement rates will be what every the secretary is able to negotiate with the health care providers. is that accurate? >> that is correct on page 80 of the underlying bill. >> just as each health plan goes to the health providers and negotiates for the cost of

different health services, the secretary will do the same and it is my view that if the secretary is able to negotiate a lower reimbursement rates in some areas because of lack of competition, lack of real competition, by health care companies, then so much the better for people who are having to pay for the premiums. i would not support a, but i would support b. that is my view on it. >> it is a chinese menu, because there are two separate and immense as i see it. -- amendments as i see. there are two different policies. paragraphs b, the reimbursement

rates should not be lured to urban providers -- that not prohibit providers. i strongly agree with that. i would now on the secretary to set reimbursement rates at such a level that providers would say, we are not going to participate in providing services to a public option in our area. that'll be contrary to the whole purpose. >> mr. chairman? i think one of the reasons for the paragraph a is the we as seen some other charts that had seen what the variations are around the country in prices. some of the ones -- it is primarily the large metropolitan areas that have the large cost. if it is set on an average, and the people in the really populous areas may not be able

to give medical care. what you are arguing against paragraph a? >> no, i am arguing for paragraph a, because it goes by area rather than -- >> it says it will set reimbursement rates based on average rates paid by health insurance issuers. i do not know the -- >> you less of the important part -- for each metropolitan area zapped >> there are statistical areas in the country where i think health insurance issuers are probably paying too much to providers. i do not know that, but i am not willing to say that the secretary has to be bound by an what the two largest health plans have agreed their reimbursement rates to be. they may be the right to read.

and they may be the wrong rates. i think the secretary should be able to negotiate rates like they negotiate for wreaths. >> the whole amendment is pointing out that it is not going to do is any good to have all kinds of health care reform city cannot get to a doctor. we talked a lot about the need for primary-care doctors. you have to have those. if we utilize those better we know that it can reduce costs. if you want to to really reduce costs, we have to repair the -- the primary care services have to be more readily available. the bill we are working from has inaccuracies that stifle the primary care market. i think that her amendment requires the rate to be on par with private insurers in each metropolitan area to ensure at a

minimum there is a rate floor. there are other ways, through transparency, that we can bring those rates down for everybody. the jets think the best way to do it is by eliminating the doctors in these areas. -- i do not think the best way to do this is by eliminating the doctors in this area. i think she has gone in a way that will assure that we can still have doctors. there are other ways that we can get that the variations of unusual costs in some of the areas. i have one area in my own. when i checked into, there is a place called musk, that has 1600 people. they have a first aid station. it is a hospital. there is a physician's assistant

there. virtually everybody that comes in gets shipped out. that is unless it is something minor. when they ship them out, they ship them out to a specialist. they have to go along way to get care. that dries up the cause. that was a major problem in our area. if we had more doctors, then we would not have quite that same problem. i appreciate the way she is going about to try to make sure the government plan is not one to drive away doctors. >> mr. chairman? it is my understanding that the community health insurance option would set its provider payments by negotiation and locally, state-by-state. in rhode island, the single statewide rate -- in larger states there may be larger areas, there is nothing in the

community health insurance option that would prevent those subcategories from being part of the negotiations by the secretary of the rapes that providers would be paid. -- by the rates that providers would be paid. there is flexibility already in the option. i do not seeing part a as adding anything here in terms of flexibility. what it does is drive the provider rates up to where the average, and that i am afraid will take away one of the best opportunities that the community health insurance option has,

which is try to change the business model of health insurance, to try to drive provider payments down, not necessarily in ways compromises providers, but to do things like limit the cost that the health insurance option is putting on providers. as we have already discussed, 12 to 27% of insurance costs is the administrative overhead. a great deal that overhead is dedicated to what a provider would call fermenting the providers over authorization. i told this story were more than 50% of personnel is dedicated to fighting with the providers overpayments and authorizations plus a three and a thousand dollar payment to consultants a year. -- $300,000 payment to consultants each year. it is a huge cost. they are able to find a better

way to deal with providers and decreed that race over claims denial and payment that is running such huge costs into the system. i think the lewman group said it is 30% of the average provider. it is a big number. it is an important target as we are trying to reduce costs. if you forbid the community health insurance option to good providers and say we can work with you in different ways, we can be more efficient, we can make you be more efficient -- the result is going to be the we can negotiate a lower price. you will more than make up for it would not fighting with us and hiring the $300,000 consultants. that should be an open door for the secretary to pursue. i am afraid this amendment slams the door. it is an import one for us to walk through. >> question for council. it is medicare and negotiate prices? >> medicare has a different

structure. it is much more such a terribly priced and applied here. >> does medicating good share prices? >> -- medicaid negotiate prices? >> it is a different set of structures. i'm not sure what the comparison is. i am sorry. >> the answer would be "no" on both of those. >> much less so than this market-based kind of structure negotiation. >> we are talking about it being a more statuary structure. we have no real indication that it will be. i am mentioning to government plans that exist right now. we use price controls. we set the prices. we do not negotiate. that is what government will do. i think there is every indication that that is what the government will do. cbo said this government plan

does not lower the costs. it does not lower the costs. that is unless you use price controls. unless we all the model and medicare and medicaid, we do not drive the costs down. we eliminate doctors. this amendment is to make sure we do not eliminate doctors. we have the baby boomers coming up. without doctors, they will not be there. i appreciate the amendment. >> it is all too -- good to be talking about the negotiation aspect of it, but at the ended the day, senator enzi is right. if you have senator -- the providers that can afford to keep their doors open, if i continue to take medicare enrollees and have to be a part

of a government run plan that says that this is what my reimbursement will be and that reimbursements goes solo to be as low as medicare or even lower --i had a sit-down with a dozen providers about a month ago. we were talking about some of the details at the time of this plan. i asked, if we were to pass legislation that says that in order to be part of -- providing medicare for medicare enrollees your reimbursement will be medicare plus 10%. what would that do to you?

every single one of them said i would have to drop my medicare eligible patients. i cannot afford to keep my doors open. i could not afford to take these individuals. we have already cut a crisis in alaska. i think you have a crisis and some of your other rural communities as well. this is all about access to providers. if we said the rate so low that the providers say i am moving on, i am not taking these individuals, we have not provided them anything other than a card that says you are eligible for care at their this government-run plan. we have not provided them care or access to providers. what we are doing here is we are saying there is a minimum floor. you know it cannot go any lower than this.

i think that is reasonable. >> i just want to say that she makes a good point. as i listen to senator lindsey talk, i thought about three issues of i have been involved with and the last 12 months with reimbursement for durable medical equipment. there has been no negotiations. there is been a said changing the way they are reimbursed. it is not in negotiation system. you can drive prices down to something that looks great and meet the demands, but nobody's pointed deliver the health care or is going to be poor quality, you are hurting folks. i think the senator makes a very good point. i am not from a state is nearly as rural as wyoming or as alaska, but i believe she is right on target. >> i just was going to point out

this language on page 77. it is the first serigraph in the section dealing with this community health insurance option, saying no requirement for health providers to protest pay. nothing shall be construed to require health care providers to participate in a community health insurance option or to oppose any penalty. the next sentence says nothing in this section shall be construed to require individuals to participate in a community health insurance option. this will be a dead letter if the secretary set reimbursement rates so low that providers decide not to participate. nobody is going to participate if providers to not participate, then individuals and not

participate either. as i say, i have no problem with saying that the secretary in setting reimbursement rates shall in short that providers -- ensure that providers are incented to participate. to say that the secretary has got to set the rate at what the private plans and that area have already determined it takes away the competition that we are trying to encourage your by establishing this community health insurance option. >> senator gregg? >> i think the language of this bill makes it fairly clear and that if the secretary has the authority to set rates lower

than what the market is sending the matter, that the purpose is to take market share by reducing the costs of the premium to people to participate in forces people to use that system. this is clearly in -- the only purpose is clearly price control. the result is obviously that to force out of the system of the private insurer and you end up with a system of single payers. i do not understand why there is such resistance to imaging the purpose of this bill. i do not understand why there is such resistance to admitting the

fundamental purpose of this bill. that is to put this on the track to a single payer system. it has been admitted that there are a number of folks who support the single payer system. the way this bill is drafted and power secretary to create a series of scenarios i just do not understand this hide and seek exercise that has been going on. why play this game? what the senator from alaska has suggested is that a government plan will not be used for the purposes of perverting the marketplace using the authority of the government. she is saying that if we are going to have a government plan, and the purpose is to knock to create a market place, then the government has to compete on a

level playing field. what the bill says if the government does not have to compete on a level playing field. the secretary has the authority to set rates. there is only one purpose for that. that is to give the government a disproportionate advantage incapacity to drive the market place -- drive the market place out of private insurance. when he put this language in -- you should either put this language in our stamp on the front of this plan of a " single payer \." >> i would urge my colleagues to read the language that we are talking about before leaving -- leaping to the conclusion that this gears toward a single payer. senator bingaman just described

imported as to the language that says "no provider will be forced to participate." on page 80, we say "the secretary shall negotiate rates for the reimbursement of health care providers." there is no authority for the secretary to set rates. that is just imaginary. the authority that the secretary has under this program is to negotiate rates and the providers are -- >> why this is a higher and lower? >> excuse me. i did not interrupt you. if i could finish my sentence, i would appreciate it. the providers are free to completely produce for dissipation. there is a very strong market pressure for the secretary to negotiate in good faith.

the second point i would make is that half of the state in this country, including many of the state of our republican members of this committee, have health care that is delivered through a public plan in their states in the workers' compensation system. it is the only way in which health care is delivered and what you mean. -- in wyoming. the action had a single payer option. nobody is printed about that. that is not what we are arguing. we are saying it cannot participate side by saide. arizona is one state -- there is a worker's compensation plan that provides health insurance for the minor injuries, the chronic injuries, the catastrophic injuries, that

workers sustained. those markets continue. some of them have gone on for 60-70 years. the notion that the instant that a state government gets involved with a health care program in the media collapses into a single payer program is belied by the practical experience in a number of states that are members actually represent. between the clear language of the statute and the clear practice of private and public plans competing side-by-side, i just think this is a red herring of an argument. i know it is everybody's favorite whipping boy to single- b-1 to the national health insurance, but that was taken away by president obama and the other candidates with the altogether said the first

promise on health care is that if you like what you got keeping keep it. that was the end of national health insurance. to fight that battle now seems to be totally at odds with what we are really talking about here. if we want to talk about that, it is fine. it does not really make sense in context of the statute as written and produced. -- and proposed. >> i think senator white house has made a very compelling argument, clearly pointing out that the secretary only has the authority to negotiate and the negotiation we be based upon the market power of this particular option. if you look at the current arrangement in state of market power, it is not small companies. since then -- senator