plan documents that we do not even have a price tag on before we vote on them, they are becoming more and more concerned, so thank you very, very much for participating. i yield back. >> well, thank you, mr. chairman, and i want to thank you for being here and your comments. my concern is, obviously, how chilling the testimony was, mr. baker, the waiting lists and the affect on people, and my question is really about the kind of innovation that is necessary to continue to deliver the highest quality care to patients, and if the doctor is still listening, i would like to hear his comments. i would like to hear your comment, as well. how do you see in the u.k., and then maybe we will go to mr. baker in canada, the ability to use new procedures to try new

therapy? , obviously, those are often more expensive, because they are new, and they are untested. . untested, how do you see a national plan affecting the ability of physicians to be able to try these new treatment techniques, use the higher cost, particularly with regard to cancer and comparing the survival rates of cancer between the u.k. and u.s.? if you can comment please. >> sure, very good comparisons of drug use across european countries that were published countries that were published just in january of this year. it's very clear that because of the way in which we whether a drug will be available through a cancer treatment through nice, the rationing organization in a way, we're falling way behind over the last three years. and that means that over time cancer survival, which is

already low in britain will drop considerably compared to the rest of europe. i think that the real issue is how you can get things moving. and i think that doctors, my generation of doctors have had the have felt the control over the destiny of patients and indeed their own destiny has gone down as the system has got far more concern with looking in the costs trying to rationalize costs and make comparisons, that's one of problems. it's individual freedom and that causes a lot of concern. the other problem you end up with and certainly i can see you have it in canada, regional variations, one patient may go down a refer path that allows access to certain drugs and expensive treatments, on the other side of the street it may go down a different route and not get them. that's really a problem. the problem with government

systems, i think, the lack of any incentive to move forward and embrace innovation, one thing your country has really done in self-technology. >> thank you, mr. baker, your comment on not only being able to get treatment but the quality of treatment with using the ability of innovation to find new ways to cure disease. >> i'll tell you a story i found chilling, i got a call from a gentleman in newfoundland. his father has a blood condition. he really needs bone marrow transplant. this is impossible in new foundland. but this is what would save his life. alternatively, having weekly blood transfusions and doing this going on a year. the doctors recently told his son, you know, we're going to have to stop these transfusions.

he said wouldn't my father die. yes he ultimately will. we can't give him transfusions forever and we don't have the money for him to pay the jurisdiction go to boston, for instance. the system in canada, will happen here too, the people that deliver health care become hardened and immune to these sympathetic stories that normally you and i would feel so sorry for people, they are hardened to it and learned to tell people, no, it's not available. you cannot have it. move onto the next person. and i haven't been able to do that in my own business but unfortunately i haven't had to because i have access to the u.s. >> i was surprised to find out the medicine that's might be available to you depend on your zip code, where you live? do you understand that? >> each province has their own

budget, they are their own taxes that contribute to these budgets. if the budget is gone and there's no more money, the only way is to cut off access to more expensive procedures. >> mrs. brown? >> dr. sykora, just last year i lost my husband to pancreatic cancer so i became very much involved in cancer treatment. and how -- i know you have an independent cancer facility. how many cancer facilities are there in great britain? >> sure, all together there are 61 cancer centers in the u.k. all of them within the nhs. we're just creating a private, an independent system now and providing radio therapy and chemotherapy. what's been happening in the nhs, as i've said in my

statement, the conservative generation a decade ago wanted to get competition between the independent sector and nhs and labor the same. they really pushed through under tony blair a very competitive way ford, which is resisted by other politicians to drive value out of the service. now it's sort of half and half and i suspect that whatever happens in our next will determine whether we get choice in competition or whether we have more of the same. and i think it's very difficult, the british public love the nhs and have a lot of -- does deliver to many very good care. the difficulty is it finds it difficult to embrace innovation and cancer, sadly pancreatic cancer, there's not been new over the last decade. the speediness of getting the diagnosis, the speediness of which you start treatment really

ee lays the psychological problems, you know what's going to happen. we have delays in diagnosis because of lack of imaging capacity. >> let me ask you a follow-up question, doctor, there was a study that was done in brussels and i brought this to the attention of an on kol gift. and if a patient comes to you having discovered a formulary that works that has been proven through clinical trials, if you were in the nhs, would you be free to use this system, this protocol? >> not unless nice approved it. or i can get special exemption from the primary care trust, the payers of care.

canada a smaller country, obviously, we have 152 pcts that make decisions. obviously they are going to come to different decisions and that's the basis of zip code prescribing over there i guess. and it's one of things that causes such heart ache amongst cancer patients and their families because they can't understand why the doctor, can i have this? it could help but they won't pay for it. >> how long would it take for nice to approve a new protocol? >> up to three years. available to private patients and private medical insurers which cover 15% of the population, pay in a very good about paying, n.i.c.e. takes a long time. if you long at the drug analyses they've done for cancer or others, it's thorough but time

consumer. they seem pretty mean a lot of the times. my view is they seem mean but it's a matter of how you prioritize, on behalf of individual patients. >> doctor, as you know being an oncologist for three years, many times cancer means a death sentence. i don't think anyone wants that for americans or their family or loved ones. that's not what american health system should be all about. thank you for participating. >> mr. baker. >> my question is for dr.

sikora, i have a daughter and family that live in london, lived there 11 years and love it. and i asked her a couple of questions about the health care system there and i would like to ask if you have the -- any information on this. number one, she gave me a website that cancer post code lottery and explained the fact that in a zip code they run out of cancer drugs, even though they might have it three blocks away in another zip code, the people that live there cannot get access to those drugs. is that true? >> it's not quite they run out. it's because there are 152 primary care trusts that are independent decision makers. the certain drugs that have not been approved centrally, it's up to each individual pct whether they'll approve it. whether they approve or not may depend whether they have the money and budget at the time of

the year and whether they would rather support cancer than some other aspect. that's the problem in the system. >> i was speaking more of the allocation rather than what they had -- >> exactly. >> then we see, that, for example, breast cancer, the rate of cure is about in the 60% versus what we have a much higher rate here in the united states. >> doctor is that your impression? >> our numbers would indicate, if you have early detention of cancer in the united states -- >> absolutely. >> do you have any percentages on that. >> the early detention of cancer is greater in the u.s. than europe. i think that one of good things about government-run service, it can do prevention screening programs very well. our breast screening program is a population based screening program based on call and recall. and it covers 90% of the

population to come forward for that. that's been a tremendous achievement that can only be done i guess in a government service. but governments are great at prevention and education and screening, not great at delivery of care, that would be my observation. >> then there was another question that the expectation of getting these drugs, experimental drugs in particular with cancer, if a patient decid they want to have -- go to a private doctor in the uk, they can get access to these experimental drugs. they pay for them and they cannot go back into the public sector to get just the regular drugs. is that true? >> right. that's changed slightly. last year, there was a review on what are called top up payments. exactly that. you have the regular drugs from the government nhs and then you

pay privately so have what are called the top up drugs and that's been approved. our government did a u-turn during the autumn of last year and agreed that would be the case because there was a lot of an outcry that the people that want to top up their drugs, they pay for their taxes for their nhs. why not let them top up? the public didn't object. it was the idol gists mainly to the left of center that objected to this inequity. >> i think that was a good idea. probably that shows the power of objecting to things like that. >> exactly. >> and then just to other one is that with having to go to the private doctors, but my daughter said you can go to the public sector. you can get an appointment if you say have a rash on your arm. go to the doctor and they say, yes, you need to see a specialist. you can get that first appointment right away but 18 months when you can get the appointment with the dermatologist. >> right.

there are huge delays. the cancer they have been corrected but the trouble is you have to know -- you have to know you have cancer, a breast lump she will be seen and treatment started in two to three weeks but unfortunately the many illnesses, you know, dermatology getting a routine appointment as you say can take up to a year. and if that's the case, it is a melanoma, then you are going to delay a cancer diagnosis. >> and also access to a wait list on the website so i went on that and it was like for a hip replacement was a year. for a knee replacement, it was ten months. for a slip disk was five months. >> i think -- >> there must have been a lot of hits on it because it's been taken off the website. >> the wait lists have been addressed. there have been a -- on the wait list, the target is8 weeks and i saw the data yesterday, 90% of the population waiting for a surgical operation get treated

within 18 weeks. i think you are right. we are impatient people. we also want to be -- we are used to our health care system. thank you very much. >> i got help. you know, we are here today because our goal is to get every american in this country access to health care. not help insurance is created equal. based on what we have heard today, held insurance does not equal access to health care. the bill before the house create a government-run health care plan that said the show will force over 100 million people into from their current health

coverage based on the testimony of our witnesses. i believe it is critical that we talk about what kind of coverage. testimony of our witnesses, i believe it's critical we talk about what kind of coverage the democrats in this congress are deciding's good enough. i think we would be disserviced to the american people if we just talk about getting more health insurance without discussing what type of insurance we're going to be forcing them into. miss holmes, i appreciate you coming here today to share your experience with the canadian health care system and you state over 5 million people in ontario don't have access to a family doctor. i got two questions for you. one, is the family doctor a fading breed up there? one. and two, i've heard town lotteries give the lottery winner access to a physician. is that true? and tell me why it's so hard for people to get access to a doc.

>> it is actually 5 million people in all of canada. 18,000 in the province of ontario so each province has different shortages of family doctors. family doctors are your gateway to any specialist, any testing. you cannot get anything without that family doctor. and so people -- and this is why, you know, people will say that, you know, patients are overusing or misusing the emergency room but if you go into a walk-in clinic or something like that, you can't often get referrals to where you need to go and why they're in emergency rooms. >> well, if they go to the emergency room, does that give them access to a specialist? >> if they'll see you. no, not necessarily. they'll treat whatever the instance thing is or sit there for 12, 15 hours because, of course, it is triage and rightly so it should be. so, you know, there is a patient responsibility not to misuse the

emergency rooms but unfortunately these people have no choice and so that, you know, and definitely we do have lotteries run in -- and we also now have a system where family doctors come in and interview you. and you have to go in for an interview and they can decide whether or not they want you as a patient. there was a very upsetting article in my opinion done in a magazine in toronto by a doctor. and he laid out how to be a really good patient. and to get accepted by a family doctor and the number one thing was to be nice. and quite often, you know, tell your friends. like, oh, can you see my friend? he is really nice. quite often when you're sick, you are not the nicest person if you're on a wait list. i always try to credit myself that i have been nice so, however, i thought that was very, very sad. the other thing is there are shortages within them that, you

know, you may only get a physical once every two years and when you go in to get that physical, you have to decide if you're going to have a top half done or the bottom half done because you can't do both. so when you walk through that door, you know, you're really trying to get the most out of that thing. a lot of doctors will say, one complaint per visit because they only get paid for that one visit so you can't say, well, i have a headache and i got an ear ache and -- you have to be very, very specific or else make another appointment. so -- and the other thing that's happening, too, is if you can't see your family doctor, if you're one of the fortunate one that is have a family doctor and something happens after hours or you can't make a daytime appointment, can't get in or too long to see them, if you go to a clinic and you go -- some doctors make it as much as three times. some doctors make you seen a piece of paper that you just go once. they can drop you as a patient.

so you have a contract with them. >> top half or lower half? >> yeah, yeah. i know. it is -- you know, i feel terrible because i have the most wonderful family doctor and that's been the hardest thing for me. and this whole thing about me speaking out has put a tremendous pressure between myself and her because everybody will lay blame on who did the right thing, who didn't do the wrong thing. you know? and it has been considered that the backlash that i'm getting from the canadians about being here speaking out is that i'm an embarrassment and i am anti-canadian. and i think that it's so sad because i think canadians should be embarrassed that i have to be here talking. i think even if one person from parliament, from o-hip, from any place of position, the doctors that let me down and apology from one of them would go a long, long way.

>> you know, we are having trouble getting family docs in this country, too. dr. sikora, as a health care provider in the national health service for 37 years, i know what you think about health reform. i have heard many tostories of england. as a matter of fact, when i was stationed there in the air force, my son got sick and we walked in to a waiting room with twice the number of people that are in this room and i walked up to the counter and they said, are you paying? i said, yes. come right in. i saw the doctor and i wonder how many docs are taking advantage of private pay over there. is it still an option? and yet, you know, even with the private option available, it seems like the statistics show that cancer's worse over there than it is here. can you discuss that? >> right. yeah, no. i think that the nhs has separate system to the private

system on the whole. but there are private facilities in some hospitals, private rooms and so on. but on the whole, the private system is kept separate from the nhs and the doctors work in both. they spend maybe three days a week in the nhs and two days a week in the private sector and that was allowed from the very beginning of the nhs from 1948. i think the problem now is that technology's moved on. we work in teams. it is not just a lone doctor doing things. treating cancer, whole team of people. if you're doing hip replacement, again, it is a team including rehabilitation, occupational therapy and so on so that cost means that you have to rigidly divide the private and the public systems. but i think the problem governments have is this inability, government-run systems have the inability to meet innovation. to head on. because all the time you're fire fighting to try to keep up with

the targets you're being sent by the waiting time targets, going up and trying to sort of fight those. at the same time, you have new technology coming at you and the managers some of whom are very capable in the nhs spend their time doing the here and now are not looking at the strategic development of the service because of the pressures on the media sy and that's a big problem. >> mr. shaddock? >> can you hear me now? thank you for holding this hearing. i think it is tragic. i serve on the energy and commerce committee and we have not heard testimony anything like this in that committee and it is important for the american people to hear the facts brought out at this hearing and understand them before we make, quite frankly, drastic, shocking changes to the current system and i want to thank the witnesses. you are doing a great service. i think a service not only for the united states and for the american people who need to know this information but for those

of you who are not americans, dr. sikora in england and the two of you here who are canadians, you may be being criticized back home but we can improve all the systems. the canadian system is looking at improvement and your testimony here is vitally important. ms. holmes, i particularly want to thank you for coming -- my friend from minnesota won't appreciate this. i want to thank you for coming the clinic here in arizona. the mayo clinic in arizona. i have gone out there and talked with the doctors at arizona. i do represent phoenix and they were deeply concerned about this level of reform and as you know the clinic spoken out and said this -- while the american system needs reform, this is not the reform we need. i want to ask you. your personal experience dplon straited both the failure of diagnosis under a state-run program and getting the services you need, as well. >> that's right.

what happened to me and this is why i feel my particular case is so genuine because i took three stabs at the system for the same problem. so what i did was i couldn't get diagnosed so i department know what i had. i knew i had symptoms and i was fortunate because quite often when you have a tumor inside you, you don't know what's going on. i was fortunate there was very obviously physical things that had started to change with me and the most obvious was my eyesight. and so when i traveled down to the u.s., it was boom, i got a -- all the diagnosis. the thing i found so remarkable about the mayo clinic and i have -- i cannot say enough about the treatment that they give. was that the cooperation that they were prepared to work hand in hand with canada. the amount that they were prepared to go in order to send me home for treatment. and to stick their necks out to

try to get me help back at home. i came home. i had that diagnosis and it was -- i think more to their shock than anybody else that i was back on their doors three weeks later saying we need to do this. let's go. they never, ever looked at my bank account. they never said that, you know, i'm -- can you afford this? like do a credit check. absolutely nothing. >> thank you. >> and i think that's important. >> i really appreciate it. miss kerrigan, quick question. i assume you're an advocate and have been for many years and read substantial portions of the house bill. i was shocked last night. the president said a number of things in his remarks. i don't think he addressed the real concerns but one of the things he said point blank the reform we are proposing will keep the government out of health care decisions. is that an accurate or fair or even reasonable characterization of at least the house bill? >> um, no. i mean, in short, no.

you know, the -- if you just look at the, you know, what is being set up from a federal government perspective in terms of, you know, all the different departments, all the different offices, the health care -- new health care choices commissioner, you know, the amount of regulations and just really i think the amount of specific regulations that will make decisions in the system, you know, it's quite extraordina extraordinary in terms of the level of intrusive and also the level of intrusiveness of -- >> the chairman cuts me off. dr. sikora, i would like to conclude with you. the cancer statistics are pretty stunning. i've lookedality them. if you look at the five-year cancer survival rates in the united statesf you look at breast cancer, prostate cancer or cancer in general, in all three categories, at five-year

survival rates, the united states beats canada quite dramatically. it beats europe overall by an even wider margin and it beats england by an even wider mar yin than that. i'm looking at the concord and euro care study for breast cancer. the united states five-year survival rate is 89.5% t. european rate is 73.1%. and it shows that the survival rate at five years for breast cancer in the uk, is 69.7%. as i listen to your earlier testimony, i think you used the word falling way behind. >> right. >> some i believe here in the united states say, well this,'s not because of the system. but i think i heard you say it is in part because of the system both because of delay and because of access to drug or treatment. drugs or treatment. could you expand on that? >> yeah. i believe -- i'd be studying

this for 25 years, looking at why we're high. there are many factors and they're different in different cancers. interesting thing about our statistics, looking at the common cancer, the four commonest lung, breast, prostate and co-lung, that's where we're ahead. looking at leukemia, testicular cancer, we are not falling behind. it can be the best care in the world for certain conditions. what it's bad at is cancers common and require access to general health care. so these common cancers you need to be diagnose niced, have access to imaging, a specialist and all takes time and then access to radio therapy and good chemotherapy and may not be available for all cancers so i think the reasons are very complex for individual cancers but it's a total system problem rather than an individual cancer or individual skill problem. we have the skills. we have got the knowledge.

it's just the system doesn't allow patients to come at the right timely fashion through it to get the best possible care. >> i thank you very much for td@ @ h@ m >> i want to thank you and all the witnesses. peter the fact the american people need to know. -- these are the facts of the american people need to know. >> thank you board doing this. this is the only active health care hearing on the house side that is going on right now, even though we are under pretty tight timeline. your testimony is always moving. i do not think i'd ever heard that wrap up you gave about knowing down here checking the bank account. last night the president called as out and said we were not seeing six people. that is wrong.

america's doctors and nurses have been stepping up and doing the right thing in spite of medicaid, in spite of an abysmal reimbursement rate. thank you for seeing that. i did not intend to do that. he forced me. i am glad you did. can i ask a question? saying that. you forced me and i'm glad you did. dr. sikora, can i ask you a question if you could and the chairman has a tight gavel here, i know. can you delineate some of the differences as you're aware between the medical justice system in your country and ours? >> yeah. it's regionally organized and there are thorough path allows very little choice. your go do a gp referring you down a route that the primary trust -- >> but as far as if someone gets in trouble and there's a bad outcome and a lawsuit that results, how's it different in the uk than in the united states? >> we have much more -- much

lower levels of litigation. patients are much more compliant with the system because that's what we've been brought up with and used to. i think there's very little lateral. patients don't feel they've got the right to get second opinions, the right to move to a different -- choose a different pathway. >> is there a difference in the contingency arrangement, the fee arrangement that exists in the uk and the united states? >> there are. for medical litigation, you mean? >> yes, sir. >> there are. it's coming. it is interesting how the two systems coming together in terms of medical litigation and here it is going up considerably. >> we're glad to export it to you. unfortunately, we retain our own. >> thank you very much. >> let me ask you about question. you talked briefly about the inability to meet innovation and then in answer to a question of jenny brownwaite, you said not much has happened in history of the cancer of the pancreas and are there areas of medicine where you see a stagnation of

research? >> i think it's when there's innovation, obvious one that affects many, many people is angioplasty for coronary artery disease. after someone suffering from a heart attack instead of delay, you go to a center to do the angioplasty and the patient walks out two days later and problem solved, at least a few years and now that availability of that and the introduction of that was enormously slow in our system. whereas in many systems we have this choice in competition. those providers that can introduce the innovation, patients want to go so -- >> interesting. >> they want to go a place they can't get the innovation. that's the market and choice in competition and lacking in a government-run system. >> we are accused of overroute lizing that. you referenced the fact about budgets. and i don't know that people quite understand. when we're compared with canada,

the canadian system is on a budget and when the budget is spent, the budget is spent. our public system, we have a much larger public system than you do, it is -- you send us a bill and we pay it no matter what. we may reduce the amount but there's no upper limit on the system. we just pay whatever comes across the counter. can you speak to that for a moment? >> well, the budget in canada each hospital has a block budget at the beginning of the year. they're given, let's say, $6 million. it's irrespective of how many people come, irrespective of the acuity of their problems, you must treat everybody within this budget. we don't care how you do it, just do it. well, that's an impossible task. how can you set a budget without knowing how many patients you will have? without knowing what their complaints will be. it's an unworkable system and we've seen it's not working. >> is there a contingency pool of funds that a hospital can go

to if a patient like shona walks in after the money is spent? >> i'm not an expert on the budgets. i know that people do not get turned away. normally. if they have urgent conditions. but i will tell you that there's some conditions which you and i would, say, are urgent such as urgent spinal surgeries in the town of edmonton, alberta. you cannot get an elective spinal surgery because they don't have funds to pay it. the only way to get a spinal surgery is go through the emergency ward. if you come to the emergency ward and you have soiled your underwear, you will get service. otherwise, do not get it. >> thank you. >> well, thank you, thanks to our panel. dr. sikora, thank you for being with us from the uk.

shona holmes and richard baker from canada, karen kerrigan. thank you for your efforts. just a couple of concluding points one is we've worked hard for alternatives we think makes the system work better. dr. sikora said repeatedly praise that we've been using. i'm not sure i have it as concise as he did when he consistently said competition and choice drive value. we want more market factors in the system. more choices. more opportunities to choose your doctor. more opportunities for you and your doctor to choose your health care determinations. but we think we can have a system where people have many more choices than they have now. karen kerrigan talked about that as she has and small business folks have for years, opening up this system where you have all the choices you have now but you have choices beyond that. and inside the health care system itself, things like medical liability reform, more

health care transparency, more health i.t. all save money there, as well. we want to see personals get better health care with -- and pay a price they feel better about because it's driven by competition and choice. what we don't want to see is the elimination of choice and to come to the kind of government-run system that we have seen discussed here today. and not just in canada and the uk, but in any country that has a government-run system. they all have rationing. they all have lines. they all develop a two-tiered mechanism. that's not what america wants and we'll continue to come forward with alternatives we think solves these problems instead of make the problems better. so to my colleagues, to the audience here that patiently stayed with us through votes and mike phone challenges and other things, and particularly to our panelists, and particularly those who traveled or stayed up

late, later in the evening in great britain to be with us, [captioning performed by national captioning institute] [captions copyright national cable satellite corp. 2009] >> our coverage of the health- care debate continues over the next three hours. first, with president obama's town hall meeting in ohio. in an hour, nancy pelosi tells reporters that health care legislation will pass the house. after that, a forum on health care. the house financial services committee continues hearings tomorrow morning on financial regulation. members will hear from treasury

secretary timothy geithner and the headed the federal reserve, ben bernanke. live on c-span35 -- at 1030 easter. >> won a round face questions on british politics in afghanistan. sunday night on c-span. >> house c-span funded? >> for donations? >> some kind of sponsorships? >> taxpayer funded? >> philandered be? >> fundraising? >> how c-span funded? 30 years ago, america's cable companies created c-span as a public service, and private business initiative, no government mandate no government money. >> president obama was in ohio today for a town hall meeting on health care legislation. after touring the cleveland senate, he was at shaker heights high school for an hour.

>> thank you, thank you. have they see. thank you. hello. hello, shaker heights. hello, ohio. it is great to be here. there are a quick. some quit acknowledgments out to me. please come and give rick a round of applause. [applause] some special guests that we have. first of all, the governor of the grazing of ohio, ted strickland is in the house.

your secretary of state gen firm brunner is here. -- jennifer brunner is here. shaker heights mayor, earl lichen is here. the shaker heights school superintendent mark freeman is here. knottier -- not here, marcia and sherrod brown. they have more to do in washington.

it is such a good night in the great state of ohio. i know there those who like to report on the back and forth in washington, but my only concern is the people who send us to washington, the family is feeling the pain of this recession, the folks i have come across to of lost jobs and savings and health insurance but have not lost hope. the citizens who defied the senate and the skeptics who went to the polls to demand a real and lasting change. change was the cause of my campaign. it is because of my presidency. when my administration came into office, we were facing the worst economy since the great depression. we were losing an average of 700,000 jobs per month.

hundreds of thousands of people and ohio have felt that change for tampered of our financial system is on the verge of collapse. it let families and small businesses cannot get the credit they need. experts were warning there was a serious chance that our economy could slip into a depression. because of the action we took, we have been able to pull our economy back from the brink. now that the most immediate danger has passed, there are some who questioned those actions. let me report to you exactly what we have done. we passed a two-year recovery act that meant an immediate tax cut for 95% of americans and small businesses. 95%. it extended unemployment insurance and health coverage for those who lost their jobs in this recession.

it provided emergency assistance to states like ohio to prevent even deeper layoffs of police officers and firefighters and teachers and other essential personnel. at the same time, we took steps to keep the banking system from collapsing and the credit flowing and help responsible homeowners hurt by falling prices. in the second phase, we are now investing in projects to repair and upgrade roads and bridges, ports and water systems, and in schools come clean energy initiatives throughout ohio and the country. these are projects that creating good jobs and bringing lasting improvements to our communities and our country. there is no doubt that the steps

we have taken have helped some -- prevent greater job loss. they have helped create jobs and have begun to put the brakes on the devastating recession i know that for the millions american settle looking for work, to those who are struggling, full recovery cannot come soon enough. read your letters. the stories i hear for the first thing i think about in the morning in the last thing i think about at night. they are focused on my attention. the simple truth is that it took us years to get into this mess and it will take more than a few months to dig our way out of it. i want to promise to this. we will get there. we are doing everything in our

power to get our people back to work. >> i love you. >> i love you back. [applause] we also have to do more than just rescued this economy from a recession. we need to address the fundamental problems that allowed the problems to happen in the first place. otherwise, we would be guilty of the same as short-term thinking that got into this mess. that is what washington has done for decades, we have put things off. that is what we have to change. now is the time to rebuild the economy stronger than before. strong enough to compete in the 21st century, strong enough to afford the waves of boom and bust that had unleashed misfortune on middle-class families throughout the country. that is why we are building a

new energy economy. it will unleash the innovative potential of america's entrepreneurs and create millions of new jobs, helping to end a dependence on foreign oil. we are transforming our education system so that this nation has a better -- the best educated work force on the planet. we are pursuing health insurance reform so that every american has access to quality and affordable health care coverage. i want to talk about healthcare. i want to be clear. reform is not just about the 46 million americans without health insurance. i realize the all the criticism

that many americans may be wondering, how does my family stand to benefit from health insurance reform? what is in this for me? someone to answer those questions for you. if you have health insurance the reform we are proposing will be more security. you deserve reform. it will keep the government out of your health care division, giving you the option of coverage. to not let folks say that will be forcing government-run health care. that is not true. it will keep the insurance companies out of your health care divisions, too. [applause] by stopping insurance from cherry picking who the cover and holding insurers to a higher standard for what they cover.

you will not have to worry about receiving a surprise bill in the mail. we will limit the amount your insurance company can force you to pay out of your own pocket. you will not have to worry about pre-existing conditions, because never again will anyone in america be denied coverage because of a previous illness or injury. [applause] you cannot have to worry about losing coverage if you lose or leave your job, because every american who need insurance will have access to affordable plans

through a health insurance exchange, a marketplace for insurance companies will compete to cover you not to deny you coverage. if you run a small business and you are looking to provide insurance for your employees, you'll be able to choose plans through the exchanges will. i've heard from business owners tried to do the right thing but year after year premiums rise higher in choices grow more limited. that is certainly true in ohio. if you are a taxpayer concerned about deficits, i want you to understand i am concerned about deficits, too. in the eight years before we came into office, washington enacted to large tax cut for the wealthiest americans, added a prescription drug benefit to medicare, funded two wars, all without paying for it. if they did not pay for it.

the national debt covers it. we were handed a $1.30 trillion deficit when we walked in the door. we have to add in the short term to deal with this financial crisis. i have to tell you, folks have a lot of nerf who -- nerve who helped get this in this hole and then tried to go around trying to talk about fiscal responsibility. [applause] i'm always a little surprised that people do not have a little more shame about having created a mess and then trying to point fingers. that is another topic.

[laughter] the truth is, i am now president. [applause] [cheers} i am responsible. together we have to restore a sense of responsibility in washington. we have to do what businesses and families do. we have to cut out the things we do not need to pay for the things we do. that is why i pledge that i will not sign health insurance reform, as badly as i think it is necessary, i will not sign it if that reform even at one dime toward deficit over the net cost -- next decade, and i mean what i say. we've estimated that 2/3 of the

reform can actually be paid for by reallocating money that is already in the system. let me repeat what i just said the. about his last three of reform can be made not with revenues and tax, but with taking money that is not being spent wisely and moving in into things that will it better. that includes -- right now is the more than $100 billion in unwarranted subsidies that go to insurance companies as part of medicare. subsidies that do nothing to improve care for our patients. we ought to take that money and use it to actually treat people and cover people, not to line pockets of insurers. i am pleased that congress has already embraced these proposals. while they are currently working the proposals to finance

the remaining cost, i continue to insist that health care reform not be paid for on the backs of middle-class workers. in addition to making sure that this plan does not add to the deficit in the short term, the bill i sign must also improve care in the long term. i just came from the cleveland clinic where i toward the cardiac surgery units. and that some of the doctors who are cheating incredible results for their patients. there is important work being done there as a lot university hospital a metro health. -- of metro help. cleveland clinic has one of the best health information technology systems in the country. that means they can track patients and their progress. it means they can see what treatment work and which treatments are not necessary. they can provide a picture.

the and i have to do the great test after test. it is all online. -- and they do not have to duplicate test after test. it is all online. here is the remarkable thing. they actually has some of the lowest costs for the best care. that is the interesting thing about our health care system. often the better care produces lower and not higher expenses. better care of lead to fewer errors that cost money. you or your doctor to not have thought the same forms a dozen times. medical professionals are free to treat people not just illnesses. patients are provided preventive care early, like mammograms. this will avert more expensive and invasive treatments later.

that is why our proposal includes a variety of reforms. it was saved of both money and improve care. of the largest organizations -- that is why some of the biggest organizations we -- of doctors and nurses have supported our plan. we want to create an independent system of doctors who are suspicious -- each fission. barbara personals will improve the quality of cares for seniors and saved and thousands of dollars of prescription drugs. that is why aarp has endorsed our efforts as well. the fact is glorying costs is essential for families and business in ohio and all across the country. the stick the ohio example.

-- let us take ohio example. as in any today, we are seeing double digit rate increases all across america. there are reports of insurers raising rates as much as 20% in california. 23% in connecticut. proposing as much as a 56 the% in michigan. -- 56% in michigan. it is just a preview of coming attractions. that is the future you cannot afford. that is the future america cannot afford. we spend one of every six of our dollars on health care in america. that is why i am looking a double in the next decade. small businesses struggle to cover workers while competing with large businesses.

large businesses struggle to pay workers while competing in the global economy. small businesses are never found it for the fear of being without insurance are having to pay for a policy on your own. ohio, that is why we are here. in pursuit of this reform, we forge a consensus that has never before been reached in the history of this country. senators and representatives from five committees are working on legislation. three have reproduced a bill. health care providers have agreed to do their part to reduce the rate of growth in health-care spending. hospitals have agreed to bring down costs. the drug companies have agreed to make -- prescription drugs more affordable for seniors. the american nurses association and american medical association who know our health- care system best supported the reform. we have never been closer to

achieving quality and affordable health care for all americans. at the same time, there are those -- is that the air- conditioning? [laughter] you can still hear me, though. we had one republican who told his party that even though they may want to compromise it is better politics to go for the kill. another republican senator said that health care reform is about freaking me. it is really the american people who is being broken by rising health-care costs. the republican party recently

went so far as to say that health insurance reform was happening to soon. first of all, let me speak clearly. if there is not a deadline in washington, nothing happens. nothing ever happens. we just heard today that while women of people to get the bill out of the senate by the end of august or the beginning of august, that is ok. i just want people to keep on working. just keep working. i want to the bill to get out of the committees and then i want the bill to go to the floor and then i want that bill to be reconciled between the house and senate and then i want to sign a bill. i wanted done by the end of this year. i want it done by the fall. [applause]

whenever i hear people say it is happening too soon, i think that is odd. .

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commerce committee and ways an means committee have been active, many of our doctor members have been involved here as have others involved in health care. so two dozen of us have worked hard to put ideas out that we think would send the system in a better direction. i think it's very fair to say that this health care solutions groups to create a system where people have more access and more competition that creates both better price and more patient satisfaction, but writ real focus on the doctor/patient

relationship. beyond that, i'd say that we are here today to really talk about what might happen if you wind up with a government competitor that eventually becomes the only competitor and our panel is a panel that has real experience with that, both in terms of medical tourism, personal health challenges and economic impact both in canada and in great britain. let me go next to others for some brief opening statements. dr. begin gri if you're ready, we'll see if we can make these mikes workt right way. >> yourses have had a go off first. >> i turn mine off first. is yours on? >> is this on? i believe it is. well, surprise, surprise. so mr. chairman, thank you very much. and of course this health care working group that, as chairman blunt has described that we've been working together, the group of about two dozen of us.

as he point out, the ranking members of the three respective committees of jurisdiction, education and labor, energy and commerce and ways and means. we have number of physician members. i happen to be one of the physician members and a member of the energy and commerce committee and the health subcommittee, so we bring a lot of talent, experience to the issue. we clearly feel that health care reform is needed@@@@@@@ @ @ @

necessarily babies. but the delivery of health care in general. we clearly feel that liability reform, expanding electronic medical records, giving everybody access to health care creating high risk pools, equalizing the tax treatment, i could go on and on and on, but there are other members of the panel that are more expert on some of those areas than i am. but i've been proud to work with this group. i think we have got a great plan, if just given the opportunity to sit down with the democratic majority and with the president, i think we could show them how to fix this system and fix it right. i really welcome the panelists and look forward to hearing their testimony and asking them some questions. >> let's go next to our whip, mr. cantor. >> thank you. i want to just commend you, roy,

for having this panel today. because i think it is very important that we respond to the many questions thathe american people have with regard to what a government health care plan would mean for their families. and as we know, there are many people across the country that are very, very uncomfortable with the rush to get something done if we don't get it right. health care obviously is important to every man, woman and child in this country. and frankly, as we saw last night with the president's press conference, there are still a lot of unanswered questions as far as his plan is concerned and that which is making its way through congress. the reality is right now as it stands there is a bipartisan majority against the bill, which creates a government health care plan. and a lot -- the reason, i think, for a lot of that

opposition has do with the uncertainty around what government health care has produced in other countries. and what that would mean for the ability of american families to continue to access the kind of care, the quality of care the timeliness of care that they have become used to or that many that have health care have become used to so. i look forward to this hearing and i want to welcome the panelists and thank them very much for being here. >> let's go to mr. klein who's the ranking member on our workforce committee. joining us today. >> i don't think this microphone is working. oh, it is working now. thank you very much, mr. chairman. i want to thank the panel iists

for being here. it's particularly gratifying to have an expert all the way from the united kingdom who is willing to stay with us on the phone. let me just say very brief ly, e looked at this bill, it was 1,018 page after it was 852 page, then the amendment was 1, 1,042 pages. there are some very, very troubling concerns. we in education and labor marked up this bill, tried to amend this bill starting at 10:00 one morning going straight through until 6:00 the next morning. a very healthy debate as my friend dr. gingrey said, we had three physicians on the republican side and i can telling you that they were engaged an we were have happy to stay gauged if we could fix this bill. our concerns are enormous. this legislation creates a new federal bureaucracy and with a new commissioner, you can only think of as a high commissioner

because it's enormously powerful position to fundamentally, i believe, wreck the delivery of health care in this country. so i'm just delighted to be here. i applaud the work of my colleagues and looking forward to the testimony of our witnesses. i'll yield back. >> dr. fleming. >> okay. thank you. yes. thank you, mr. chairman. i just want to say briefly that there are three fundamental problems with the takeover, the government takeover of this health plan. one is cost despite what our president says, despite what members of the other side of the aisle says. every analysis that has credibility including the cbo says the cost will go up for years and in fact in the out years it will go up infinitely.

bureaucracy stepping between the patient and the physician, a psyche kred sacred relationship. it's tremendously bureaucratic. we may hear more examples of that today from other countries. and finally, a big concern, despite where you may be on pro-choice or pro-life, this ploisd taxpayer fund abortions which 69% of the american people are against. so we have some very fundamental flaws with this plan and quite honestly despite what you hear democrats say, every single republican is not for the status quo. we are for true health care reform. common sense health care reform. not nonsense health care reform. >> paul ryan. >> hi, i'm paul ryan. ranking member of the budget committee and also serves on the ways and means committee which marked this bill up last friday

morning. a couple of cost points i think ought to be made give than we're here to learn from experiences from other country has have done this. number one, the congressal budget office is telling us that not only is this bill not paid for in the first tenor use, it the has $239 billion deficit. i expect the majority will close that but they're telling us that costs grow at 8% a year and offsets grow at 5% a year, what that means is congress is on the verge of creating a new entitlement which will be unfunded. a new unfund liability on top of the ones we already have, medica medicare and med. the reason i point those is it's very important if the government is to earthly take over the rest of the health care sector. they're telling us that with the health care option, two out of three americans will lose the private coverage they have and be dumped onto the public plan in about three years because of the cost shifting that curse. if the public plan underpays providers as they do, typically 20% on the hospitals and

physicians. what will happen is they will overcharge on private plans. this will precipitate an enormous dumping onto the public plan whereby the public plan option inevitably becomes a government-run monopoly. and under that signed kend of a system with huge cost eck explosion. a $38 trillion unfunded liability for medicare. we estimate about $28 trillion unfunded try looiability for medicaid. additionally, for this new entitlement, the only way to solve this cost problem, the only way to deal with our spiraling debt and deficit that will come is to ration care. that i think is one of the reasons why in this stimulus pack archg the institute compared of effectiveness was form in the first place to design what will and not be paid and reimbursed for providers. so we are very fearful instead of addressing the problems we want to address in health care cost, accessibility, making sure

the uninsured get insurance and making sure people with pre-existing conditions can get affordable health insurance, we believe we can fix those problems without new taxes and spending. unfortunate lit path this bill is on is going to put us in a position where distant bureaucrats will have to ma make cookie cutter decisions on how medicine is to be practiced in america if we're ever going to deal with the cost explosion just right around the corner and the fear is that will take the doctor/patient relationship out and replace it with bureaucratic dictates who do not know the uniqueness of a particular patient's ailments. inevitably, rationing, i know that's a dirty word, must inevitably occur. that's why it's valuable we don't rush this to the floor which is being done next week that we patiently look at this and learn from the experiences of other countries as to what this road looks like that our new government is trying to put

us down. that's why i'm excited to hear the input we're going it get from our witnesses. >> mr. whitman. >> thank you, mr. chairman. it's an honor and privilege to be here today as part of this group and to these have these fine folks before us to testify today. as you've heard the common theme amongst this is solutions to health care and the solutions rest in reducing cost. that's the bottom line. and you've heard a lot of different aspect about where the problems are with this bill and where it does not reduce costs. we hear from the governor's conference about their concerns about increasing costs of medica medicaid. they are deeply concerned about the unfunded mandate, also the congressional budget office speaks to the unsustainability of this bill passed 2012. also the mayo clinic points out the problems with the bill and its sustainability. as we see, we want good workable solutions that get to the basic issue at hand and that is controlling costs within this

system. at 17% of gdp going to health care costs and that rate growing at 1% a year, everybody in this congress realizes what the issue is. it's cost and containing costs. secondly, what you heard is also about making sure that we maintain the integrity of the patient provider relationship and that is also critical in whatever comes out of this body to make sure that we maintain that that's where the most efficient decision making takes place is between the patient and provider. we must preserve that and do all we can to reduce costs f we do that we create a sustainable system of health care in the united states. the current path we're on is not sustainable. the bill currently before us is z not create that sustainability and it interferes with a patient/provider relationship so we are here to make sure we can achieve those two goals in our efforts and hopefully we'll find folks object other side of the aisle willing to work with us in getting that accomplished. again, thank you so much, mr. chairman, for being a part of this today. >> thank you, rob.

is this -- we're going to struggle with this for a will. first of all, let me mention some of the things i want it say here which is to reiterate that the choices are not the choices that the president laid out last night. the president has been an expert at creating the straw man, you can either do what he wants to do or we can do nothing. nobody on the solutions group and my belief is nobody in the republican side of the aisle in the house believes that we couldn't make this system better. and in facting we're proposing plans and ideas and legislation that would create access for everyone to the system regardless of pre-existing conditions that would create more choice and more competition, choice and competition will have more impact on price than anything else. and has been said several times, we're also convinced if you have a government provider, every outside study that is objective on this indicates that you won't

be able to keep what you have even if you like it. another thing we constantly hear from the president is if you like what you have, you can keep it. but believe me, if 114 or 125 million of the 160 or 180 million who get their insurance at work go to the new subsidized government plan, what you like won't be there anymore and at cost will go up. it will just -- those things will disappear and then you have governmen government-run health care. and we want to have some discussion about that today. we have three witnesses with us and one witness on the phone with us from the unite the kingdom. so four witnesses to testify, four witnesses to ask questions of. i'm struggling a little bit to decide the exact best way to do that. but since i don't think we've gone to the second vote yet, i'm going to go ahead and introduce shona holmes. shona has traveled from canada to be with us today.

she was diagnosed a few years ago, with a brain tumor and because of the system in canada, she was told it would be months before she would see a neurologist in canada. fortunately, if you live in canada, you're not too far from the united states and in her case you're not too far from the mayo clinic and she was able to go there and receive treatment and shona, we appreciate the personal effort you've made to be here today an we look forward to your testimony. >> can i figure this out? >> i don't know. i think mine is on. somebody is going it have to -- >> hello? >> yes, there you go. >> thank you very much. >> sorry about the mike problem. >> no problem. i feel strongly that if we don't start talking to each other in

the same language that the truth is going to get lost in the translation of this debate. it has always been my view and my message that both canadians and americans have so many miss conceptions about each@@@@@@@@@ r population as the state of california, we have 5 million people that are without access

to a family doctor. i was fortunate enough to have a family doctor. one that cared for me very deeply. she was unable to expedite the tests we needed, nor the specialists, the diagnostic testing, the imaging, the blood testing and some of which weren't even provided under our governme government-run health care. one simple blood test could have saved me grief and expense that's not even available in canada. not because we can't do the test, it is a simple blood draw. but because the government mandates the lab hours. i required a test at 11:00 p.m. at night and the government closes at 7:00. within one week, i received a complete comprehensive diagnosis from two former kanacanadian dos who now work at the mayo clinic in arizona. the most amazing part of my story, issie ooh file is that both of doctors recommend i go home. for this surgery and for

follow-up testing. as we now knew what the issue was that i should have been able to be treated rapidly through our free health care or government-run services. confident that i was armed with the information required to be triaged to the emergency list, this was sadly not the case. i was to find out many months later that doctors in canada are not required to take other doctors' reports. the doctor i saw refused to review my record, read the diagnosis and worse yet, personally declined a call from the mayo clinic doctor himself as he frantically contacted him with updates on my condition. sadly, stories like mine are not a rare case. as some are trying to discredit me by saying our country is using the united states on a regular basis to help out with emergencies when we arise, we

are lacking the resources to sort them out ourselves. as recently as two weeks ago, two premature babies were born in one of the largest teaching hospitals in my cities and there were no facilities available for them. one was sent to buffalo, new york. while the other was sent to ottawa, some seven hours away. the month that i came to the u.s., 26 people were with the cross the border for brain surgery due to a lack of neurosurgeons. i can count story after story in this discussion, but the most compel thing to me was the other day when i spoke to the border guard reported to me the must bes daily of people that are crossing the border from canada to the united states for cancer treatment, mris and other emergency treatment. and he wondered why people in the u.s. were glorifying the canadian system. we have government websites that post targeted goals for wait times in our areas. as well as the average wait time and sadly, we are never near target. lost in the language is

coverage. the basics that americans have complained to me about not being covered is not covered in our government plan. things like prescription medicine, eye exams, unless you're referred to an ophthalmologist and the wait times to see ophthalmologists are up to one year. hearing tests, and even things like a cast on your leg if how is break it. the doctor tending your injuries will be paid for his services but you would be out of pocket for the cast, the crutches, the physiotherapy and ambulance ride to that hospital. i'm saddened by the glib attitude that if it didn't happen to me, that it can't be true. canadians are terribly proud of our health care because we fear what we have been raised to believe what america is like. no insurance coverage is very different from no access to care. nor the ability to step out of the system and take care of yourself and/or your family without being fined.

to leave your country to get treatment in a timely manner alone tells the tale of too much government control. i have yet to meet an american who boasts about the health care in both the medicare process all right in place in the u.s. or your va hospitals. sadly many of those stories only mirror our whole system. this debate seems to polarize people. it's polarizing points and worse, it's polarizing professionals. when i watched president obama give his peach the other day and he spoke about being surrounding by nurses because they didn't choose the profession to get rich it drummed into me what the problem was. this is unfair to assume that the driving costs of health care lay on the backs of only one specific field of individual, be it doctors, the medical profession, pharmaceutical companies, the insurance industry or patients themselves. this is irresponsible. canada, with our, quote, free

health care, battles the exact same suffering, the exact same issues under socialized medicine. health care is expensive. our only way to control costs is not through competition, not through choice, but with more taxes or rationed services. everyone wants and deserves health care. they weren't affordable health care but most importantly they want accessible health care. this is the lesson that i've learned in the past few years. looking back, i chose what kind of canadian statistic i would become. i mitigated my own damages. i came to the united states and i saw you're with us.

>> a pleasure, thank you very much. i think i circulated a little preamb preamble, the problem is not unique to any country. all developed countries are struggling with new technology and aging populations. medical inflation is now running at about 10% a year in all economies, inevitably a national meltdown will happen. 60th birthday last year, great celebration and it's creaking, there's no doubt about it. we're sort of in love with it. sort of a religion in britain, the works when it was created free at the point of care based on medical need not on ability to pay, the great thing about the nhs, no one is uninsured in britain and that is a tremendous attribute. the difficulty is that

politicians play with the health service for political gain. it's inevitable that a health service that is run by the politicians they are going to hook look at ways to score votes. this happens locally, consultation politicians make political statements to encourage people to vote for them. similarly nationally in terms of policy. if you take my area, cancer medicine, certain cancers become more important because they are politically more important, breast cancer is more important than colon cancer, if you're a national provider of a service, like a budget ally you want to please your customers. in health care, especially

government run service it is difficult to do that. there are really five problems in government-run health services, first of all you get huge bureaucratic -- nhs is the larger single employer in the whole of europe. the second problem, and when you've got a large workforce that's bureaucratically structured there's tremendous resistance to change. if you look at other consumers like the shopping malls, it has changed dramatically in both countries over the years. our health care system remains almost exactly as it was 30 years ago. the the second problem is what i call the value equation. the competition that you've heard about earlier this morning, price in competition drives value. i would define value as the quality of the care together with access to that care of

patient, canada had to wait several months if you wait in the canadian system. so if the quality goes up and the access goes up and costs go down, the value goes up. that's the driver in any consumer industry service industry. operation is et up to compete and those that provide better value as judged by the end user, those that provide poor value close down. that dynamic incurs every exception of government-run health care. the third one i mentioned is inevitable. we've seen it both in our conservatives and with our labor, a lot going on in health service. it is one of the most important issues to people how health care is going to be provided. politicians struggle to find ways to solve it. and one way -- and of course, the issues as we've heard from you, the consumption of gdp

potential is massive. then the fourth problem is a delicate one. that's the majority of health that goes to our senior citizens and i'm nearly there, so i'll be one of them very soon. older people tend to people little tax. on a tax only basis, you're asking the older people who now have all this wonderf futechnol to get it at cost to younger people that will have to pay more tax. more tax to pay for the health care wishes of aging health consumers. inhe ha that is a huge political problem. then the last problem with a government-run service, is you've got to ration it, it's the only way to do it. we sort of do it here through an

organization the national institute of clinical excellence. the problem with nice, its value judgments are not agreed by everybody. so we use a cost for quality, and if you try to calculate that, there are all sorts of arguments about the calculation n my area, cancer, going through a rapid surge of new technology, how do you know whether they are giving new drug for cancer is a better health intervention than doing something for mentally handicapped children. that's impossible to put into single numbers. trying to get in conclusion some sort of system that allows the benefits of universality which the nhs certainly does and alws choice in competition to move through is clearly to me the way we go through. but what i do admire about what you're doing, both you and the

democrats, you seem to have a greater realism of -- we tend not to have that here. but it's coming in the next three to five years, i guess because of the increase cost of health care and the fact that new technology will keep coming at us and solving the problem today doesn't mean it's going to be solved two years. still new technology that people know about. thank you very much. >> doctor, if you can stay with us, we have two more witnesses, then i'm sure we'll have questions for you as well. >> let's go to richard baker, founded timely medical alternatives. it's an organization that sends thousands of canadians to the united states for a surgical procedures. he's become one of leading spokespeople for a free market reform in the canadian single payer health care system. he's appeared off and on radio and television to discussion

health care reform and made a considerable effort to be here today. thank you, richard. >> well, it was working. >> how about now? >> yes, working now. >> mr. chairman, ladies and gentlemen, my name is richard baker and six years ago i founded an organization to help canadians who are on long medical waiting lists to get timely care in u.s. hospitals. now currently there are over 3@

admitted that people are dying on waiting lists in canada right across the country. over the years, my organization has sent well over 500 canadians to the u.s. and rewe refer to the u.s. as canada's health care system of last resort. if you are dying, if you cannot get care, there is always the option to go to the u.s. two years ago, building on our success and our experience i founded north america surgery, offers deeply discounted surgery procedures for uninsured americans. in the course of this works we have saved the lives of six of our fellow canadians and never had the opportunity to work with -- i will tell you some of our other clients whose stories i believe are compelling. we helped an 8-year-old girl who

had a message cranial infection. she was on a 15-month waiting list in canada to have the most simple of surgeries. she needed drains put in the ears to drain off the infection and needed her ton sills out and add noids out. this is the simplest surgery yet she was on a 15-month wait after having gone deaf in january of 2004. couldn't hear her teacher or participate in school. >> in month nine of the 15-month wait, we sent her to a surgeon in seattle. and told her father had she waited for the 15 months she was asked to wait in canada, she would be dead. he said, never mind her hearing, he said my job now is to try to save her life. happily, this surgeon did save her life. this little girl lost all of her hearing in one ear and half of

the hearing in the other and her wants of drain tubes in her ears and ton sills and adenoids. another one, his family doctor would have estimated it would have seven and a half months from the time he collapsed on the street until the time he got his surmgry, that included a 4.5 month wait for the mri to confirm the diagnosis of a brain tumor. we sent him down to buffalo, new york where he had a ma lilignan tumor removed and compressed seven and a half months into four and a half weeks. he had his first hearing in court yesterday. he's gone to supreme court and suing the canadian government

for violation of his charter rights, specifically the charter right of security of person. it would be ironic if just as canada appears to be going more to the right on health care delivery, the u.s. would be copying the canadian system and going to the left. it would be very ironic. our client in british columbia was told by her vascular surgeon that she had two, maybe three weeks to live due to a blocked artery. starving to death. she could not digest her food. lost 40 pounds. -- is that another vote? >> i don't know what that is. that's another disruption. >> surely surgery was planned in british colombia, on the table being prepped for the surgery

whether the word came down that all elective surgeries were to be canceled for the day. this is a routine procedure, they don't have sufficient beds. had she her surgery, they wouldn't have had beds. they don't have nurses to tend to the patients in the bed. shirley waited. her second surgery the following week was canceled. her surgeon said get in touch with timely medical alternatives. they will help you to get care in the u.s. next day, shirley was at an excellent hospital down in bellingham, washington, where she was told you were hanging by a thread. you had less than a week to live and saved her life. shirley went back -- this is an important part. she went back to canada. went to the government, said i would like to have my money back please. why would we give your money

back? because there's an implied contract, i've been driving a school bus all my life. paid crushing taxes all my life. the implication being when i needed health care it would be there for me. i want my money and the minister of health said your decision to leave the jurisdiction was an elective decision. your application is denied. now, this brings up an important point. by the way, shirley's response to that comment was the only thing elective about my decision to go to the u.s. was i elected to keep on living. that was a great quote. you will hear from proponents of single payer health care there is anecdotal evidence that in canada some elective surgeries are sometimes postponed. the implication is that mrs.

smith's planned tummy tuck had to be postponed. you need to know elective medical procedures in canada is any condition which does not immediately threaten life or limb. give an example. if you're hit by a bus in canada, you get immediate and competent care. that's an emergency situation. if, though, you were hit by a bus six years ago and you now need spinal surgery and you need a walker to get around and you're addicted to painkillers, this is an elective condition. you might not be able to function but it's an elective surgery you were looking for. again, there are three quarters of a million canadians waiting for elective medical procedure. one is lynne gilbert from vancouver, her son is 15 years old and needs a lumbar fusion. lynn, herself needed the same

surgery when she was 15. she did not get it. by the time lynn was 28, she couldn't pick up her two babies or hold down a job. she was walking with a walker. she was addicted to morphine and worst of all, in my view, she had to walk around all day in diapers, age 28, mother of two walking around in die perz. she said to her surgeon, when can i get the surgery? he said, well, you're too young to have a spinal fusion. now, life had come to an end or a stop, she was too young to get spinal surgery and besides, he said, there are so many others waiting in line behind you. -- ahead of you. hundreds of people ahead of you that we have to operate on first. besides, lynn, he said, you have not yet suffered long enough. now want you to remember that phrase, you have not yet

suffered long enough. 28-year-old mother of two in diapers addicted to morphine. the elective health care system in canada. when she was 31, she finally got her surgery, she came to us, two weeks ago to help her get surgery for her son who has some same condition. she told us she would pay anything, she would mortgage her home or sell her home or do anything to avoid having him go through the same suffering that she went through. we'll be send her son to an excellent physician in south dakota for the surgery in the next couple of weeks. you'll hear from prominent canadians on the left of the political spectrum about how wonderful canadian health care system. jack lay ton, the leader in canada, recently came to washington to tell you folks how wonderful the canadian health care system is. why would he do this?

why would he care? here's why he came. the only reason canadians put up with the dysfunctional health care system is the fact that the government tells him that ours, the canadian system is the best health care system in the world. however, when canadian citizens are willing to pay to get timely care in the u.s., even though it's free in canada, people begin to question the government's propaganda. it's inconsistent they would pay to go to the u.s. if they have the best health care system already. why would they come to the u.s.? now, if the canadian and american governments can arrange things so that both countries have single payer health care, then the freedom train that my company operates for canadians will have no place to send our canadian clients. that's why i'm here today. americans need to know the truth about the strength and weaknesses of both health care system and with six years of

experience working in both systems, i have, i think a unique insight into the subject. you will hear from the u.s. congressional leaders that we have the doctors on our side. i work closely with 60 u.s. doctors. i have not talked to a single doctor, not one, who believes that single payer health care system is the answer. certainly the association of american physicians and surgeons is four square against the single care plan. now, i noticed the title of today's discussion is health care solutions. so far all i've been doing is talking about solution that simply will not work or cannot work. interestingly, you should know that our organization able to negotiate pricing for canadian clients at prices significantly below the customary prices charged to american citizens. quick example, hit replacement

cost uninsured people 43,500, american insurance companies get a break. they don't pay 43,500. they pay 24,000. our canadian clients pay 18,000. we get far better prices than the insurance companies do. a believe this is a free market solution in part to the perceived health care crisis in america. mr. whitman earlier stated that the solutions rest with reductions in cost. i have been able to find a way for my clients to reduce those costs dramatically. now, in conclusion, as you americans work to create new laws, to govern the delivery of health care in your country, you should know that the canada health act in my country has caused more pain, caused more suffering and has caused more

death than any other piece of domestic legislation in the history of canada. i thank you. >> thank you, mr. baker. let's go next to karen kerr again, and listen to her testimony and then we'll go quickly to some questions. >> thank you. >> am i on? >> i am on. let me thank all of you members of the house republican health care solutions group for hosting this event today and for inviting small business to be a part of the discussion. i feel i don't have to go in too much detail with all of you about the challenges faced by small business owners regarding the epic struggle to provide and keep health coverage for their employees or for themselves. this is certainly been a long-term problem for small business owners as you know. the central issue being cost.

that is, high cost and rising costs. even in the best of times these rising costs have hurt business growth and hiring opportunities and competitiveness. certainly during this tough economic period, it has been an extraordinary challenge. for the people that do not provide insurance and want to and cannot afford to, it goes without saying, economic conditions have exacerbated their situation. many small businesses are in survival mode. they are cutting expenses and cutting hours and cutting jobs and doing what they can with very limited resources to keep new business. like many americans, the economic confidence is rather gloomy. a late june discover small business watch survey found 59% of small business owners rated the economy as poor. 30% rated it as fair and only 8%

rated it as good or excellent. 57% believe economic conditions are getsing worse and 49% see conditions for their own conditions for their own business getting @@@@@@@@+@ @ to fall most heavily on small business owners. new taxes and mandates and penalties and regulations that

will raise costs. this is not what small business owners need when many are struggling to survive. the mandate requiring employers to provide insurance, acceptable coverage as defined by the federal government or pay a penalty would drive up costs and kill jobs. the sur tax doesn't make sense and we need the entrepreneurs to invest in businesses to keep employees in a payroll. we are in a recession and the economy and private sector needs its capital. we need to keep capital in the hands of productive business owners. with the government defining what is acceptable coverage, we're very concerned this would drive health insurance costs higher for many small businesses. an acceptable benefits plan will likely include new man dated services and other provisions not included in some current plan which means costs will

increase. we're very concerned about the overall regulatory impliance cost in the bill. you can read this bill and not acknowledge that it is a regulatory monster. complying with hr 3200, will be costly. they will develop a system to track whether they are providing insurance and making considerations as well as the proper proportion amount and paying the correct penalty tax and the exchange if you don't offer insurance and the list goes on and on. none of this is going to lower cost for business. as we know the cost of regulation falls disproportionately, more burdensome for some business. small business owners december sfratly want reform. they've been leading the parade for reform but it has to be small business friendly and has to lower cost and it has to

produce reasonably priced coverage and more choices of plans for small business owners and their employees. small business owners can lead us out of the current recession, but that will not happen if they are covered with costly new man dates and penalties and unfortunately that is the direction of the legislation that is moving through the house as we speak. and it certainly is not a plan that small business owners can afford. thank you. >> thank you, karen. what i would like to do now, i think we can go until 2:00 and what we'll do is give each member five minutes to ask questions. we'll watch that clock since we don't have a clock in front of us, i may tap the gavel if i need to, but we'll try to do this in the order the members came to the hearing. mr. klein, mr. herger, mr. camp, mrs. brown, mr. jenkins and

cassidy and if there's any time or questions left, i'll be last. mr. klein, do you want to start? >> thank you, mr. chairman, i think the microphone is actually working. i want to thank the witnesses. they've been absolutely tremendous. i'm from minnesota so, of course, canada is neighboring. and we foresee anecdotal evidence all the time of canadians coming to minnesota because we have a mayo clinic there too. i'm not sure why you travel all the way to arizona -- that's all right. but we have a mayo clinic in rochester minnesota that is world famous. and you chose to come to a mayo clinic, you could have chosen several hospitals in other states and mr. baker has given examples of hospitals around the country where canadians have gone. you did that because you needed

to, you had to and you could. you could do it. i think that the phrase that i think it was mr. baker said that the u.s. is the canadian system of last resort, a place you can go. so i'll start with you mrs. holmes, if i could. if the united states were to adopt a system like canada has with a government-run health plan that operates like that, do you think that the mayo clinic in rochester and others would still be able to provide services for you and other canadians? >> well, i'm not sure that that would continue to happen. i think that it would -- i don't see where the need would be on either side. and what i think is that if americans then needed a place to run, if your facilities are now

completely bogged down and backed up and near the system of which we have, would canadians be able to then turn around and be able to help americans that couldn't get any help. and i think that we would become neighbors with the same problem and no solutions. >> thank you, i'm not sure how the microphone switching back and forth is going to work. i think this one is working again now. mr. baker, you did leave us with some thoughtful and terrifying quotes. the quote of the doctor to lynn of quote, you have not suffered long enough, i wonder how one determines when one has suffered long enough. and of course, we are very much afraid if you have a bureaucracy making that determination that you will have many people suffering for a very, very long

time. let me move very quickly again, mr. baker. you're providing a service, your entrepreneuri entrepreneurial, have a program here, see a need and canadians are being referred to you by concerned physicians that say i've got to get help for my patient. >> that's correct. >> you're providing a service. and i've heard as we're trying to catch up on what the canadian system does, the canadian government may actually try to create something that would compete with your services. >> well, if they did create something, i've said many times that i feel blessed in operating my business that my major competitor is the government. because who cannot succeed in business if their only competitor is the government and listen, my competitor offers the same product i do but they don't charge for it. it's absolutely free. i charge for my service and yet

people still come to me. what kind of an indictment is that of our system if people willingly pay for a product, a service that's free and in their own -- i think it's pretty clear indictment. >> i just have a comment and perhaps within more question to move on. i've got a lot of colleagues waiting here. we've seen clearly when we were marking up the legislation of education and labor and talking to our colleagues and talking to businesses back in minnesota that the small business owners and employees there and those who have started to look at this realize that the bill payer here is going to be overwhelmingly placed in the hands of small businesses. and so miss kerr gan, you gave good testimony. what is it that you would say from a small business perspective, what is it small businesses really want to happen here?

what do they want in the way of fixing health care? >> well, it's very obvious, they want their health insurance costs to go down or at least to stabilize. those who don't provide insurance, either for themselves or their employees, want access to affordable coverage. and i think there's -- there are solution that's have moved through congress previously and have been proposed that will help them do that. certainly there is the pulling that is moved through the congress previously that allows small business owners to pool as a group and leverage numbers to negotiate better prices and have more choice of plans. there is on the tax side there are tax credits that can be offered both to individuals and business owners. the tax code can be fixed for the self-employed with respect

to tax parrity. we can open up the health insurance market on a nationwide business. some are locked into the insurance market and it is very expensive in some states, new york and new jersey where they have excessive mandates. and that is a barrier to coverage for many business owners. so certainly have a nationwide market, a true nationwide marketplace, not something run by the government, i think that makes total sense. more choice, more competition and i think some very simple targeted reforms without taking over the whole system and making small business owners pay for it. so -- >> thank you, you sound just like a member of the republican health care solutions group. those are the exactly the discussions we've been having. thank you very much. i yield back. >> thank you.

excuse us, these are government-run microphone systems so -- all right. thank you for your patience. we just received very recent analysis of hr 3200 which is a bill we're probably voting on next week. and the analysis to make

decisions customerize treatments for patients with respect to reimbursements and not just waiting lines, we got a good idea of that, but the concern that we have under this system where the public option becomes the only option, we've already created this institute of creative effectiveness to determine what care is reimbursed or is not. meaning it decides the treatments that can be given to patients. how does that work in canada. >> well it works in canada in this fashion, not only is access to medical care rationed but access to the medications and the techniques involved in the care are rationed. we go back to my client who we sent to belling ham, washington for her blocked artery. had she had that surgery in

canada, she would have had a an arterial bypass. she was emaciated and debill tated. her surgeon told her later, had she got the surgery in canada, she likely would not have survived it. when she went to bellingham, she had a stinting procedure, far safer and far easier and quicker. why is it not offered in canada? because a stint, costs, i don't know, a thousand dollars, it's know, a thousand dollars, it's cheaper to do the bypass procedure. so that is one way that the customized system is affected. another excellent example is an access to drugs. there are evidently 25 pharmaceuticals which are deemed to be effective for treating cancer. depending on which province you

have, you may or may not have access to them. in british columbicolumbia, we of 25. hopefully if you come down with cancer, your particular type is receptive by one of those 23. what if you live in prince edward island, they only approve one out of the 25. you would have to be very lucky to have cancer that was treatable by that one drug. but what if you had cancer that required one of other 24? you would be just out of luck. >> that's exactly what our concern is, which is physicians ought to be able to have the maximum amount of freedom to customize and taylor the care per the particular need of their patient. each patient is different and he'll ailment is unique, if we set standards by government body, the uniqueness of that patient is completely disregarded. cookie cutter, standard bas

medicine. it's all cost driven, not theáah@@@@@@@ @ @ @ @ @ @ $@ @ we remember that you are there. [captioning performed by national captioning institute] [captions copyright national cable satellite corp. 2009] [inaudible] >> testing. ah, there we are. i wanted to direct my question to mr. baker, who was just speaking about -- you made a comment. this is not a question but you said -- i want to -- this is not a question pertaining to this

comment, but you said who cannot succeed in business if their only competition is the government. and i think that was in reference to the fact that you weren't worried about competing what the government your business and your business model and your plan and your entrepreneurship and how well you've done. american success story, i can tell you who would not be able to succeed in this country competing with the federal government. no insurance company, no private insurance company that offered a health care product could win and succeed against the federal government if they were not only competing but setting the rules they were on the playing field but also a referee. that's a real problem with this

situation with a public plan, a government default plan. and i'm sure my colleagues have talked about that in the time that i had to be away from the panel. but that's -- you may want to comment on that. but, you know, in regarding your patient, shirley healy, you talked about the need for the stint and what she went through because of what i would like to call and i think you described as rationing, when we had our first mark-up energy and commerce the other night in regard to hr 3200, the america's affordable health choices act of 2009, i asked the chairman and i asked my colleagues if they were as concerned as i was about the possibility of the government making medical decions and literally with all of this comparative effectiveness

research council taking the decision-making out of the hands of the physician, taking the art -- not just the science but the art away from the practitioner of that act, and so what i want to ask you is, if we go to this system as those 1100 pages now describe, without some significant changes and that becomes law in this country, what do you see for your business in regard to trying to get them access to care and out of that long queue and not be rationed out of the health care system? >> there are other countries who offer health care. isn't a week that goes by we're not contacted by hospitals in india and pakistan and bangladesh and phillipines and thailand. i don't want to be sending my

clients offshore. there are risks inherent to traveling to these countries. i have faith, however and i hope it's not misplaced, that while we canadians tend to go to the end of the line willingly and without grum bling, i don't see americans doing that. i have a higher regard to the american resistance being pushed around and remain kstd that there's going to be a way that people want timely delivery of health care that one way or the other they will work out a way to deal with the doctors. i would like to thing the american spirit is more -- or less willing to roll over and play dead. >> let me reclaim my time because i know we're getting short of time and the chairman is just giving me the signal. i think that the answer is if i could just xpound on your answer a little bit, that you certainly won't be able to send them to the united states any more because if we adopt this system

the same kind of problems they are trying to get away from, they will inherit when they get to their shores. i yield back. if we have a second round, i have a small business question for you. >> thank you, doctor. >> thank you mr. chairman, and thank you for your line of questioning. we appreciate that. i would like to ask a question of mrs. kerrigan. we know there is a mass shift in programs like medicare and medicaid and private shushs plans, private insurance plans essentially subsidize the under payments of government programs and according to a study by the act wear ral firm, this cost shifts results in people with private insurance s paying an

average of $1,788 more out-of-pocket every year. do you think this would change under the government plan option proposed by the house bill and wouldn't the government plan simply place further pressure on private insurance and employers leading to even more and more people dropping employer coverage to selects the government plan? >> in short, yes. with respect to the government option, the government is going to set the rules of the game. certainly they'll have a competitive advantage. they'll give themselves a regulatory advantage, and it will crowd out private insurance. more companies will leave the

market and more individuals will end up in the government plan. so, again, if government sets the rules of the game, the competitive game, it's going to be to their advantage. and what that means is that there's going to be few erin surers and more people going into the government option. i share your concern and your appraisal of what i see happening and it's not like we don't know how the government plan will be rub. we see examples and just heard from it from mr. baker what is taking place up in canada. we also have similar stories for the u.k. and europe and miss holmes, i know in a you have similar concerns. so, again, i thank you and the good news is that the american public, the american people and

the american voters are becoming more and more aware and as they are, of what is being overnight in these 1100 page plans that no one is able to read and we don't have a final price tag on, the more that are becoming aware of the more and more concern they are having. thank you very much for participating. i yield back. >> thank you, mr. chairman, i want to thank you all for being here and for your comments. my concern is obviously how chilling the testimony, mr. baker was about waiting lists and the effect on people and their health. my question is about the innovation that is necessary to deliver the highest quality care to patients.

and if dr. sikora is still listening, i would like to hear your comment as well. how do you see in the u.k. the ability to use new procedures to try new cancer therapies, for example, obviously those are often more expensive because they are new and untested, how do you see a national plan affecting the ability of physicians to be able to try these new treatment techniques, use the higher cost, particularly with regard to cancer and comparing the survival rates of cancer between the u.k. and u.s.? if you can comment please. >> sure, very good comparisons of drug use across european countries that were published just in january of this year. it's very clear that because of the way in which we whether a drug will be available through a cancer treatment through nice, the rationing organization in a

way, we're falling way behind over the last three years. and that means that over time cancer survival, which is already low in britain will drop considerably compared to the rest of europe. i think that the real issue is how you can get things moving. and i think that doctors, my generation of doctors have had the have felt the control over the destiny of patients and indeed their own destiny has gone down as the system has got far more concern with looking in the costs trying to rationalize costs and make comparisons, that's one of problems. it's individual freedom and that causes a lot of concern. the other problem you end up with and certainly i can see you have it in canada, regional variations, one patient may go down a refer path that allows access to certain drugs and expensive treatments, on the

other side of the street it may go down a different route and not get them. that's really a problem. the problem with government systems, i think, the lack of any incentive to move forward and embrace innovation, one thing your country has really done in self-technology. >> thank you, mr. baker, your comment on not only being able to get treatment but the quality of treatment with using the ability of innovation to find new ways to ce disease. >> i'll tell you a story i found chilling, i got a call from a gentleman in newfoundland. his father has a blood condition. he really needs bone marrow transplant. this is impossible in new foundland. but this is what would save his life. alternatively, having weekly

blood transfusions and doing this going on a year. the doctors recently told his son, you know, we're going to have to stop these transfusions. he said wouldn't my father die. yes he ultimately will. we can't give him transfusions forever and we don't have the money for him to pay the jurisdiction go to boston, for instance. the system in canada, will happen here too, the people that deliver health care become hardened and immune to these sympathetic stories that normally you and i would feel so sorry for people, they are hardened to it and learned to tell people, no, it's not available. you cannot have it. move onto the next person. and i haven't been able to do that in my own business but unfortunately i haven't had to because i have access to the u.s. >> i was surprised to find out

the medicine that's might be available to you depend on your zip code, where you live? do you understand that? >> each province has their own budget, they are their own taxes that contribute to these budgets. if the budget is gone and there's no more money, the only way is to cut off access to more expensive procedures. >> mrs. brown? >> dr. sykora, just last year i lost my husband to pancreatic cancer so i became very much involved in cancer treatment. and how -- i know you have an independent cancer facility. how many cancer facilities are there in great britain? >> sure, all together there are 61 cancer centers in the u.k. all of them within the nhs. we're just creating a private,

an independent system now and providing radio therapy and chemotherapy. what's been happening in the nhs, as i've said in my statement, the conservative generation a decade ago wanted to get competition between the independent sector and nhs and labor the same. they really pushed through under tony blair a very competitive way ford, which is resisted by other politicians to drive value out of the service. now it's sort of half and half and i suspect that whatever happens in our next will determine whether we get choice in competition or whether we have more of the same. and i think it's very difficult, the british public love the nhs and have a lot of -- does deliver to many very good care. the difficulty is it finds it difficult to embrace innovation and cancer, sadly pancreatic

cancer, there's not been new over the last decade. the speediness of getting the diagnosis, the speediness of which you@@@@@@@@@ @ @ @ @ @ @ we have a delay in the diagnosis because of lack of imaging. >> let me ask you a follow up question. there was a study that was done in brussels and i brought this to the attention of the doctors to make certain that my husband got the correct combination of drugs. if a patient comes to you after discovering a florida at that works and has been proven through clinical trials, if you are in the national health service, would you be free to use this system? to use this system, this protocol? >> not unless nice approved it.

or i can get special exemption from the primary care trust, the payers of care. canada a smaller country, obviously, we have 152 pcts that make decisions. obviously they are going to come to different decisions and that's the basis of zip code prescribing over there i guess. and it's one of things that causes such heart ache amongst cancer patients and their families because they can't understand why the doctor, can i have this? it could help but they won't pay for it. >> how long would it take for nice to approve a new protocol? >> up to three years. available to private patients and private medical insurers which cover 15% of the population, pay in a very good about paying, n.i.c.e. takes a

long time. if you long at the drug analyses they've done for cancer or others, it's thorough but time consumer. they seem pretty mean a lot of the times. my view is they seem mean but it's a matter of how you prioritize, on behalf of individual patients. >> doctor, as you know being an oncologist for three years, many times cancer means a death sentence. i don't think anyone wants that for americans or their family or loved ones. that's not what american health system should be all about. thank you for participating. >> mr. baker.

>> i have a daughter and her family who are living in london. i asked her a couple of questions about the health care system. it. and i asked her a couple of questions about the health care system there and i would like to ask if you have the -- any information on this. number one, she gave me a website that cancer post code lottery and explained the fact that in a zip code they run out of cancer drugs, even though they might have it three blocks away in another zip code, the people that live there cannot get access to those drugs. is that true? >> it's not quite they run out. it's because there are 152 primary care trusts that are independent decision makers. the certain drugs that have not been approved centrally, it's up

to each individual pct whether they'll approve it. whether they approve or not may depend whether they have the money and budget at the time of the year and whether they would rather support cancer than some other aspect. that's the problem in the system. >> i was speaking more of the allocation rather than what they had -- >> exactly. >> then we see, that, for example, breast cancer, the rate of cure is about in the 60% versus what we have a much higher rate here in the united states. >> doctor is that your impression? >> our numbers would indicate, if you have early detention of cancer in the united states -- >> absolutely. >> do you have any percentages on that. >> the early detention of cancer is greater in the u.s. than europe. i think that one of good things about government-run service, it can do prevention screening

programs very well. our breast screening program is a population based screening program based on call and recall. and it covers 90% of the population to come forward for that. that's been a tremendous achievement that can only be done i guess in a government service. but governments are great at prevention and education and screening, not great at delivery of care, that would be my observation. >> then there was another question that the expectation of getting these drugs, experimental drugs in particular with cancer, if a patient decid they want to have -- go to a private doctor in the uk, they can get access to these experimental drugs. they pay for them and they cannot go back into the public sector to get just the regular drugs. is that true? >> right. that's changed slightly.

last year, there was a review on what are called top up payments. exactly that. you have the regular drugs from the government nhs and then you pay privately so have what are called the top up drugs and that's been approved. our government did a u-turn during the autumn of last year and agreed that would be the case because there was a lot of an outcry that t people that want to top up their drugs, they pay for their taxes for their nhs. why not let them top up? the public didn't object. it was the idol gists mainly to the left of center that objected to this inequity. >> i think that was a good idea. probably that shows the power of objecting to things like that. >> exactly. >> and then just to other one is that with having to go to the private doctors, but my daughter said you can go to the public sector. you can get an appointment if you say have a rash on your arm. go to the doctor and they say,

yes, you need to see a specialist. you can get that first appointment right away but 18 months when you can get the appointment with the dermatologist. >> right. there are huge delays. the cancer they have been corrected but the trouble is you have to know -- you have to know you have cancer, a breast lump she will be seen and treatment started in two to three weeks but unfortunately the many illnesses, you know, dermatology getting a routine appointment as you say can take up to a year. and if that's the case, it is a melanoma, then you are going to delay a cancer diagnosis. >> and also access to a wait list on the website so i went on that and it was like for a hip replacement was a year. for a knee replacement, it was ten months. for a slip disk was five months. >> i think -- >> there must have been a lot of hits on it because it's been taken off the website. >> the wait lists have been

addressed. there have been a -- on the wait list, the target is 18 weeks and i saw the data yesterday, 90% of the population waiting for a surgical operation get treated within 18 weeks. but, you know, 18 weeks is still a long time and i don't think americans would wait 18 weeks for a lot of surgery that some of which could turn out to be cancer. >> i think you are right. i think we are well -- well, we are an impatient people and want to be given -- we are used to the health care system as working and being taken care of right away. thank you very much. >> mr. johnson? >> i got help from the aide over here. my family doc. you know, we're here today because our goal is to get every american in this country access to health insurance. however, i think everyone would agree not all health insurance is created equal. and based on what we have heard

today, health insurance does not equal access to health care. health care bill currently before the house creates a government-run health care plan that studies show will force over 100 million people into their -- from their current health coverage based on the testimony of our witnesses, i believe it's critical we talk about what kind of coverage the democrats in this congress are deciding's good enough. i think we would be disserviced to the american people if we just talk about getting more health insurance without discussing what type of insurance we're going to be forcing them into. miss holmes, i appreciate you coming here today to share your experience with the canadian health care system and you state over 5 million people in ontario don't have access to a family doctor. i got two questions for you. one, is the family doctor a fading breed up there? one. and two, i've heard town

lotteries give the lottery winner access to a physician. is that true? and tell me why it's so hard for people to get access to a doc. >> it is actually 5 million people in all of canada. 18,000 in the province of ontario so each province has different shortages of family doctors. family doctors are your gateway to any specialist, any testing. you cannot get anything without that family doctor. and so people -- and this is why, you know, people will say that, you know, patients are overusing or misusing the emergency room but if you go into a walk-in clinic or something like that, you can't often get referrals to where you need to go and why they're in emergency rooms. >> well, if they go to the emergency room, does that give them access to a specialist? >> if they'll see you. no, not necessarily. they'll treat whatever the instance thing is or sit there

for 12, 15 hours because, of course, it is triage and rightly so it should be. so, you know, there is a patient responsibility not to misuse the emergency rooms but unfortunately these people have no choice and so that, you know, and definitely we do have lotteries run in -- and we also now have a system where family doctors come in and interview you. and you have to go in for an interview and they can decide whether or not they want you as a patient. there was a very upsetting article in my opinion done in a magazine in toronto by a doctor. and he laid out how to be a really good patient. and to get accepted by a family doctor and the number one thing was to be nice. and quite often, you know, tell your friends. like, oh, can you see my friend? he is really nice. quite often when you're sick, you are not the nicest person if you're on a wait list.

i always try to credit myself that i have been nice so, however, i thought that was very, very sad. the other thing is there are shortages within them that, you know, you may only get a physical once every two years and when you go in to get that physical, you have to decide if you're going to have a top half done or the bottom half done because you can't do both. so when you walk through that door, you know, you're really trying to get the most out of that thing. a lot of doctors will say, one complaint per visit because they only get paid for that one visit so you can't say, well, i have a headache and i got an ear ache and -- you have to be very, very specific or else make another appointment. so -- and the other thing that's happening, too, is if you can't see your family doctor, if you're one of the fortunate one that is have a family doctor and something happens after hours or you can't make a daytime appointment, can't get in or too long to see them, if you go to a

clinic and you go -- some doctors make it as much as three times. some doctors make you seen a piece of paper that you just go once. they can drop you as a patient. so you have a contract with them. >> top half or lower half? >> yeah, yeah. i know. it is -- you know, i feel terrible because i have the most wonderful family doctor and that's been the hardest thing for me. and this whole thing about me speaking out has put a tremendous pressure between myself and her because everybody will lay blame on who did the right thing, who didn't do the wrong thing. you know? and it has been considered that the backlash that i'm getting from the canadians about being here speaking out is that i'm an embarrassment and i am anti-canadian. and i think that it's so sad because i think canadians should be embarrassed that i have to be here talking. i think even if one person from

parliament, from o-hip, from any place of position, the doctors that let me down and apology from one of them would go a long, long way. >> you know, we are having trouble getting family docs in this country, too. dr. sikora, as a health care provider in the national health service for 37 years, i know what you think about health reform. i have heard many tostories of england. as a matter of fact, when i was stationed there in the air force, my son got sick and we walked in to a waiting room with twice the number of people that are in this room and i walked up to the counter and they said, are you paying? i said, yes. come right in. i saw the doctor and i wonder how many docs are taking advantage of private pay over there. is it still an option? and yet, you know, even with the private option available, it seems like the statistics show

that cancer's worse over there than it is here. can you discuss that? >> right. yeah, no. i think that the nhs has separate system to the private system on@@@@@@@@@ @ @ @ @ @ this is kept separate from the national health service. they have them three days a week, and they have the private sector. this was allowed from the very beginning, from 1948. i think that the problem right now is that technology has moved on, and they are treating cancer. this is 18, including the rehabilitation. -- a team, including the rehabilitation. you have to divide the private and public. but i think the problem governments have is this

inability, government-run systems have the inability to meet innovation. to head on. because all the time you're fire fighting to try to keep up with the targets you're being sent by the waiting time targets, going up and trying to sort of fight those. at the same time, you have new technology coming at you and the managers some of whom are very capable in the nhs spend their time doing the here and now are not looking at the strategic development of the service because of the pressures on the media sy and that's a big problem. >> mr. shaddock? >> can you hear me now? thank you for holding this hearing. i think it is tragic. i serve on the energy and commerce committee and we have not heard testimony anything like this in that committee and it is important for the american people to hear the facts brought out at this hearing and understand them before we make,

quite frankly, drastic, shocking changes to the current system and i want to thank the witnesses. you are doing a great service. i think a service not only for the united states and for the american people who need to know this information but for those of you who are not americans, dr. sikora in england and the two of you here who are canadians, you may be being criticized back home but we can improve all the systems. the canadian system is looking at improvement and your testimony here is vitally important. ms. holmes, i particularly want to thank you for coming -- my friend from minnesota won't appreciate this. i want to thank you for coming the clinic here in arizona. the mayo clinic in arizona. i have gone out there and talked with the doctors at arizona. i do represent phoenix and they were deeply concerned about this level of reform and as you know the clinic spoken out and said this -- while the american system needs reform, this is not the reform we need. i want to ask you. your personal experience dplon

straited both the failure of diagnosis under a state-run program and getting the services you need, as well. >> that's right. what happened to me and this is why i feel my particular case is so genuine because i took three stabs at the system for the same problem. so what i did was i couldn't get diagnosed so i department know what i had. i knew i had symptoms and i was fortunate because quite often when you have a tumor inside you, you don't know what's going on. i was fortunate there was very obviously physical things that had started to change with me and the most obvious was my eyesight. and so when i traveled down to the u.s., it was boom, i got a -- all the diagnosis. the thing i found so remarkable about the mayo clinic and i have -- i cannot say enough about the treatment that they give. was that the cooperation that they were prepared to work hand in hand with canada.

the amount that they were prepared to go in order to send me home for treatment. and to stick their necks out to try to get me help back at home. i came home. i had that diagnosis and it was -- i think more to their shock than anybody else that i was back on their doors three weeks later saying we need to do this. let's go. they never, ever looked at my bank account. they never said that, you know, i'm -- can you afford this? like do a credit check. absolutely nothing. >> thank you. >> and i think that's important. >> i really appreciate it. miss kerrigan, quick question. i assume you're an advocate and have been for many years and read substantial portions of the house bill. i was shocked last night. the president said a number of things in his remarks. i don't think he addressed the real concerns but one of the things he said point blank the reform we are proposing will keep the government out of health care decisions.

is that an accurate or fair or even reasonable characterization of at least the house bill? >> um, no. i mean, in short, no. you know, the -- if you just look at the, you know, what is being set up from a federal government perspective in terms of, you know, all the different departments, all the different offices, the health care -- new health care choices commissioner, you know, the amount of regulations and just really i think the amount of specific regulations that will make decisions in the system, you know, it's quite extraordina extraordinary in terms of the level of intrusive and also the level of intrusiveness of -- >> the chairman cuts me off. dr. sikora, i would like to conclude with you. the cancer statistics are pretty stunning. i've lookedality them.

if you look at the five-year cancer survival rates in the united statesf you look at breast cancer, prostate cancer or cancer in general, in all three categories, at five-year survival rates, the united states beats canada quite dramatically. it beats europe overall by an even wider margin and it beats england by an even wider mar yin than that. i'm looking at the concord and euro care study for breast cancer. the united states five-year survival rate is 89.5% t. european rate is 73.1%. and it shows that the survival rate at five years for breast cancer in the uk, is 69.7%. as i listen to your earlier testimony, i think you used the word falling way behind. >> right. >> some i believe here in the united states say, well this,'s not because of the system. but i think i heard you say it

is in part because of the system both because of delay and because of access to drug or treatment. drugs or treatment. could you expand on that? >> yeah. i believe -- i'd be studying this for 25 years, looking at why we're high. there are many factors and they're different in different cancers. interesting thing about our statistics, looking at the common cancer, the four commonest lung, breast, prostate and co-lung, that's where we're ahead. looking at leukemia, testicular cancer, we are not falling behind. it can be the best care in the world for certain conditions. what it's bad at is cancers common and require access to general health care. so these common cancers you need to be diagnose niced, have access to imaging, a specialist and all takes time and then access to radio therapy and good chemotherapy and may not be available for all cancers so i think the reasons are very

complex for individual cancers but it's a total system problem rather than an individual cancer or individual skill problem. we have the skills. we have got the knowledge. it's just the system doesn't allow patients to come at the right timely fashion through it to get the best possible care. >> i thank you very much for that. i hope the american people get to know those facts before we're forced to vote. i am just seen a report that says the speaker of the house is at least it appears to report going to pull the report from the commerce committee to get a vote next week. i don't know why the rush to judgment but i want to thank you mr. chairman and thank the witnesses. these are the facts the american people need to know before we vote on this kind of legislation. >> doctor? >> thank you and thank you for doing this, for people who aren't aware, i guess this is the only active health hearing on the house side that's going on right now even though we are told we're under a tight time line and shown -- i know i heard

your testimony before and always moving. i don't think i'd ever quite heard that wrap-up you gave about no one down here checking your bank account. and damn it, the president called us out as doctors saying we're not seeing flat peopl-- p. that's flat wrong. in spite of abysmal reimbur reimbursement rates there in the public sector so thank you for saying that. you forced me and i'm glad you did. dr. sikora, can i ask you a question if you could and the chairman has a tight gavel here, i know. can you delineate some of the differences as you're aware between the medical justice system in your country and ours? >> yeah. it's regionally organized and there are thorough path allows very little choice. your go do a gp referring you down a route that the primary trust -- >> but as far as if someone gets

in trouble and there's a bad outcome and a lawsuit that results, how's it different in the uk than in the united states? >> we have much more -- much lower levels of litigation. patients are much more compliant with the system because that's what we've been brought up with and used to. i think there's very little lateral. patients don't feel they've got the right to get second opinions, the right to move to a different -- choose a different pathway. >> is there a difference in the contingency arrangement, the fee arrangement that exists in the uk and the united states? >> there are. for medical litigation, you mean? >> yes, sir. >> there are. it's coming. it is interesting how the two systems coming together in terms of medical litigation and here it is going up considerably. >> we're glad to export it to you. unfortunately, we retain our own. >> thank you very much. >> let me ask you about question. you talked briefly about the inability to meet innovation and then in answer to a question of

jenny brownwaite, you said not much has happened in history of the cancer of the pancreas and are there areas of medicine where you see a stagnation of research? >> i think it's when there's innovation, obvious one that affects many, many people is angioplasty for coronary artery disease. after someone suffering from a heart attack instead of delay, you go to a center to do the angioplasty and the patient walks out two days later and problem solved, at least a few years and now that availability of that and the introduction of that was enormously slow in our system. whereas in many systems we have this choice in competition. those providers that can introduce the innovation, patients want to go so -- >> interesting. >> they want to go a place they can't get the innovation. that's the market and choice in competition and lacking in a government-run system. >> we are accused of overroute

lizing that. you referenced the fact about budgets. and i don't know that people quite understand. when we're compared with canada, the canadian system is on a budget and when the budget is spent, the budget is spent. our public system, we have a much larger public system than you do, it is -- you send us a bill and we pay it no matter what. we may reduce the amount but there's no upper limit on the system. we just pay whatever comes across the counter. can you speak to that for a moment? >> well, the budget in canada each hospital has a block budget at the beginning of the year. they're given, let's say, $6 million. it's irrespective of how many people come, irrespective of the acuity of their problems, you must treat everybody within this budget. we don't care how you do it, just do it. well, that's an impossible task. how can you set a budget without knowing how many patients you will have? without knowing what their

complaints will be. it's an unworkable system and we've seen it's not working. >> is there a contingency pool of funds that a hospital can go to if a patient like shona walks in after the money is spent? >> i'm not an expert on the budgets. i know that people do not get turned away. normally. if they have urgent conditions. but i will tell you that there's some conditions which you and i would, say, are urgent such as urgent spinal surgeries in the town of edmonton, alberta. you cannot get an elective spinal surgery because they don't have funds to pay it. the only way to get a spinal surgery is go through the emergency ward. if you come to the emergency ward and you have soiled your underwear, you will get service. otherwise, do not get it. >> thank you.

>> well, thank you, thanks to our panel. dr. sikora, thank you for being with us from the uk. shona holmes and richard baker from canada, karen kerrigan. thank you for your efforts. just a couple of concluding points. one is we've worked hard for alternatives we think makes the system work better. dr. sikora said repeadly praise that we've been using. i'm not sure i have it as concise as he did when he consistently said competition and choice drive value. we want more market factors in the system. more choices. more opportunities to choose your doctor. more opportunities for you and your doctor to choose your health care determinations. but we think we can have a system where people have many more choices than they have now. karen kerrigan talked about that as she has and small business folks have for years, opening up

this system where you have all the choices you have now but you have choices beyond that. and inside the health care system itself, things like medical liability reform, more health care transparency, more health i.t. all save money there, as well. we want to see personals get better health care with -- and pay a price they feel better about because it's driven by competition and choice. what we don't want to see is the elimination of choice and to come to the kind of government-run system that we have seen discussed here today. and not just in canada and the uk, but in any country that has a government-run system. they all have rationing. they all have lines. they all develop a two-tiered mechanism. that's not what america wants and we'll continue to come forward with alternatives we think solves these problems instead of make the problems better. so to my colleagues, to the audience here that patiently

stayed with us through votes and mike phone challenges and other things, and particularly to our panelists, and particularly those who traveled or stayed up late, later in the evening in great britain to be with us, we're grateful to you. >> thank you, doctor. we'll hang up the phone here. thank you more your patience. -- for your patience. >> in a few moments, the memorial service for longtime cbs anchor man, walter cronkite. "washington journal" is live with robert gibbs, sherrod brown and newt gingrich.

the house will be in session at 9:00. they will talk about labor and health and human services. >> the house financial services committee continues hearings this morning on financial regulation. they will hear from the treasury secretary and head of the federal reserve. this will be on c-span 3 at 10:30 eastern. >> on q and a, susan jacoby on the trial of alger hiss. at 8:00 on c-span. >> friends and colleagues a-- coleagues paid tribute to walter cronkite. this service is a little bit over one hour.

>> i am the resurrection and the life, sayeth the lord. he that believes in me though he be dead shall live. and who believeth in me shall never die. i know that my redeemer liveth and that he shall stand at the

latter day upon the earth. and though this body be destroyed, yet shall i see god, and my eyes shall behold. and not as a stranger. for none of us liveth to himself, and no man dyeth to himself. for if we live, we live unto the lord. and if we die, we die unto the lord. whether we live or die, we are the lord's. blessed are the dead who die in the lord. even so, says the spirit for they rest from their labors.

welcome to st. bartholomew's church and the celebration of a great life. let me ask you a couple of favors. one, please turn off anything that makes a noise. two, please abide by the wishes of the cronkite family that there be no photography or audio recording. i will ask you to find a hymnal and join in the singing of hym 608, chosen because this is the hymn for sailors. eternal father, strong to save. ♪ ♪

[singing] ♪

♪ oh hear us when we cry to thee, for those who peril on the sea ♪ ♪ and hushed their raging at they word and who walked on the foaming deep and calm amidst its rage didst sleep oh hear us when we cry to thee oh hear us -- for those in peril on the sea most holy spirit

who didst brood upon the chaos dark and rude and bid its angry tumult cease and give, for wild confusion, peace oh hear us when we cry to thee for those in peril on the sea o trinity of love and power our family shield in danger's hour from rock and tempest, fire and

foe protect us wherevesoever we go thus everymore shall rise to thee glad hymns of praise for land and sea ♪ the lord be with you. let us pray. oh god, who's mercies cannot be numbered, accept our prayers on behalf of walter, and grant him an entrance into the land of

life and joy in the fellowship of they -- thy saints. with jesus christ who liveth with thee in the holy spirit. one god now and forever. amen. please be seated.

>> let loath be genuine, hold fast to what is good. outdo one another in showing honor be ardent in spirit. serve the lord. rejoice in hope and be patient in suffering. extend hospitality to strangers. bless those who persecute you and bless and do not curse them. rejoice with those who rejoice, weep with those who eep. d-- weep. do not repay anyone evil for evil but take thought for what is noble in the sight of all. if it is possible, live peacably with all. never avenge yourselves.

leave room for the wrath of god. vengeance is mine, i will repay, sayeth the lord. if your enemies are hungry, feed them. overcome evil with good. the word of the lord. >> praise be to god. >> the 23rd psalm. please read along. the lord is my shelter, i shall not want. he leadeth me beside still

water.s -- waters. he restoreth my soul. yeah, though i walk through the valley of the shadow of death, i will fear no evil. thou art with me. thou preparest a table for me before my enemies. my cup runneth over. surely goodness and mercy shall follow me all the days of my life and i shall dwell in the house of the lord, forever. >> a reading from the gosphel of

mark. on that day, when evening came, jesus said, let us go to the other side. leaving the crowd, he left them an there arose -- and there arose a fierce wind. jesus himself was at the stern. they woke him and said, do you not care we are perishing. he said to the wind, hush and be still. and the wind became calm. he said, why are you afraid? do you still have no faith. they said, who is this, that the wind and the sea obey him? the word of the lord.