authors about summer releases. these include haynes johnson. they will be taking your calls, e-mails, and tweets. >> pennsylvania senator arlen specter met with constituents about health care legislation. this will provide our event was near harrisburg. >> good morning, ladies and a gentleman. thank you for coming out this morning. for the past three decades in august, when the senate is in recess, i made a practice to have town meetings. i will make a very short opening statement for about five or seven minutes. . .

and i'm looking forward to a civil discussion. where we have ideas and freedom of speech is a precious commodity in america, and freedom of speech means to express yourselves, but if somebody else wants to express themselves, to have quiet and

decorum and civility so we can exchange ideas. there are a great many subjects of importance in washington today. we're working very hard on global warming, the president has put immigration on the agenda for later this year, we are working on judicial nominations and confirmation of supreme court justice sotomayor. we are working hard on the issue of economic recovery, and there are already some positive signs. but it is too early with less than six months on a two-year program to really know. the preliminary indications are positive. but they are tentative.

it is understandable that there is a lot of concern in america about what is happening in our country because of the loss of more than 4 million jobs. people are losing their health insurance. there is uncertainty of the future, concern about the large deficit, concern about the large national debt. after being in touch with 12 million people in pennsylvania for meetings, calls, letters, there is a lot of anger in america. there is a lot of cynicism about what is going on in washington. the best way to deal with it in my opinion is to have meetings like this one where i tell you briefly what is happening, but

rely principally -- is a big issue in america today. people are very concerned about what is going to happen. i know that you do not want to add to the deficit. the president says he will not sign a bill that adds to the deficit, and i will not vote for a bill that adds to the deficit. [applause] we know that preventive care is very important. and one of the requirements for insurance is going to have to be you have the have an annual checkup. if you have an annual checkup, you'll catch a lot of problems early on.

i am a beneficiary of early checkup on medical problems i have had. there is a lot of question about medical care that members of congress have, and we want the same kind of care for everybody on a matter of choice. if you like the plan you have at the present time, you can keep it. we're talking about a government auction, a public auction, we are debating it. so far, no bill has passed the congress. in the house of representatives, five committees have passed bills, but the house has not passed a bill. in the senate, we are still working on a bill, trying to get bipartisanship. i know the american people are sick and tired of republicans and democrats fighting. and the american people would like to see some bipartisanship

and coming together in the public interest. and whether we will have a public auction, we have talked about single payer, everything is on the table in my opinion. we ought to be flexible and let's see how it works out. we want to stop insurance companies from denying coverage on pre-existing conditions. we want to eliminate the so- called done knotholes for senior citizens -- donut holes for senior citizens. everybody is paying an additional thousand dollars, a hidden tax. when people go to the emergency rooms, taxpayers and up paying for it. we want to solve that issue. these are all very important matters.

6.5 metz's as long as anybody ought to talk. -- 6.5 minutes is as long as anybody ought to talk. we have distributed cards on a first-come, first-served. that way, people can ask questions. who has card number one. if you want to stay and all hall, we are not going to tolerate any demonstrations or any booing. it is up to you. >> i'm sorry, i don't really have a question. my concern is, i am angry. i am a voter and a taxpayer. i do not like the fact that my elected officials are running around calling me un-american, and rabble-rousers', [applause]

i am sick of allies. i did not being lied to. i'd not being lied about. this administration is doing both of those things. go back to washington d.c. and tell the people what the president said i should do. shut up, get out of the way. [applause] >> i am not calling you a rabble rouser. we had a session the week ago on sunday, nine days ago. the secretary of health was there, and some people were talking about it being organized. i said, and america, people have a right to organize. if it is organized, that is

fine. you have a right to freedom of speech. i make a point to lay on the line. their entire career, i am known for it. who has number three? >> i appreciate your time and your courage to show up today. [applause] i want to first tell you that i am here of my own free will and accord, not with any organization. it eliminates the private option. this hurts capitalism to the creation of monopolies. what are you specifically going to do to ensure that the private option is there and viable? >> the plan will allow people

who have insurance coverage on the present time for their employers or individually to maintain their current policy. if you like your policy can keep it? -- if you like your policy, you can keep it. >> [inaudible] >> the question is, if the policy changes, it creates a new program. first of all, there is no bill in the senate. >> what is your specific plan to ensure [inaudible] they will only vote if this [inaudible] >> how can i be sure that we will have a private auction or a public auction? you want to have a private auction, you will have it.

you can maintain your current policy. if there is a change, you can have a modification of the policy in public auction -- a public option is just that, an option. when you say public option, you have exchange through private companies. this country is a capitalistic country. and free enterprise. [applause] >> [inaudible] >> you want to be led out of

here, you're welcome to go. wait a minute. wait a minute. wait a minute. >> he is traveling on my rights. >> wait a minute. he has a right to leave. >> [inaudible] >> wait a minute. you want to leave? leave. >> i am going to speak my mind a bit for leave because your people told me i could. i called your office and i was told i could have our right to speak. and i was lied to because i came prepared to speak. instead, you wouldn't let anybody speak. you handed out what? 30 cards? i have news for you.

you and your cronies in the government do this kind of stuff all the time. [applause] i don't care how damn corrected york, -- crooked you are. he will keep the citizens of this country. i will leave, and you can do whatever the hell -- one day god is going to stand before you and judge you and the rest of your damn cronies up on the hill. [applause] and you'll get your just desserts. i'm leaving. >> ok. we have just had a demonstration of democracy. [applause]

when the gentleman says he is dissatisfied with the procedure, we have to figure out some way to have an orderly procedure. an hour-and-a-half is a fair amount of time. we had a lot of notice that there would be a lot of people here. and we had his comment, and i made a decision. even though he did not have a card, to let him speak his piece. if you wanted to leave, he has a right to leave. when he says i am traveling on constitutional rights, i have to disagree with that. i am encouraging constitutional rights. i am encouraging constitutional

rights by coming to lebanon to talk to my constituents. i can be somewhere else. i don't get extra pay, i have no requirement to be here. [yelling] i am reporting to you. no. 4. you have the floor. >> i do not want to pay on a health-care plan that includes the right for a woman to kill her unborn baby. is it true that this plan is in the healthcare bill? >> her question is, will there be payments for abortions in the healthcare bill? first of all, we do not have a bill and the seine at, as i said -- in the senate, as i said.

what we're looking for is to have both options. if you want to have a health care plan which does not have payments for abortions, you can have that one where you will not be charged for somebody who has an abortion. if you want a different health care plan, an option where you can have payments for abortion, and you pay for it because it will be a little bigger premium, you have the choice of being in one plan or another. nobody has to be in a plan to pay for somebody else's abortion? >> president obama stated more than once that his goal is to have a single payer system. are you for a single payer system, and will you vote for a bill that will make a single player system either through the bill or in the future? >> i am prepared to keep single

payer on the table as a matter of consideration and flexibility. [applause and boos] when we are in the formative stage of figuring out what to do, we ought to consider every option. we ought to hear the people out. the public opinion polls are high in favor of single payer. [yelling] ok. ok. well, i guess you can get a poll about any way you wanted. my idea is to keep the public auction on the table, to keep single payer on the table, to get a sense in america as we are going to be debating this all month, with meetings like these, and figure out what the american people would like to have.

i am flexible. who has number six? >> i love you, buddy. that's ok. thanks for being here today. i have reviewed the 3200 best i could. to me, is obviously written with the assumption that government has the right to control our lives from prebirth to death. for that reason, it is not worth considering, it is not worth modifying, it is not worth amending, it needs to be dumped. [cheers and applause] i believe the polls show that most people are happy with their health care. there are a few problems. the early goals him -- and the illegals. they shouldn't even be here. i would ask congress to do

something to send them home so we can't -- so we do not have to deal with them. there are people that cannot pay for the service when they get the service. we should not have to provide for that. there are some people who are both evidence late -- it like to have care and are unable. president bush used to say help those who can't help themselves. let's focus on those minor problems. let's focus on tort reform, focus on helping people carry their coverage over to a new job. but leave us alone. and that's all we would ask. leave us alone. [applause] i would like to ask you today if you would commit to working on those problems rather than throwing everything into turmoil? [applause] >> well, what i commit to

working on those problems and not throwing everything into turmoil, that is a pretty generalized statements that i can agree with. stan touch, i will be back next year. if i am reelected, i will be back the year after that. who has number seven? >> thank you for coming, arlen specter. >> let me answer more fully. i do not want to see tomorrow, we want to have a sense of an answer. we have a series of problems. i want to take them up one by one. we want to figure out what the problem is, and what is the way that we should deal with them in a democracy. >> [inaudible] >> i am not familiar with 3400,

let me move on. >> i am a republican, but i am a conservative. i do not believe this is just about health care. it is not about tarp, left and right. this is about the systematic dismantling of this country. i'm only 35 years old, i've never been interested in politics. you have awakened a sleeping giant. that is why everyone in this room is so ticked off. i do not want this country turning into russia, turning into a socialist country. [applause] my question for you is, what are you going to do to restore this country back to what our founders created according to the constitution? [cheers and applause]

[yelling] >> there are few people who did not stand up and applaud, but not too many. i get a fairly firm message from the support you have, young lady. when you ask me to defend the constitution, that is what i have been doing. we have had warrantless wiretaps that i have objected to. we have had citing statements that undercut what the legislature has passed. we have had supreme court nominees who i have insisted follow the constitution and not

make law. in our social compact, we have provision to see to it that we take care of people who need some help. >> but the good parts of the people will do that, not the government. >> we have many people who are in need of assistance on health care. i have a number of people with me today to have very tragic stories to tell about their own situation. but we want to maintain constitutional law, and i am committed to doing that. next number, number eight? >> #9. >> i got it.

>> thank you for coming, senator. i would like to ask you a question -- could i see a show of hands in the room, sharing our views with our elected officials [inaudible] >> do have a question for the senator? >> yes, i do. >> can i see a show of hands of the people who believe we have the right to to share our views with our elected officials? take that to nancy pelosi. i would like to state that i am in opposition of this health care. the government hasn't done anything right. someone asked you the question, with social security bankrupt,

medicare bankrupt, medicaid bankrupt, you're taking our kids' future and driving it right into the toilet. we cannot afford this. keep the government out of it, we are doing just fine. [applause] >> well, i have made a commitment here today. i will not vote for a plan that adds to the deficit. next question, no. 10. >> i want to tell you that i have spent two weeks on my own trying to read that bill. trying to understand it. it is like a russian novel. in the bill itself, it says many times the requirement for plain language. i can cite you the pages and the

line numbers, because i had it up on the computer. it is very difficult to understand. this is the most important bill in my lifetime. and my granddaughter will pay for this bill in its present form, whatever form that is. i have three very important concerns that i need a share. one is, obama talks about 600 billion, the congressional budget office talks about $1.10 trillion. i have spent 40 years in government, and i have never seen a program command at the right price and stay at that price. [applause] secondly, all of that bill says nothing about abortion or reproductive rights, i have read that very carefully. there are nine amendments in the senate and house which have

attempted to prevent tax payer funding in that bill, rejected. senator coburn, and representatives gingrey have all been rejected. what does the bill say? there will be no health care until you are born. while the baby is in the mother, we do not count that as a person. medicaid and ship will only cover at the time of birth. >> [yelling] >> these are not talking points, these are my own. i have one other thing. i have spent many years in information technology. you are about to concentrate more information about more

pennsylvanian and americans in this bill in one place that has ever occurred. in fact, the congressional budget office says it gives you the right to enter, using our internal revenue service, and page 58 talks about entering our own accounts, because financial responsibility has to be ascertained. my final comment is this. massachusetts has tried something like this. tennessee has tried something like this. why don't we take a look at what has worked and what has failed their? maybe start it in a blue state. give it all we have got in one state. don't concentrate all this power and the bureaucrats and their computers in washington. you will be gone. the bureaucrats will still be

there. we don't know their names or faces, but they will be making our decisions for us and for my children her and. [applause] >> when you raise a question as to cost, i can only repeat the commitment not to add to the deficit. when you talk about abortion, the law in the united states says that public moneys cannot be used for abortions. >> that does not apply here. [inaudible]

>> i heard you out, let me respond to your points. the senate bill has not yet been written. i do not believe there'll be any change in the amendment. this lady asked a question about whether people would have to pay in a health plan for somebody else's abortion, the answer is no for the reasons i gave her. when you talk about massachusetts, we are studying their plan very closely. with respect to privacy, we will do everything we can to stop people from breaking into the files. no. 11. >> good morning, senator.

i am a public schoolteacher. i am looking at the sunday patriot news, front page. reading the bills requires expertise. at one of my roles as a teacher and an educator is to teach my children how to think, how reid, and how to understand. and over 100 years ago, we had a gentleman who was a republican at gettysburg say, we will provide the understanding, government of the people, by the people, for the people shall not perish from the earth. the editor says, and they cite this hr32, which is a complete hocus polkas mumbo jumbo. the article, the social security

act, and it goes on. since this team has been in washington, there has not been a thing written in the house, and the senate, that we as average pennsylvanian s, average americans can read and understand like you can read and understand and interpret what has been done. the last cap-and-trade had a pencil marks in it. if you wish to be remembered by the american people, when you get back there, sponsor legislation that requires every house and senate bill to be written in a junior high school level.

that is what we need in america today. [applause] >> i'll try. no. 12. >> good morning, and welcome to london on, pa -- lebanon, pa. will you ever vote for a bill that gives non u.s. citizens access to a taxpayer paid free health insurance? >> i will not support a bill which gives health coverage to illegal immigrants. [applause] #13.

who has 13? >> a good morning. president obama and you have constantly stated that we will be allowed to keep our current plans. but how can we keep them if they don't exist? more specifically, hr3200, why does this bill impose a payroll tax on employers who won't use the public auction -- option? how many workers will work for the payroll that exceeds $251,000. what will happen to them when employers drop their coverage because they can't afford a payroll penatly tax? [applause]

>> the tax is going to be directed only to the companies which do not have health coverage. we are not going at a tax to companies that have health care. so that as represented, if you like your current plan, you can maintain it. >> [inaudible] >> let me say to you that i will not support a senate bill which has that kind of requirement. [applause] who has the next question?

>> 14. 15? 14 is back there? >> i am from lebanon, thank you so much for coming. i also have been working in health care for the past 30 years. my husband works in health care as well. when i graduated from nursing school, i remember dealing a lot with a lot of the issues that our country does not have a wonderful preventative health care measures. those lead to chronic diseases and utilization of money in the wrong way. i am here to say i am happy you are dealing with health care reform. i think it is something that our country needs. i realize there are a lot of people here who do not feel that way, but there are a lot of us who do feel that way.

[applause] >> we are struggling with a microphone here. i feel like i am all wired up. thank you for your positive comments. i knew that level -- if i looked hard enough, i would find someone who like to the health care plan. who has the next number? >> [inaudible] >> good morning, senator. i would just like to tell you that i am here on my own accord, nobody paid me. i'm not part of the astroturf group. it is all grass roots.

my question for you today is, i agree with the woman over here that as indicated, there has to be some work done that our health care. unfortunately, it is not this bill. it is not this bill. [applause] >> what would you like to see done? >> some of the things i would like to see done, ok? tort reform. yes. i lost my train of thought. some of the things that are in our current bill i do not necessarily like you have addressed already. one of them was non u.s. citizen health care. you have indicated they you will not vote for bill -- a bill that has non-u.s. provisions in it.

i recommend that we do with the state of new york does for the homeless. we can take to the non u.s. citizens and give them an airplane ticket and ship them back. [applause] in addition to the bill, you indicated that we will always be able to go back to our original health care. my health care is not much different than yours as it stands today. i can hire and fire my doctor if i please. unfortunately, there is page after page of this bill that appears to go to a single payer system. there is the if factor. what we want is trust, and apparently in washington d.c.,

there is no trust. the american people and not like what is going on. [applause] senator, in the twilight of your career, -- >> absolutely not, go ahead. >> one of the things you could do to make it extremely memorable for yourself is to go back and propose a bill for term limits. [applause] >> listen, the people of pennsylvania can impose term limits on me anytime they want

to. that is democracy. who has got the next number? 16, you are up. >> i have a question on page 58 and 59 of this bill which gives the government access to private individual bank accounts at their free will. we work long and hard for what we have. if i want to spread my wealth around, it will be to my children, grandchildren, to my community, a church of my choosing. i do not think the government has the right to do that. i have to brush up on my constitution, but i believe it is unconstitutional. i know definitely is un- american. you look at that when you go back. sir, i really think you need a vote like an american. i think you need to vote no on

this bill. >> i will not support a bill which gives the government the right to get the bank account information of a private citizen. the lady has cited a house bill. to repeat, we have not gotten a senate bill. i am telling you that i will not support any bill which gives the government to the right to find out what any citizen has in his or her bank account. who has the next number? who's got no. 17? >> good morning, senator specter. i was a republican committee

person that we supported you -- you defected. why didn't you come to the people before you switched over to democrats? that is not my problem. the right of the people to be secure, houses, papers, and effects against unreasonable searches and seizures shall not be violated. there are some many problems with this obama government. when i was elected to public office, i agreed to support and defend the constitution. i have always tried to do that. people came here for liberty and freedom. our freedoms are going, constantly. i am wondering what you can do

about that? i have some in questions, i do not know about the automobile takeover, tarp, and what about this guantanamo closure? i don't want these criminals to come into our area and escape, and we find that a bunch of innocent people have been murdered. that is what is going to happen. did you ever read the quran? >> no, but you have a right to read it if you want to. >> it says that all unbelievers shall be executed. i cannot support is long. -- islam. i believe in the jewish, hebrew, christian philosophy.

i support that, not any other direction. if someone wants to read it, -- i can find it for you. >> the gentleman talks about destroying the christian, judaic order. there is no doubt that there is a problem with terrorism, and the threat that we saw carried out at 9/11. on the issue of guantanamo, the congress has spoken to insist that guantanamo be kept open until there is a plan. there are some in guantanamo have to be tried in federal courts. if you have to be tried in federal court, that is in the united states. there are ways with maximum

security to see to it that there will not be risked. guantanamo is still open, and it will be open until there is a plan to be carried out which will protect american citizens. no. 18, on the way to 30. >> good morning, senator. house resolution 3200 sections 401 subsection 59da proposes a tax on persons without acceptable health care coverage. define acceptable. at second, wouldn't you agree that every american has the right to choose their own coverage based on cost and terms? would you vote for a senate bill that has this same provision? >> the provision cited imposes

a 2.5% tax on people who do not have acceptable health care insurance. that is too vague to have my support. today to have my support. who has the next number? 19. 19? yes, sir. >> i want to know why the government feels like they have to buy a car company that makes cars that nobody wants. [applause] >> that is the most succinct question of the day, i want to give you an award. why does the government want to help a car company that makes cars that nobody wants? there is no sensible answer to

that as framed. but let me take a look at it. we are trying to get all the people who are employed by the manufacturer to keep a job. we're trying to keep all the people who have supplies to general motors and chrysler in pennsylvania, and there are a lot of people that we try to keep at work. we tried to keep a lot of dealers open to give a lot of jobs. we tried to do that by directing general motors to stop making cars that nobody wants to buy. and we are trying to restructure what they are doing. it is a tough balance when you have the automobile

manufacturers in this country going down, ford has been able to make it. gm and chrysler have not. let them fail. it may have gone through bankruptcy -- they have gone through bankruptcy, but the calculation is, it can be saved, and we are trying to do that. no. 20. here you are, go ahead. >> this is my question. you can feel the tension in this room. you can understand that people are upset. do this. let us know who is writing these bills seeing as you do not have time to read them. why don't you let us know what their political affiliations are. why don't you let us know whose

feet they sat at? why don't you make that public? and do this, please. if you guys think that we want health care reform cell -- so bad, let's have a referendum in 2010. how does that work? [applause] >> well, that is a fascinating idea to have a referendum. we don't have any mechanism for it on the federal government. they have them in california. >> you can start it. >> that is one of the ideas i am going to take back to washington. a referendum. [applause] who has number 21?

>> i am here because he sent me the invitation. i am not american. i am here for my children. my daughter is 16. my son will be 20, he'll be going back to college as a premed student. he's a president obama will not allow the health care plan to add any deficit, and the initial cost is over $1 trillion for a down payment. who is going to pay for this bill, and how do expect my son, working his way through college, and my daughter who will be going to college, and you're not going to tax the middle class people that would be my husband and myself who is out working for our health care today? my children and my grandchildren are not -- are going to pay for this bill. how can i tell them that that is acceptable? [applause]

>> the plan to keep it deficit neutral is based on specific savings, for example, medical research at the national institutes of health which i have sponsored has cut down the mortality of breast cancer and on stroke. i was the beneficiary of chemotherapy developed by the national institutes of health which have saved the lives and saved money. there are requirements for physical examinations on an annual basis. if you had a physical exam, you have early detection on things like heart disease or ovarian cancer, or any line of problem.

if people have early detection, they do not develop chronic illnesses which are very expensive. one of my ideas based on the district attorney of philadelphia is to insist on jail sentences for people who engage in fraud, medicare and medicaid -- qc people being convicted and they get finds, -- fines, which is just another license to do business. these are provisions that are built and that will provide a very substantial savings and are calculated to offset covering people who are uninsured and offset the cost of having part d for seniors. who has number 21?

did you have a part b to the question? you want to have a dialogue, go ahead. >> if the money runs out like it did in cash for clunkers, where is the money going to come from? >> i've -- [inaudible] there will not be rationing, and i have given you as much detail as i can on the savings. >> senator specter, a section of the proposed health-care plan, i thought what could i possibly ask you to make you read this plan?

as a 74-year-old man, if you develop cancer, we are pretty much going to write you all off. you are no longer a working citizen who will be paying taxes. what are you going to do about it? you are here because of the plan we have now. >> you are just not right. nobody 74 is going to be written off because they have cancer. that is a vicious, malicious, untrue rumors. who has the next number? who has the next number? [random yelling] >> thank you, senator. just for the record, i am opposed to the health care -- i am opposed to the health care.

i want to thank you for opposing the card check legislation which would have -- [applause] i appreciate that vote. is coming around again. this time, a secret ballot will be in, but you're not going to give employees time to gather information and make it honest -- an honest judgement. if they put a five portend a provision in there, that is high-pressure salesmanship. if somebody starts putting pressure on me, my answer is no. this is how these bills are being forced through washington right now, that is what the union wants to do to employees. give them time to think about it and study the issues, make an honest vote. the next issue, cap-and-trade. this is the largest single tax

we have ever seen. cap-and-trade will increase our bills by 40%-50%, and increase our fuel taxes. this will decimate what is left of our industrial sector. major manufacturers will have no choice but to leave this nation wholesale. we will have on employment not at 10%. we will have on employment at 20%, 30%. there will be a mass exodus of our manufacturing in this nation. they can go to india and china and have lower wages, lower costs. what is going to keep them here. >> you have raised to a very important questions. -- two very important questions. on cap and trade, the house of representatives have passed a

bill that has a lot of problems. we have not gotten a bill in the senate. we understand the kinds of concerns you have raised. we're going to take them up and see to it that we do not have the consequences of exporting jobs or imposing a great tax. you raise a question of employee choice. that bill is in the process of being negotiated. there will not be a time line which will be so fast that people will not have an opportunity to understand what the issue is. you comment about the secret ballot, and i think we have to maintain a secret ballot, which you agree with. we're trying to work through the other facets of it on arbitration, but bearing in mind

the concerns and worries that you have raised. no. 24. who has 24? yes, sir? don shapiro in 1997, i was diagnosed with a thyroid condition that put me in the hospital in a coma. i need to thank all of the taxpayers for paying for four years of hospitalization for me, because i did not have a plan i could afford at the time. i spent a lot of time in the library studying computer systems and telecommunications, getting a job in an insurance company where i saw a lot of corruption in the purchasing of the equipment. when i reported that to my bosses, i was summarily fired. what i would like to know is,

would you support provisions that will and that kind of corruption in the insurance companies to bring rates down, and stop making policyholders and investors pay for that kind of activity? >> what are you referring to specifically that the insurance company did or does the you don't like? >> i was in charge of writing up proposals, requests for proposals. my superiors wanted me to steal all those -- steer those proposals towards companies that they could get kickbacks from. when i reported it, they made life difficult for me. >> i am glad to hear about the early part where you got a lot of care that you needed, and you appear to have recovered. .

>> this comes from my personal experience. as a working professional, i let two years each in canada and in london. the health care systems of those two countries are eerily similar in my opinion to the proposed bill that is going through now. for instance, in canada might

tax rate was 60% for my health care. [applause] i am broadly opposed to the whole idea. i have private health care and i am very happy with that. my question relates to page four under 25 of the bill which, according to my interpretation, requires seniors, folks like us, senator, to have mandatory counseling every five years for dying with dignity. that is kind of scary. i am still a very healthy, active, working professional and teacher. i am not in my twilight. i am offended by this required

counseling. i would like to hear your views on that issue. [applause] >> i am opposed to mandatory counseling. you and i and others can get counseling if we want it, and we can think through our own issues, and we have families to discuss matters with, and nobody ought to order anybody that is competent to get mandatory counseling. it is a personal decision. no. 26, police. -- please. on the way to 30. >> now, that's ok. thank you for coming summer. as a disabled vet, i will speak a little bit for the vets. i want to shake your hand. you have done things something for us in europe done some things against us but i respect

you for being who you are. most of my questions have been answered so i will go off in a different tangent. this is only the beginning of what is happening to america. [applause] and people better wake up. we have a bunch of bureaucrats who are robbing us blind. they have been stealing from us for years, and there is nobody with the contests -- cohonejoneo stand up to them. go back and say you're going to represent us. it doesn't matter what party you are. the bottom line is, we are americans first, wherever you came from is immaterial. i personally am sick and tired of harrisburg. [applause]

i am sick and tired of our young men and women being used as pawns around the world, when all we hear about is how corrupt washington is, how corrupt north korea is -- where do you see an honest man in politics from here to washington? [cheers and applause] my question to you is would you go back to washington and represent us first as an american and tell mr. obama that he is an american, and if not, there are other countries? [cheers and applause] >> i think president obama knows that he is an american. when you ask me -- [booing] when you ask me to make a commitment to america first, i will say absolutely yes. hill is got no. 27?

-- who has got no. 27? no. 27. >> first thought, ought like you to -- i like that make you for coming out and coming amidst all these rebels and rabble and all of these people that will be terrible out here. i think this is one of the greatest talents in the country and i think they are all right here behind us. the other thing i noticed is that we got accused of being the rebels because we should appear but bad attitudes today. i don't think we have bad attitudes. we are being americans like he said. we have a right to be here. we have a right to speak. they do not have a right to accuse us of being mobs are whatever -- or whatever. there is anybody here with a swastika or nothing. we have been accused of that.

i wanted to go back to washington and tell them that the people of lebanon, if the people of pennsylvania all- american. -- the people of pennsylvania are all americans. are you going to represent us as americans? that is that. >> yes, sir. there is at 28? yes, sir. dollars just to play on his all little bit, it's -- >> it's funny about the community organizer told us to shut up. there are many people here who would like to have a word with you, and at -- and may i remind you that you work for ross. we are your employer. [applause] if the employer is willing to stay around and have a chat with

his employee, i think the employee should. i understand that there are other commitments but there are many people that like to talk to you. a couple of things. i am here for my daughter. i believe this country is going down how to quit for me to see a beautiful country. i am working for my daughter. i see the things that my government is doing. they are not working for us. they are working against us. and [applause] i know when we call your office and they put one name n.d. fo -- one named in the for category and one name in the against category, and you'll say otherwise, but in a majority of people are against this. you say that you are for health care reform, yet when people call you and say they are against it, you dismiss them.

you say it is a democracy. you are supposed to represent us. and not doing too good here, obviously. i am fired up. [applause] oh, boy. will he make a commitment to stay all a bed talk -- all little bit of talk to more than 30 people? can i ask you that? >> i and few analysts town -- i can deal in -- am due in lou istown. you are my employers but i have 12 million. i'd planned out their allocation. >> a lot of people said -- as dealing use it would not support certain provisions. house bill is probably not going to change much. but what did it in july and now they are looking at september. the compromise bill between

house and senate, most of the provision that you were talking about that you would not support probably will not be removed from the bill. if those provisions are still in the bill, you will not vote for the bill? >> on the items -- yes, i am giving you the commitment on the items that i talked about. it is all being recorded. >> we will hold your feet to the fire. one other quick -- cap-and- trade, next year are electric rates are going up at least 40%. i cannot afford it right now. i have that two kids to feed and i am laid off. i am laid off and luckily your pain for me to be here. but no bomb was on words, electric rates would necessarily sky rocket. how are you representing the people of pennsylvania by

imposing such a burden on them? the people of pennsylvania had been yelling to youth to stop taxing us, stop spending so much of our money. you can hear in this crowd. you can feel it. we have no more money. we have no more money. we went through -- when it comes to the fact that i cannot even put food on the table because you want to decide that it is bad for the environment for somebody to produce something to provide me the job, i draw the line. we went through an ice age and came out of an ice age without cars are factory and we will probably do it again. but when it comes to taking more of my money, i draw the land. we printed as much money out of thin air then what is in circulation. we have no money. [applause] and i will let other people talk.

>> 29, on the way to 30. yes, sir. >> senator, i am glad you support our right to the free- speech. the chilling effect on that is the white house collecting e- mails from people saying they are not supporting the health care system, and the white house keeping track of people that could be viewed as political opponents to the health care bill. that is chilling and i would ask the member of the senate judiciary committee, will you go back and look in that and tried at all this and see said it immediately? >> the white house is taking your e-mails and doing something against you? >> they are soliciting e-mails that you receive as a private citizen from groups or organizations that are opposed to the health care bill.

it is on there website. they are asking people to afford these e-mails to the white house. so that they can keep track of the opposition. this is been in the news for the past two weeks. he talked about it at one of the press conference. it seems like this as those soviet union, or maoist china. this is incredible in the united states of america. the people in this room want their country back. [cheers and applause] if you ever heard nothing today, please understand that, and i would ask what you have learned today from this town hall meeting that you will take back to washington. >> you ask two questions. i'll take a look at the practice which the white house is asking, to identify people or

opposed to though white house's health care. i'll take a look. what have i learned from today's meeting? that this is a very well informed part of our citizenry. we have had the quotations on the bill repeatedly, which shows that there has been a lot of study on the house bill. you have raised a number of provisions which impressed me. but, no, -- you know what is going on. i have a very good idea of the temper of a crowd. i saw a standing ovation to return america to the constitution. it is more than an earful. and i am not surprised. i have been a lot of town meetings, had hundreds of them during the course of my tenure in the senate and i'm going

wanted this afternoon, and i will be doing it all month long. i will take the word back. i would encourage my colleagues to have town meetings like this. they are not easy, and they are relative rarity in america today. but i think that they are very worthwhile. i get the message. no. 30. you have no. 30. here you are. hurt t-shirt says "proud member of the mob." [applause] >> these are my dear friends who came with me today and they were really anxious to stand up here and let their voices be heard with me. senator, i have two questions. the first is, we are quizzing you on a house bill 3200.

i am wondering where our house member, congressman holden, is and why is he not here to help us address house built 3200, and says he will not have any town hall meetings? that was my first question. the second is on page 42, talking about the health commissioner's. they will decide our benefit plans. new in heaven's name are going to be the health commissioner's? how do they get picked? on what basis will they be selected, and how will they make these awesome decisions for all of these very different people in this room? thank you, sir. [applause] >> i am opposed to anybody making the decision for you or me or anybody else about what health care plan we will have.

everybody ought to be able to choose what they want. and the idea is to have an exchange, which means that there will be a central place where you will have a whole group plans to choose from, which is what i have. i can choose any one of a number of plants. i pay for it. the amount to a different sums of money. i will not support a bill which deprives you of the right and gives it to some governmental agency to pick your health plan. thank you all very much, ladies and gentlemen. thank you. [applause] [random yelling] [captions copyright national cable satellite corp. 2009] [captioning performed by national captioning institute]

>> as members of congress hold town hall meetings across the country, we are interested in your thoughts on health care proposals being debated on capitol hill. you can share your experiences and ideas on video by going online to c-span.org. in a few moments, a look at preparations to combat the flu this year. in about an hour, a health care town hall meeting hosted by maryland center and card and -- been card and -- ben cardin. after that, but that obama takes questions at a town hall meeting in new hampshire.

on a local washington journal," we are talking about the economy with mayors across the country. tomorrow, we will hear from the mayor of youngstown, j williams. greg ballard of indianapolis joins us on thursday, and we will hear from the mayor of fort myers florida on friday. it is live on c-span every day at 7:00 a.m. eastern. >> bill clinton kicks off the 2009 netroots nation blogger convention. friday, panels on health care reform with howard dean, pennsylvania politics with senator arlen specter, making change happen, and reshaping the supreme court. >> now look at swine flu preparedness from richard hackett, director of merkel prepared this prop -- medical prepared this policy at the white house. fema us to this hour-long event.

-- hosted this hour-long event. >> thank you, glass clickers. good afternoon, everyone. i hope that you enjoyed your lunch. we are going to start our luncheon presentation to date, and it is my distinct pleasure to introduce our next speaker to you, dr. richard hackett -- hatchett. he is here today that teach us more about the h1n1 byers, to provide historical perspective, and talk about what goes into community resilience. he has also been the associated director for research and emergency preparedness at the national institute for allergy and infectious disease. he oversees a program that helps mitigate the effects of radiation exposure.

in 2005 and 2006, he served as the director for by a defense policy on the white house homeland security council and was a principal author of a national strategy for pandemic influenza implementation plans. he previously served as a senior medical adviser in the health and human services' emergency preparedness office where he worked on of wide range of issues including the delivery of vaccines to urban populations. also the role of modeling in the form of public policy. he completed his undergraduate and medical education and vanderbilt university, an internship and residency at new york hospital, cornell, and at the duke university medical center. as you can see, we are in very good hands. we are extremely fortunate that have him with us today. i give you dr. richard hatchett. [applause]

>> karen, thank you for that very kind introduction and tank -- and thank you to fema and the deputy administrator to inviting me -- for inviting me to address you on this important topic. unfortunately this is the only part of this conference that i have been able to attend. it looks like a fabulous conference. i have been to the annual conference on a couple of occasions in the past and i always found those to be terrifically inspiring. a great opportunity to learn, to hear from people working in local communities about what they were doing. i am sure that this conference will fulfil that same function for all of you. i am sorry that i have not been able to participate and will not be able to participate in sessions going forward. it is terrifically inspiring.

in thinking about the conference and looking over the sessions, i am reminded of the comment that the only entitlement hard dock receipt -- our democracy entitles anyone to its citizens. we all contribute to the well- being of our communities and ultimately to our nation. that is what i will talk to you about today in the context of thinking about h1n1 influence of, the unfolding pandemic that we have been observing for several months now and we anticipate will result in increased disease, illness, and unfortunately death in our communities in the months to come. at the national security staff, i belong to something called the resilience directorate, a new directorate within the national security apparatus that focuses on preparedness and response to disasters, and in this case, the public health crisis.

that has been a buzz word in a prepared as and response team for several years now. it is not necessarily something that is easily defined. we talked about it a lot. we try to foster it and hoped to augment it. but we often don't have a clear idea or a terrifically fixed idea of what we're talking about. i wanted to start my remarks by referring to an attempted definition by fellow named michel, and he has devised a nice framework which he calls the four r's request this, the ability to withstand stress with minimal degradation or loss of function. he talks about redundancy, the availability of substitutes,

things that can be switched in it an aspect her compound at of the community or critical infrastructure fails. he underscores the importance of resourcefulness, the path -- a capacity to identify problems and mobilize responses. and finally he talks about rapidity, to accomplish goals in a timely fashion. i think we will have to draw on all four of these elements as we move into this. and i am sure that all of your ordinances -- and your organizations, the constituencies to serve, and the public will contribute to enhancing our capabilities in this regard. would you bans the slide -- advance the slide, please?

all little bit of technical difficulties. they said that blackberries can interfere with your remote. i said, there are probably 700 black berries in the room. [laughter] that does not bode well. please bear with me as we move through this. i am going to talk about four things, basically. i will keep you an overview of the current situation. what i will not do is make predictions. anybody in the flu business knows that it is inherently unpredictable. it is a dangerous business to be in the business a prediction. i will talk about where we are now and i will look to some historical examples cotilliard how these things have unfolded in the past in the hope that that will inform your understanding of what we might face or at least what we should

be prepared to face potentially. i will spend some time talking about the vaccination program. it is by no means the only part of our response but it is an important part, and it is likely to be a part of the response that many of you in your organizations may become involved in in a volunteer capacity, going forward. and i will conclude with some over object -- overarching thoughts and comments. the current situation, of all -- show you a couple of maps and walk through them individually. these are maps that have been prepared by who. they illustrate the remarkable speed with which the virus has spread. the orange-colored countries are now officially confirmed cases of h1n1. the circles represent, according to the legend on the lower left, the number of deaths that

occurred in each country. what you can see is that to date, the virus has spread globally. the blank spots in africa are difficult to interpret. africa it is a very surveillance-deprived area. it is not necessarily mean that the disease is not there. but almost everywhere else, we can document the disease. the western hemisphere has been the most affected to date. not surprisingly, because of the origins of the virus in central america, probably early in the spring. this is a chart that was prepared by who and i draw your attention to the fact that the data is only from july 19. ordinarily if i were standing up here presenting data from july 19, i would say that this is

very fresh, but this is almost an eon ago compared to this pandemics spreading. but what you can see is that there has been widespread disease, particularly in the western hemisphere, almost all now experiencing widespread disease. at the time, australia and new zealand were not colored. there is now widespread disease in australia and new zealand, thailand, and certainly great britain. this is a slide that represents an effort by who to illustrate the intensity of the spread, the acute respiratory disease that has been observed in countries. a lot of countries are not reporting some of this is an incomplete map. and this is that their july 19.

but the united states has been deemed by who to have low or moderate intensity to date. we have had a lot of disease but we are a very big country. except for a few local outbreaks like in new york city or milwaukee, the general intensity of transmission that we have seen has not been overwhelming yet. canada has seen a little more, and mexico had a very large outbreak. he continues to percolate along and they are seeing an increase in disease transmission in the yucatan peninsula. in particular, the nations of the southern hemisphere have demonstrated very high intensity of transmission to date. that is not surprising. the two seasons are reversed, so they're in high transmission season right now. we have been watching the

nations of the southern hemisphere very closely, particularly nations like australia, new zealand, july, her white to some extent, that have had similar demographics, trying to discern patterns that may help inform our planning and prepared this for the fall. we have been playing -- paying close disease -- paying close attention to the disease domestically. we're trying to learn what we can. some countries have taken quite aggressive responses and we are striving to learn from their responses. argentina, for example -- most of the nations in the southern hemisphere, i should say, at the winter break that would correspond to our christmas break. they take that at some point in july. it is a couple of weeks and people go skiing and do the sorts of things that you do in winter. argentina took a quite

aggressive stance in terms of their winter break. they extended it -- or nearly two weeks, they started early on july 6 and they extended it through august 3. the schools work out for almost a month in argentina. they have gone back into session and we continue to watch. they are still in high transmission season. it will be interesting to see -- and they had quite intense disease. it will be interesting to see what happens going forward so that we can continue to observe it. i should warn you before we get too much further in this talk, i belong to the band of what we call flu wonks. we like to put up a lot of curves of lines going up and coming down. i will try to explain what they mean.

it is an unfortunate habit of people like me. you will have to forgive me. there will be a wonkish element to this. i will try to keep it on a high level. a little bit about what is happening in the united states. we have had disease transmitting in the united states really since early april. the first cases of h1n1 influenza were in fact diagnosed in the united states, and california and texas, but for the mexican outbreak was recognized. those samples were collected early in april so we had several months of transmission. it transmits quickly within four days of a person getting sick. they transmitted on to others. at this point is very difficult to know how many cases we have had in the united states. the cdc some time ago public estimated that there have been greater than 1 million cases.

if you talk to people in the flue modeling business, and there is a minor business there, if you get various estimates as to the number of cases that we have seen to date. i've heard private estimates from 1.5 million to 2 million cases in the united states today. no one knows for sure but there have been a lot. we now have cases in every state, every jurisdiction, and we have seen as of august 6 about 6500 hospitalizations where h1n1 has been confirmed. we've also seen 436 deaths. that suggests to us, given the estimate of the cases, that the overall case fatality rate or the risk of any given individual perishing is quite low which is reassuring.

but the numbers as it spreads throughout the nation, those will grow in a way that we have -- unfortunately we would not like to say. -- like to see. one of the defining characteristics of this virus is that it seems to be targeting our younger populations. the attack rates in younger populations -- or not that attack rates necessarily, but the percentage of total cases in the younger populations is quite high. this is a chart showing cdc data as of a couple of weeks ago, showing that about 68 percent of the cases have actually occurred in people younger than 24. influenza is a disease that is more easily transmitted among younger populations for a variety of reasons. is it -- even with seasonal flu, we see more cases in the under

people. we don't necessarily see more debts or hospitalization. the people who tend to have a problem with influenza tend have problems with other diseases. elderly people, people whose immune systems have declined, and there are greater concentrations of those people in older age parents. but this is striking. and the low number of people, even after efficient transmission for months, over the age of 50 who have been documented have the illness. the informed scientific speculation is that people born beyond -- born before 1957 likely had exposure to previously circulating h1n1 viruses that circulated between 1918 and 1957 which appeared to me more closely related to this fibrous than the h1n1 that has

been circulating since 1977. to be very clear, h1n1 viruses have been circulating in the united states for the past 30 years. but this is a very different h1n1. it is genetically quite different from the viruses circulating for the past 20 or 30 years. that community does not provide a great deal of immunity to the current virus. but exposure to viruses circulating before 1977, they seem to provide some immunity. that seems to be why the attack rates are so low and older populations. -- in older populations. that same phenomenon might explain why we have seen a disproportionate number of hospitalizations in the younger population. the seasonal influenza pattern that we see, the burden of

severe disease and mortality tends to cluster at the extremes of the age spectrum, i did a very young, young or than the age of four, and those older than 65. those are both hospitalizations and deaths. what we're seeing with this virus is that among the hospitalized, the largest proportion, 50%, are the beneath the age of 24. there are a substantial proportion in that range 24-50 knot -- 24-49, which also need hospitalization. that does not mean that these numbers of hospitalization is greater than with seasonal influence appeared we do not know yet because we do not know how many cases we're going have. this is something we will figure out retrospectively. there is a striking absence --

or production in hospitalizations and deaths are occurring in the older populations. just to give you a sense of the burden of disease that we have seen to date, and that we may see in the fall, this is some data from new york state. what you can see here, but for kurds -- the four curbs' represent the number of hospitalizations by week. the first week of january and so forth. the number of hospitalizations by date in new york state with confirmed influenza, over the last four influence the seasons. the 2008-2009 season, up until the spring, had like the ones before, are relatively mao year

as far as influenza was concern in new york state. 2007-2008 was a bit more intense in new york state, and you had more cases of influenza, hospitalization, mostly in the february-early march timeframe. this is what happened after h1n1 came out. as i said, new york city had a particularly large outbreak. in new york city department of health and human hygiene, based on subsequent surveys that they did, estimated at 2% of the population in new york city fell filled with h1n1 during their spring outbreak. what you can see is that a large outbreaks in the new york city area that spread into other parts of new york state resulted in a striking increase in the number of people who were hospitalized. just a reference point to bring this up -- we would normally expect somewhere in the order

to 5-15% of the population to develop influenza during a typical seasonal flu year. they had about 10% drop late -- and these numbers are not certain, these are our best estimates at this point -- 2% of new york's population develop influenza. that was almost like a winter's worth of influenza in the spring. historically, when we look at previous pandemics, the overall attack rate, the overall part of the population that will become ill, is somewhere on the order of 25% to 35%. while the new york state outbreak was substantial, it does not compare in this extent or intensity but what we have seen with previous pandemics. i am not going hazard any predictions because influence it

is inherently unpredictable. -- influenza is inherently unpredictable. coming to the issue of the mortality patterns that we're seeing, again, as with hospitalizations we are seeing an unusual and distribution of mortality. i _ that that is distribution of mortality. i don't want you to under -- i don't want you to think that we have more deaths in aggregate than we would have in these age groups because of seasonal influenza. but this is not a pattern that we see with typical seasonal influenza. there is a striking reduction in the elderly population. this is a slight for mexico -- a slide from mexico comparing distribution of mortality, not

absolute numbers but distribution, with the last two seasonal flu years. the last two years are the black and white bars. they are a typical pattern of seasonal flu mortality, where roughly 90% of mortality is observed in people 65 or older. a large portion of the rest of the mortalities observed in the population between the ages 0-4. as you can see, the large parts represent the distribution rate h1n1, it is not what we're seeing with the virus. the last issue that i want to touch on is the issue that i think everyone is most sensitive to, and if this is a virus largely affecting young people, unfortunately it is also causing some deaths in the pediatric populations.

typically -- and i showed a slide to illustrate what we have seen to date, and what we've seen for the last two years -- this is cdc data. cdc has undertaken to try to keep track of pediatric influence the deaths as a result of the 2003-2004 flu year, where there were stories about an increased number of deaths in children, from influenza that year. there were some scarcity issues with the vaccines which produce a lot of anxiety. in 2003-2004, we had 150 percent of deaths in children that were directly attributed to influenza. -- 150 or so deaths in children. it is usually 62-100.

it depends on what the dominant strain circulating is. but it is somewhere in that ballpark. the purpose and purple -- curves in purple and the one yellow of the pediatric deaths reported to date for the h1n1 virus. and we have roughly 29 or 30 pediatric deaths so far. again, we do not how large an outbreak we have had and how large one -- of one is coming. there is a reasonable concern that will see a larger outbreak in the future. we do not know where this number will end up. but these are poignant deaths. they attract all lot of attention. they're typically reported in local or regional newspapers. this is something that we will be keeping a very close eye on as we go forward. it's certainly contributes to

public perceptions of severity of the outbreak, for obvious reasons. let's talk very briefly about some of the social disruption that we saw in the spring. when a pandemic began the reports that order -- that were emerging mexico were initially very concerning. we were hearing stories about hundreds or thousands of young people who are becoming seriously ill and requiring hospitalization many young people on ventilators and many young people dying. at that point in late april, i believe april 23 when we got confirmation about the first mexican isolates, it was not clear how large the outbreak in mexico was. cdc took -- they erred on the side of caution in terms of making recommendations about school closures. they recommended that schools

closed at relatively low burdens of disease. what you can see -- the blue curve represents the number of schools closed in late april and early may. it's -- it peaked at 726 schools closed because of influenza, affecting almost 470,000 students. this is obviously quite disrupted. i have to say that cdc is to be commended for working very rapidly to gain a better understanding of the virus and to understand that the disease was a much more widespread than we initially understood, and that the actual average case of the h1n1 was much less severe than we had initially feared might be the case. and so taking that context, they adapted their guidance very rapidly. on may 4 or death, they released

a revised guidance that it was not necessary to close a school at the first sign of influenza. you can see the sharp decline in the numbers of schools that were closed. that type of contextual adaptation, i think, is going to be very important as we go forward into the fall. we in the government are bureaucrats and we do not typically work at lightning speed. but cdc worked very rapidly to sort out what was happening and provide the best guidance and science-informed guidance that they could. as many of you have heard, they release their new school guidance on friday. the goal would be to keep schools open but safe. that will focus on ways to protect both the general population within schools. we will continue to look our guidance and revise our finance. as context changes, we will

continue to adapt and you in your local communities will have to do the same thing. you have to look at your community and make adjustments as you go along and be ready to adapt in that rapid fashion as circumstances dictate. i should point out that one other interesting thing about this chart is that even after the guidance to reopen the schools was released, it was still necessary all the way through may to close some schools. there were reasons to close schools. a number of students or teachers were simply too high to allow useful educational instruction to occur. school closures were observed throughout much of the spring but a much reduced rate and with less social disruption than we witnessed in the early part of may. i would anticipate that we are likely to see, even though the guidance is to try to keep schools open and make sure that they are safe environments for

our students, we should see some school closures in the fall. it is important for communities to anticipate that that may occur and to work with students and families in the educational community to ensure that useful instruction can continue, that parents can continue to adapt in the case that a school here or there are perhaps the school districts were to close. being prepared for that does not mean having to implement it. it just means that it is something that may happen. it may be forced upon us by circumstances. so just to summarize, that is the end of the situation update. the big news, if there is good news, is that the overall pace of fatality rate appears to be quite low. we cannot put a fix on it but it seems to be in the range of what we see with seasonal influence

appeared that challenge for us in the poll is that we may see a substantial increase in the burden of disease, perhaps as a -- as much as a factor of two or three. we're not out of the woods but we're certainly not dealing with the andromeda strain or 1918 virus. what we are seeing from our surveillance, both domestically and abroad sequence saying new isolates and comparing to santa that i saw once we have seen before, if that is not mutating any way that would increase its severity or transmission. it seemed to be behaving in the southern hemisphere free much as it behavior. is transmitting because if they are in flu transmission season.

but it continues to be, with a few exceptions, susceptible to our main antiviral drugs, which is good news. i want to talk about historical -- since i said i would not make predictions, i will talk about our historical experience. these charts -- it is complicated and i hope everyone can see. i've got the arrow or will try to have the error to walk you through this. their illustrations of the epidemic curves of the last four pandemics in different locations. there is a pandemic in 1989, and the 1918 pandemic, there was an 18 -- a 1957 pandemics. and the reason i am putting this slide up is to illustrate something that is very important to understand about pandemics.

pandemics are multi wade, multi- year events. we're heading into what will be the fall wave of the 2009 pandemic. the previous pandemics have returned over several years to cause enhanced mortality, higher rates of hospitalizations and deaths, over several years. the 1957 pandemic -- that is in the lower left corner. in 1957 in the fall, there was a sharp spike in a fairly dramatic decline in the number of deaths that were observed. and then returned in the spring. we need to mentally prepare ourselves for the duration of the campaign that we are about to face. we are racing against a fall wave to develop a vaccine that can protect a large part of the population. but even if that wave meets

the vaccine, it does not mean that we were too late. this is in a bet that will occur -- we may see a spread wave wave the next fall or the following spring. we do not know. the need to educate the public will be critical even if the virus gets here before the vaccine does. we're moving as fast as we can to make sure that we have vaccine available but it is not all about fall. just to illustrate another point about pandemics, this is deep into wonky part of the speech. i'll try to get away curves that go up and down. we have seen this same skewing of attack rates toward younger populations. it is very characteristic of influenza because of the social

environments that we and our children live son. there is nothing peculiar about this epidemic except the amplitude of the case burden that we're seeing in the younger population. the reason i showed this to you is that the blue curve represents the eight specific clinical attack rates of the 1957 virus, which was actually different from the 1918 and 1968 viruses, the red in greencurves, in the striking propensity for attacking the population. 1957, for the people who live through it, was a pandemic that was triggered by the opening of the schools in the fall. a lot of us are looking to the 1957 pandemic as a potential guide to what we might expect because of this virus -- the way that this fire is seems to be heading. instead of looking to 1918, a

lot of us are trying to learn more about the 1957 pandemic and understanding the dynamics of that event. a lot of the slides i will show you relate to the 1957 pandemic, not 1918. i'm sure you've seen presentations about 1918 before. these are mortality curves. the deadline represents the mortality and the solid line represents mortality in the united states. i surely it is to point out that this is likely to be around -- the 1957 pandemic caused higher rates of mortality for about six or seven months once it actually started. the 1957 and 1918, actually, are important examples or less historical because they were that two pandemics when we knew

that the pandemics virus was circulating in the united states and late spring and early summer. it percolated during the summer and there were a number of outbreaks -- the boy scout jamboree, that was a big outbreak. and that was entirely through the summer. i had the opportunity to spend a couple of hours with the doctor who was most well-known for the who smallpox eradication programs, but in 1957 was the chief operation officer at the cdc. he gave a wonderful metaphor for what they experience. he said, "it was like the virus laid down and grew roots during the summer, and when the conditions were right, but virus came up like a virus of sprint

-- like the grass of spring and came up everywhere." he said it was almost overwhelming how it happened. that is a useful analogy, i think. it certainly is governing our efforts to prepare for what we might see in the poll. we cannot know anything for certain. this is a chart to illustrate how quickly the fire spread -- the virus spread. this is how it spread in 1957 in real time. counting the number of counties that reported outbreaks. this chart shows how the virus over september and october, peaking around a week of october 19, rapidly spread to hundreds of counties. each outbreak lasted from 6 to 10 weeks. you are probably looking at 1800 counties that had simultaneous

outbreaks. that is a diffusion of disease that would place insurmountable burdens on the several government's abilities to respond at the same time. this is the message that everyone has heard, that communities will have to draw deeply on their resources if and when this occurs. subsequently in 1957, through the use of survey tools, they tried to recreate the actual cases curve and a estimated in that week of october 19, when the pandemic peak, about 12 million people actually became sick and had to stay home in bed for at least one day during the peak week of the 1957 pandemic. that was over denominator of the total population of the united states of about 170 million people. that was 8% of the population

becoming sick in one week. this is a complicated chart. it shows absentees in the schools. it's an issue to be concerned about and fall. in 1918 there were few states that left their schools open. only three that i am aware of, new york, chicago, and new haven. chicago kept the best records and elected absenteeism in different parts of the city over time. which you can see looking at the chart is that absenteeism in chicago schools peaked around 40%, right at the peak of the epidemic. it peaked at the numbers of deaths were peaking. because deaths were delayed by a week -- absenteeism was probably driven by parental care and anxiety. .

it peaked about 2% or 3% around the baseline. they sought absenteeism that was

up to around 8% or 10% above their base line absenteeism -- they saw that. they were quickly. let's talk about the vaccination program, are basing -- vaccination program. we have a couple of historical things to look at in terms of vaccination programs. i will talk briefly about three of them. there was the vaccination program in new york city. a traveler came back from mexico and developed a hemorrhagic form of smallpox that was not as easy to diagnose as classical smallpox. he moved around the city for several days, caused a few more cases of smallpox, so they implemented a crash program for the whole city. new york city succeeded. the population that was probably about 8 million people, and they

claim to have vaccinated about 6 million people within one month. there are others, an infectious disease specialist in new york city, has gone back, and they estimate only 3 million to 4 million people. they are not sure, but it is something that is in our collective memory in the emergency response community. another example that bears scrutiny is the 1954 polio vaccine field trials. this was the largest clinical field trial conducted in the united states. it involved about 1.3 million students in the spring of 1954. david riske a book called "polio and american stories" that won the pulitzer. it is a very interesting study. -- david wrote a book. of course, it was a successful campaign.

it was not a perfect example because it was a clinical trial, so there were lots of additional recordkeeping. in setting up a vaccination program where you are targeting 1.3 million students, they had to get the assistance of something like 50,000 physicians, almost 200 thousand volunteers. just to give you a sense of the magnitude of what we may be facing going forward is when we talk about vaccinating 150 million or even 250 million or as many people that want to be vaccinated, actually. many of you have heard about the swine flu fiasco, as it is known popularly. there was an h1n1 outbreak at fort dix, a young soldier, a

22-year-old man died. this is the first time that h1n1 had been seen in the population since the late 1950's. it was thought that the virus that broke out in fort dix was close to the 1918 vaccine. there was tremendous anxiety that we may be facing the recurrence of the 1918 situation which had a terrible mortality. there were some questionable decisions about what was made, and it is not my intention to review the decision making process. a historian at harvard and another man actually wrote a very, very interesting study in 1978 about the decision making process.

this is not why i am bringing the example of. there was perceived to be an emergency and an effort to rapidly vaccinate the american population, and the effort in 1976 focused on all populations, and we succeeded in actually vaccinating 40 million people in about 2.5 months, and that was a remarkable accomplishment, but if you dig down into that accomplishment, what you see is the vaccination rates were quite variable. some cities vaccinated 60% of the target population, some 20%. it depends a lot on the efforts of people in the local communities and the commitment of local public health officials. the other thing about 1976 that is important to bear in mind is that many of the vaccinations, were done through public-health clinics, and only about 15% were done through private providers. i think we can envision a

different mix in terms of our vaccination strategy for the fall. fortunately, the only example that we have returned to that even approaches in scope of what we are attempting -- fortune to, what we do every year, which is our seasonable flew vaccination. we tend to vaccinate millions of people a year, and most of those vaccinations take place in high- risk individuals and the elderly, increased risk in children, unfortunately. most of the vaccination actually occurs before influenza actually begins to circulate. with the seasonal fluke because of prior immunity and prior exposure to vaccine, most people only need one shot, but there are some striking differences about what we are looking at in the fall. we are looking about a vaccination program while influenza is circulating, and that may put a real strain on

our delivery systems. the community immunization practices has issued its high priority recommendations, which cover 159 million americans, so we are aspiring to vaccinate a much higher number of people that we normally vaccinate with seasonal fluke, and it remains to be seen. we're in the middle of clinical trials and studies, but because people have never been exposed to this virus before, it may actually required two shots, and that could be one of the additional burdens. there are many elements to our program. i will not belabor this. delivering the vaccine is only part of it. we need to track the vaccine, how much we have, how much we are using. we need to make sure we track the safety of the vaccine. that was one of the unfortunate outcomes in 1966, an unfortunate side effect, and after back city millions of people, we had hundreds of people that came down with the neurological

guillen by our syndrome -- billy anbar syndrome -- guillain barre syndrome. i was having a very interesting discussion at lunch with michael sweeney about the challenges that they face in reaching grips that predominantly live in another language. that would be a terrific challenge. we need to be mindful of everyone in our community as we try to move forward. this is a slide showing people to be vaccinated in a bunch of dierker places.

-- a bunch of different places. we hope to utilize all of these locations as we move forward. we are still working on this. we, you know, certainly welcome the input and assistance of people at the local level in terms of helping us figure out how to deliver vaccine most efficiently to those who need it. and, finally, these are the high-priority groups that i mentioned in the advisory committee. there has been a lot of press and play about this. pregnant women are certainly at high risk. health-care workers will be on the front line. children younger than six months of age, actually, the vaccine is not licensed for children that young, which is why we want to vaccinate people taking care of infants, because of the disproportionate burden of disease in young people. they are an ordinarily high- priority group. and then, people who have

documented high-risk conditions, pregnancy, and neurological disorders, asthma, chronic obstructive pulmonary disease. and this is a chart showing our coverage rates for seasonal flu. in normal risk populations, the coverage rates by different age groups are actually not as high as we would like them to be. they are higher in groups that are identified as being at high risk, but we certainly want to aim to achieve higher rates of coverage even then we have achieved here. -- efen taven than we have achieved here. this will be one of the goals in the fall. we brought this up earlier about adaptation and social resiliency. this is a chart that we have shown frequently. many of you may have heard the

story comparing philadelphia and st. louis in 1918. philadelphia was one of the city's on the east coast that was hit quite early. they actually allowed a large city parade to take place. they resisted implementing any measures to retry to control the spread of disease in 1918. -- they resisted implementing any measures to try to control the spread of the disease in 1918. st. louis, on the other hand, have a couple of weeks of advance notice, and they acted very aggressively. the health commissioner in st. louis was sort of arm and arm with the mayor and with other public officials and voluntary organizations, actually, and they implemented a broader array of community mitigation measures, closing schools, theaters, banning public gatherings, and they kept them in place for about six weeks, and you can see that the death rates in st. louis were

dramatically lower as a result. i bring this up and not to talk about the virtues of community mitigation measures but to talk about adaptability of an entire community, that was a little bit of lead time and effected key indication from its elected leaders, the leaders of its voluntary organizations, was able to adapt to a very challenging circumstances. st. louis, it was only about two weeks after philadelphia's first case that they had theirs, but they were able to act very, very quickly. not just on the city by city basis. in 1995, chicago had a terrible heat wave in the middle of july. and you can see the mortality peek over a few days in the middle of july when temperatures despite up to around 95. there were high rates of unity. many people died. -- where temperatures spiked up

to around 95. their high rates of humidity. -- there were high rates of humidity. you could see what happened. having lived through the terrible heat wave in the middle of the month reacted very, very quickly. they sent people knocking on doors, and they actually prevented a recurrence of the high rates of mortality is that they had seen just a few weeks before. i think this kind of adaptation, rapid adaptation, rapid response to what is happening in your community is what we're going to be looking for from you in the fall. communities are not just built environment. they are composed of people, social and political institutions, activities, and infrastructure. i think getting a handle on this

conceptualized adaptation, this ability of individuals and groups to draw on available resources and their own ingenuity is to help solve problems is our biggest challenge, what we will be tested on in the fall. i have to say, and i would offer to you, that our ability to adapt and adapt quickly should not be underestimated. such adaptation is much easier when a community is magnetized by an external threat. external threats are wonderfully effective in promoting cooperation, breaking down barriers, where moving bureaucratic obstacles, -- removing bureaucratic obstacles, and i think we should all go into the fall knowing that we can draw on this. i would like to call this the dunkirk affect. i will finish up by talking about the dunkirk's affect --

dunkirk effect. i will finish up by talking about the dunkirk effect. the men ended up being trapped when the king of belgium surrendered their army, and others are coming in from both sides, and they retreated to the beaches of dunkirk, and when the evacuation started on may 26, churchill thought that they would be lucky if they could get 50,000 men out. and the problem was that the british destroyers, you can see in this picture, there drafts were too deep. they could not come into short, some men were having to wade out and stand neck deep in water for hours at a time, so a couple of days later, the british ministry of shipping actually put out a call for all boats with shallow draft, pleasure boats, fishing boats, a merchant marine

vessels, merchants craps, none of them with arms -- fishing boats, a merchant marine vessels, none of them with arms -- fishing boats, a merchant marine -- fishing boats, merchant marine vessels, and they were evacuated successfully. it is pretty interesting. this is a wonderful example of what i would call contextualized adaptation. churchill called the evacuation a miracle deliverance achieved by valor, discipline, but thought was service, our resources, by skill, and by incomparable ability. he also reminded people and parliament that wars are not won by evacuation's. [laughter] -- by evacuations.

finally, i just want to draw on experience. i was a civilian in 2002. i had the privilege of responding to ground zero after the attacks of september 11. it was an utterly like changing experience. this is actually why i am standing in front of you today. in instill in me a terrific confidence in our public, in our ability to respond. looking towards the fall, looking towards whenever we encounter, the same resources will be drawn on by you, by your organization's, in your public and community is -- and

communities. thank you for your service, and thank you for allowing me to speak to you -- drawn on by you, by your organization's -- organizations. >> i want to think the doctor for presenting this information in a clear and only slightly wonky way. please join me in thanking him once again. [applause] blast announcements are to please use this next greg deshawn -- sign up for the workshops if you have not already, and we will be serving desert on independence level, so thank you again, and we will see you in a bit -- my last

announcements are to please use this next break to sign up for the workshops. [captions copyright national cable satellite corp. 2009] [captioning performed by national captioning institute] >> in a few moments, a health care town hall meeting, hosted by maryland senator ben cardin. in 1.5 hours, president obama and takes questions about health care legislation at a town hall meeting in portsmouth, new hampshire. after that, the georgian ambassador to the u.s. talks about the russian invasion one year ago. and later, white house economic adviser lawrence summers on the economy and the deficit.

on washington journal tomorrow morning, we will be joined by christopher watney with the council of state governments to discuss state budgets. -- christopher whatley. jay williams talks about the economy in his town. michael joseph gross says that obama has not carried through on campaign promises to the gay community, and we will look at how congress works with a reporter for cq politics. "washington journal" is live on c-span at 7:00 a.m. several live events to tell you about tomorrow. the commission on wartime contract thing in iraq and afghanistan continues its series of hearings. this one focuses on contracts for translation services. businesses include private

contractors. that is on c-span2 at 9:30 a.m. eastern. hear on c-span, live at 10:15 a.m., -- here on c-span, justice sonia sotomayor at the white house. over the next 1.5 hours, maryland senator ben cardin hosts a town hall on health care. there were constituents at towson university. ♪ >> my name is dr. gary rubin, and i am vice president for university advancement, and i am pleased to welcome you to a university with over 21,000 students. while we have the 6200 graduates and other graduate programs, in the health professions, we produce the largest of graduates in the state. we have nursing, occupational

therapy, in gerontology, speech, language, audiology, and others. we are the second-largest producers of nurses in maryland, and we have the largest under graduate nursing program in the state. onstage with me this afternoon is senator ben cardin. [applause] and a woman. we also have some elected officials, and i want to recognize them at this time. bicaanni, delegate adrian jones, delegate steve lafferty, delegate joseph bodner. bodner, delegate john cluster, delegate bill frank, rick empowerellaria, and a representative from senator barbara mikulski's office.

"bro [booing] >> i see we have our favorites. diana turner, and delegates representing mayor sheila dixon. [booing] >> the topic of tonight's discussion, as you all know, is health care reform, a topic that has energized the public on both sides of the issue. as you can see from the turnout this evening. let me just say this, this is a town hall meeting. it is a chance to hear the surrounding health care reform and to ask and answer questions. all of us here tonight -- those of us on stage and in the audience -- all have our thoughts and concerns about health care and how it will affect us. that's why we're all here. so i hope and i know that throughout this evening, we will all demonstrate respect for each other and allow for a very robust discussion in the time that we are allowed. before we get started, i would like to go over the agenda and

the rules for this evening so everyone knows where we're going in this next hour or so. the agenda will begin with miss handy, who will share her own personal story and relate her experience with the present health care system. then i will introduce -- [booing] >> then i will introduce u.s. senator ben cardin, who will walk us through the goals for health care reform as well as the staff us and proposed legislation working through congress. after senator cardin's presentation, senator cardin will respond to a few of 9 of te questions that some of you posted on cards that you received when you entered the theater. then the senator will take -- then the senator will take, after those questions, the senator will take questions from the audience from the two microphones set in the aisles. so that we get through as many questions as possible, as many

as possible in our allotted time, audience participants will be asked to present questions quickly and not make statements. at this time, i would like to welcome miss dina handy to the podium. [applause] >> a few months ago, i sent a letter to senator cardin and other federal and state government officials to challenge them to find health insurance for my daughter, sarah grace. [no audio] sarah was born with a rare genetic disorder called lukeric aceltaria, or g-1. this disorder affects her ma to be lymph and how her -- metabolism and how her body breaks down protein. a person with this is at risk for a stroke every time they are ill, especially with a fever or

vomiting. sarah suffered just this kind of a stroke when they was five months old, which left her with cerebral palsy. now at the age of three, she cannot sit, stand, walk or talk. despite her physical limitations, she has proven to be intellectually intact. she knows colors, shapes, some letters and numbers, she can sort. she loves books and to play with her two older sisters. sarah had been on state medical assistance in the rare and expensive management program. with this insurance, we were able to get her care which was denied her through her prior insurance, a wheelchair and a prone stander, all necessary and necessary expandable pieces of durable medical equipment. earlier this year, we received notice that sarah was no longer eligible for assistance because

our income had increased due to an increase in income from my husband. this is when we started on get nervous. we cannot afford tore sarah grace to have insurance. due to her disorder and cerebral palsy, she is on a feeding tube, requires special formula, medication, frequent doctor visits, and frequent hospitalizations. all of these unique everyday challenges add up to a costly medical condition for our precious little girl. just her medications, formula and feeding supplies for one month, the cost would be approximately $800 without insurance. not to mention that the nurse that usually comes out to our house once a month to access sarah's infusa-port would not come if she was not insured. we attempted to have sarah placed on our private insurance but she was denied because of her preexisting condition. we then fought for two months to get her insurance through the

maryland health insurance plan, or mhip. it is important to note that sarah could not have a lapse of insurance because then she would have been uninsurable for six months. mhip is a state insurance health insurance program for maryland residents who have been unable to obtain health insurance from other sources. at the time of our original application, sarah was two. she was denied mhip because the did i mention that she was it two? not 62? so i spent an afternoon along with her at the social security administration to get a letter from them to state that she was not eligible for medicare. even after receiving this letter, medicare denied her again, still saying that she is eligible. it was only when i started to send letters to government

officials that i saw some progress being made. it is heartbreaking to me that because we now make a little bit more money, our daughter will not be as well insured. my husband works two jobs. we are fearful of our situation and what the medical costs will put on us. have we are challenged to give adequate medical care for her was not going bankrupt or having to sell our house. i can understand how this situation will really cause people to try and ethical or nonconventional solutions to this challenge -- to try it unethical or nonconventional solutions. -- to try unethical or nonconventional solutions. why should they do more if they can get more by doing less? there has to be an answer out there, and if there is an answer, we have to make it easier. sarah grace is now insured.

after two months of emotional stress, we received her model waiver list because although mhip is better than their insurance, it is not adequate for all of sarah's medical needs. i won't pretend that i know all the ins and outs of all that is going on in the debate over health care reform or that i even agree with it. but i do know there needs to be revisions to the current system. because of my daughter, i know i need to become more informed and this town hall meeting is one way of doing so. thank you, senator cardin, for inviting me to share sarah grace's story. i hope that her story will benefit anyone who finds themselves in a similar situation. [applause] >> thank you for sharing your own personal story and sharing that with us. it is now my pleasure to introduce senator benjamin cardin. but let me just mention a couple of points about senator cardin. in more than 20 years in the u.s. congress, senator ben

cardin has become a national leader on health care, retirement security, the environment, and homeland security and fiscal issues. from 1987-2006, he represented maryland's 3rd congressional district in the house of representatives. he was elected to the senate in 2006, where he currently serves on the foreign relations, judiciary, environment and public works, budget, and small business committees. he has served as chairman on the commission on u.s. cooperate in europe, the u.s. helsinki commission. in the house, his proposal to expand medicare, and to include several screening tests was enacted into law. he has authorized legislation to fund graduate medical education, guarantee coverage for emergency services, and improve the medicare drug benefit for seniors. earlier this year, senator cardin was successful in getting a guaranteed dental benefit included in the reauthorization of the children's health insurance program.

it is now my pleasure to introduce to you, senator benning main cardin. senator -- senator benjamin cardin. >> dr. rubin, thank you very much. and i do want to thank towson university for opening up this hall so i could have a town hall meeting. i dare say when i made this request several weeks ago, they did not know what they were getting themselves into, but i thank them very much for always being available to provide an opportunity for the community to get together. i also want to thank dena handy for being here. i do that because there are thousands of cases similar to dena's in our community. our health care system is complicated and doesn't respond well to individual family challenges. if dena had worked for a small company that had a health care

plan for their employees and the insurance covered her daughter's condition, the small company may have been forced to give up their insurance because it would have been increased dramatically the following year because it's experience rated premium. small companies have a hard time finding large plans in order to join. if it were not for the state of maryland -- and i thank my colleagues in the maryland legislature -- in adopting a program to try to fill the gaps for the federal government act, you may still be uninsured today. so we want to be able to provide a system in which every person in this country has access to affordable quality care. we don't want to see any child in america denied necessary health care. so i thank you all for joining me at this town hall meeting.

i have town hall meetings frequently. i was asked by a reporter before coming in here, "why did you do this? why don't you just do one of those go on the internet and have a chatroom or answer the calls? where did you want to have a town hall meeting?" and my answer is very simple. i do town hall meetings. i do other types because i want to give you an opportunity to ask questions. i want to be able to respond to your questions. health care reform is a very important issue, very important issue that affects everyone in our communities. and i want to make sure that you have the information before you. i was one who encouraged the leadership in congress to take its time so that we could have these types of discussions. [applause] at this moment, we don't have

one bill. we have bills that have been reported out of committee. but what i want to do tonight is give you ample time to ask your questions. and my own request -- i only have one request -- is that you respect the people that are in this room. [applause] they waited a long time to get here in the room tonight and i think they have the right to be able to hear the questions and the answers. and the more time we spend on the questions and the answers, i think the more productive the evening will be. i'm going to be here until 8:30 answering questions and we'll do the best we can to have as many people as possible get their points across. let me start off by pointing out the obvious. president obama has made health care his top priority.

he said this during the campaign and he's now started to act on it. so far this year, we have seen health care passed by the congress, the children's health insurance program was enacted into law covering another 4 million or 5 million children, including dental care for our children. [applause] the american recovery and reinvestment act was passed by congress. it includes a significant investment in our health care system. it provides cobra protection for those who lose their jobs so that they can continue their health insurance even though they may have lost their employment. it includes a significant amount of money in research -- for research for discovering the answers to many of the unknowns, including perhaps we hope one day, dena's child, to be able to find answers to these diseases. it includes a significant amount of money invested in health

information technology so that we can get a better way of portability -- interportability among the different health care providers in our system. it provides a significant amount of money for prevention and wellness programs, a down payment on what we hope will occur through health care reform. the president also was successful in getting legislation passed that will regulate tab he counder the f.d.a. this will -- regulate tobacco under the f.d.a. this will at least give us the opportunity to try to deal with young people and smoking. so we have seen a focus health care reform and the major issues, of course, will be whether we will pass major health care reform this year. now, i want to start off with some of the basics so we all c can -- i want to make sure that everybody understands where we are today.

[talking [and shouting] >> that's why we need reform. currently we have 177 million americans who have coverage through their employer or individual insurance protection. now, some of those are self-employed -- self-insured plans with large companies. others are commercial private insurance plans. the numbers, though, reflect a large number of people, 177 million, with private coverage through their employment. we are committed to making sure that those who are satisfied with their current insurance coverage are able to keep it. [talking and shouting] i think most people agree with that. [shouting] >> no, i think most people agree that you want to keep your private insurance.

okay, i'll rephrase it. now, in medicare, medicare today covers 45 million americans under the medicare system. now, of the medicare system, 10 million are in private insurance plans. these are private insurance plans that write medicare. in traditional medicare, which is fee-for-service, run -- paid for by the public option medicare -- it's all paid for under the public option of medicare -- 34 million are in traditional fee-for-service medicare. of that amount, 24 million have some form of supplemental insurance. in many cases, these are retiree benefits that they have from work n. other cases, it's -- from work. in other cases, it's supplemental plans that they buy commercially. under the medicaid program and the children's health insurance program, which are government plans, another 40 million americans get their health care

needs paid for. and then there's 47 million who are uninsured. 47 million. [shouting] >> that number has increased by 20% -- has increased by 20% in the last decade. the vast majority of the uninsured, the vast majority are younger workers, people who are working, in many cases they could buy health insurance, they choose not to today. these are young workers. maybe some are in your own family. in maryland, our numbers are slightly different and i want to point this out, because we have a different demographic than the national. our number in private insurance is similar, 3.6 million, to the national average, but the major difference is in medicare. we only have 48,000 that are in

private plans in medicare. i want to repeat that because this is an important number. the maryland seniors and disabled who are qualified for medicare have chosen basically to stay in traditional medicare. they have not opted for the private insurance option that is available to them. the rest of the numbers are comparable in percentages to the national numbers. now, one of the reasons we're looking at health care reform is costs, so let me get to the costs today of what it costs to insure a family and an individual in today's market. in 1999, a family plan in america cost $5,700. that's what a family insurance plan cost. by 2008, ten years later, that

plan cost over $12,000. that's an increase of over 100% in ten years. this is private insurance and the cost of private insurance. i think many of you have seen the consequences of this. employers have shifted costs over to the employee, where employees pay a larger percentage of the costs of their employer-provided health benefit. you've seen it in tougher rules to cover families where you work. they'll cover the worker but it's more expensive to cover your family. and we've seen it unfortunately happen with many companies choosing to eliminate their health insurance. what is really disturbing is what the scorekeepers tell us will happen to the cost of health care if we do nothing. if congress decides that this is

too controversial of an issue to pass, it is projected -- [shouting] -- it is projected that health care costs will go up in ten years from $11,000 a family -- that's 2006 -- to over $23,000 a family by 2016. now, even if your employer covers a significant part of that cost, it affects your this is what you are paid for as a worker today for a family plan -- what you are paying. let's talk about the facts. i know some of you do not want to listen to the facts, but listen to the facts. today in marylander, in

maryland, in maryland -- in maryland, 71% of marylanders are in one of two private health plans. we do not have much competition with private insurers in maryland. one-third of the employers' offer no choice to their employees -- one-third of the employers offer no choice. one is to give more competition and choice to bring down costs to, one option. [crowd noise] now, i understand that many of you, many of you really want to hear what is going on, so let me

try to get through this. thank you. the goals of health care reform are to allow you to keep the coverage you have. now, look, there's no bill that says i can assure you, that the majority of members of congress will not pass a bill, nor will president obama sign a bill, that does not allow you to keep your insurance coverage. we do that -- we do that by stabilizing costs. if we don't stabilize costs, we will see an increase -- we will see an increase in the number of people who will lose their insurance. [audience shouting] >> the second goal of health care reform is to make coverage

available to everyone. we want all families to have health insurance. now, the question might be ask asked: how do the 46 million without health insurance affect me? i have insurance, how does it affect me when 46 million americans do not have health insurance? now, the answer is simple. those who don't have health insurance use the health care system in a more costly way. they use the emergency room. they don't pay their bills. and it costs all of us money. today in maryland, every family that has health insurance is paying an extra $1,100 a year because of those who don't have health insurance.

so one of our reasons for being concerned is to bring that to an end. it's wrong for those who have health insurance to have to pay for those who don't have health insurance, particularly in a more expensive way.

>> if you give me a moment, and only have a few more slides. the next goal is to improve the quality of care. we improve the quality of care by -- let me just give you one statistic here.

according to the world health organization, the united states ranked 37th of of 191 countries. -- out of 191 countries. >> if you would just allow the senator -- please. if you will just allow the senator a few more moments, we will get to the questions. just a few minutes. [crowd grumbling] >> let me just complete these slides. we went to provide better health outcomes and slow the growth of health care expenses. -- we want to provide better health outcomes. listen. i know a lot of you have your minds made up, and i understand that. that is fine, but i want you to

know what is common to all of the proposals. we can therefore have a discussion. maybe you disagree with that. these provisions are in all of the health-care proposals that are working their way through congress. think you're going to agree with some of these. first, insurance reform. insurance reform means that insurance companies today will no longer be able to discriminate on preexisting conditions. they will not be able to have exorbitant out-of-pocket expenses for copayments. no charge for preventive health care. no dropping of coverage of seriously ill. no gender discrimination. no annual caps. no lifetime caps. and there will be a guaranteed insurance program. that's included in all of the bills. included in all of the bills is individual responsibility.

everyone will have to have health insurance and carry their own responsibility. that's in all of the proposals. in all of the proposals is employer responsibility, and we'll get to that in a few moments. employers have to help. in all of the proposals, you have a chance of plans, doctors and hospitals, that's maintained in every one of the bills that are moving through congress. in every one of the bills, we have a focus on prevention and chronic care, diseases. we want you to be able to -- [applause] -- >> we want you to be able to take care of your preventive care and wellness issues. in all of the proposals, we are going to lower u.s. health care costs or we're not going to pass a bill. [audience shouting]

>> now, i only have -- i only have one more slide to go. [applause] >> and if i -- look, some of you -- all, again, i ask, is if you give people a chance to have their questions heard and give a chance for response, i think it might be a little bit easier. now, these are open issues. there are no decisions that have been made on the bills that have gone through congress to date. so we can't answer these questions on any definitive answer. your comments on this will be very helpful. we don't know what's going to happen with the public insurance plan. we do know that there will be exchanges where you'll be able to buy private insurance. we don't know whether we'll have a public insurance option or not.

we can debate that issue tonight. i have strong views about it. you may have strong views about it. this issue's an open issue in washington. we have not yet decided employer responsibility. we want to make sure that small companies are not burdened by the health care reform. we want to help the small companies so there's going to be exemptions for small businesses and tax credits for small businesses. we don't know how we're going to pay for the costs in the short term. let me explain that. let me explain that so you'll understand. we have a common rule. there will be -- there will be a loss of revenue to the federal treasury because of the extension of tax relief to more people, as more people become insured, they use before-tax dollars. that costs revenue to the federal government. there will be investment in getting more primary care facilities because we'll have more people that will need

primary care, and we're going to provide subsidies for low-wage workers and small businesses. all that costs revenue. how do we pay for it? we are committed to making sure that it's deficit-neutral. the budget requires it and i can tell you, we are not -- i'm not going to vote for a bill that's not paid for, so it's going to be paid for. [audience shouting] >> now, i'm going to tell you this. i am confident -- i am confident that we're going to get this right. i am. and that's a confidence in the american people. we're not there yet. we're not there yet. but i can tell you, those who are engaged in this discussion who are willing to look at the facts, are willing to look at the problems that we have in this country understand that our

budget and our economy require us to bring in the costs of health care. we know that. if we're going to keep jobs in america, we need to be competitive. we've got to bring down the costs of health care. so we've got to get this right. the current status -- the current status is that more four committees in congress have passed bills. you can get information on those four bills. there is no bill yet on either the house or senate floor. there will be in the fall of this year. there's a fifth committee -- there's a fifth committee, the senate finance committee. the senate finance committee is working over the august break to try it to resolv re -- to try to resolve differences. it's a bipartisan effort -- three democrats, three republicans. i certainly hope -- i certainly hope that we will have a bipartisan bill because i think we'll have a better bill. so my advice is to get engaged

in the process but understand what is going on. my last point -- >> let the senator say his last thought and then we will go to the questions. >> my last point -- my last point is this. we are on the verge of taking up a significant health care reform bill. we want you to get the facts. unfortunately, many of the -- much of the information that's being presented there is taken from one of the bills or a misunderstanding of one of the bills, so i hope -- i hope you're willing to listen to the facts. i will do my best to leave the editorial comments out of answers if you will do the same in your questions. i think that will be of service to the majority of the people that are here that have sat through quietly as i was making my presentation waiting to hope to get some information.

and with that, let me turn it over for the questions. [applause] >> we're now going to address the questions. each of you when you walked in tonight had an opportunity to write down a question on the card. some of you did. some of you did not. here are some of the questions. when we finish this set of questions, we will then go to the questions at the mike. okay? if you'll please respect the members of your audience that are sitting next to you who want to hear the question, we want to hear senator cardin address the question. again, we want statements -- we want questions, not statements. first question submitted: will illegal immigrants have access to health care under the new health plan? [audience shouting] >> the answer is no, they will not be covered under the bill. they will not be -- they will

not be -- there -- i -- there will be specific language on this for the immigrants. those who are not lawfully in this country will not be entitled to any of the benefits of the bill that we're talking about. they will not be part of the universal system. they will be excluded entirely. >> second question. as a small business owner, i am very concerned about the cost of our insurance. it went up 15% last year, 26% this year, and will go up again next year. how will the proposed plan help us? >> small companies today are in plans that reflect the health experience of their employees at 0 il's 50 employees, in view of a commercial health-care plan, and, first of all,