companies make their own decisions on whether or not a portion -- abortion should be a cover procedure. their subscribers can determine whether or not they want to enroll in that plan. many of work -- many offer coverage because many people want that option. some do not. but it is determined by private insurance plans. it will not be paid for with federal dollars. in fact, currently reform efforts will continue in that vein to allow consumers to choose the plan through the exchange, so that when you go to this exchange, you can pick which plans do not provide coverage and you do not have to choose -- pick a plan that offers that coverage. but these will be private plans and it is up to the private insurer.

you're on moral decision, whatever you want to do, it is your call. . the are monitoring the insurance companies. they are not going to choose which benefits for which insurance plan you choose. nothing in this section or in any of the bills that we have put through committee permits

the health taurus commissioner to choose benefits for you. -- health choice commissioner to choose benefits for you. we are almost finished. that is why it has become so contentious. the government will have direct access to your bank accounts for elective funds transfer. this section that they are referring to is on page 59. it encourages the development of standards to encourage electronic payments between providers of insurance companies -- this is what insurance companies ask for to make it easier to pay insurance premiums. much less cost delay. it is an administrative simplification measure and it will save billions of dollars. but nothing gives the government

access to your bank account. nothing. two more final myths. the government will mandate private packages for private health-care plans. the facts -- insurance companies in this exchange will have to offer a basic benefits package in every service area. and minimally adequate package. it includes hospitalization, a physician visits, medical equipment, mental health, preventative care, maternity and baby care and medicines -- services that anyone would expect an insurance policy to cover. [applause] we are going to require that those basic services be covered by every insurance plan. private insurers can and are encouraged to and probably will

offer a higher tier of services with more benefits from the government. but they can do that in order to acquire more subscribers to get more people to make more money. that is what the private competitive system and is about. that is why we want to be able to do that. but there needs to be a minimal -- a minimally adequate level of benefits. a lot of people pay into an insurance plan and then they get sick and find out that it is not covered. the last myth -- government will reduce services to all medicate seniors. this is completely wrong. the section that is referred to on page 239 adjusts the sustainable growth rate, sgr.

a formula that is calculated to help prevent massive cuts for physicians. we worked with the physicians to come up with this. all of the physicians and the american medical association are in strong support of this section. [applause] it is their section. they wanted it in there. it is not cutting physician reimbursement for physician services. that is last -- the last thing that the physicians and the ama would want. it is staying in. there may be other myths out there. there are a number of reasons for why people would quite genuinely have reason to oppose this legislation. cost, the fact that we cannot always control what we try to

do. i will be honest -- frank with you, even though many seniors were disappointed -- i voted against the medicare prescription drug benefit because i thought it would be too expensive. as soon as they put the language in that change things, i thought it would be too expensive. hundreds of billions of dollars. you cannot always control what you are trying to do, but it does not mean you should not try to do the right thing and do it as inexpensively as possible. now -- for me, the highlight of the evening, i want to introduce our featured guest

speaker. [cheers and applause] [boos] [applause] [both boos and applause] let the record showed there was an overwhelmingly positive response. i do not want to encourage the other side. apparently he needs no introduction, but i will give him one anyway. howard dean is a physician by trade. he was a state legislature and the tenant governor and he was governor of the state of vermont and did a fine job.

he continued to practice medicine in the entire time he was a state legislator and lieutenant governor. he is dedicated to his profession -- public service and medical care. three terms as governor of vermont, and under his leadership he got through and law -- and law that provides coverage for children and pregnant women in the entire state. [cheers and applause] and he balanced the state's budget. [cheers and applause] five years ago today, he ran for president of the united states. he ran primarily on a platform of health care that was affordable and accessible to all americans.

now we have tonight -- we are honored to have a real fighter for the people. a grass-roots leader. he has worked his adult life for reform of our health-care system. he is a great guy. a terrific person. we are honored to have him with us. governor howard dean. [cheers and applause] [boos] [whistles and applause] >> thank you. thank you. the last time i was in front of a crowd this size, it was made that was doing the screening. thank you.

i am just going to say a very short few words. the reason i am going to say a few short words is because i think he did a terrific job laying out his thoughts on the health care. a round of applause for jim moran, a great congressperson. [unintelligible chanting] the reason we need health care is that the cost of health care is 70% more expensive in this country than in any other country. this country spends 17% of its gross national product on health care. >> i am sorry, but i cannot hear the governor and i am sitting next to him.

there are hundreds of people in this gymnasium who cannot hear him because of a handful of people. these folks are not from the eighth district. they do not belong here. i am going to ask them to leave. [unintelligible chanting] >> we will not be silent! we won't be silent. we won't be silent. [unintelligible chanting]

>> we will not pay -- >> coming to this meeting to represent this -- [unintelligible chanting] [cheers and applause] [boos] [cheers and applause] [boos] [unintelligible chanting] >> apparently most people can hear me because my staff per cent -- cannot tear me because my staff per cent did not hear me. he is randall, an abortion- rights activists. i consider him a radical because all he does is try to disrupt

meetings. he announced that he was coming to disrupt this meeting. that is why i am asking him to leave because we have other purposes for this meeting. mr. terry, if you would please leave. if you please leave, mr. terry. [unintelligible chanting] >> what? no, no. you know, i am willing -- relax. mr. terry, if you were so inclined, let me suggest this.

you would have to abide by this -- rather than being escorted out, you can have the option of having the first question and five minutes to say whatever you want. but then it would be restricted. we need to hear from other people. otherwise you really need to leave. we need to move forward with this. >> we will -- we won't pay for -- [unintelligible chanting] >> howard dean is a baby killer. [unintelligible chanting]

>> baby killer. abortion is murder. abortion is murder. [unintelligible chanting] >> i know you think you are special, but there are hundreds of people. governor dean? >> kill your children -- >> as i said, i am going to be extremely brief because of like to hear from you. not that i haven't already. there are three problems we have to fix. regardless of whether you are a conservative or liberal or democrat or republican, you agree we have to fix them.

insurance is 70% more expensive in this country than in the next three most expensive countries. harming our economy and businesses. two, there are a large number of people in this country that have no health insurance. i do not know anybody wherever you are in the political spectrum that thinks this is ok. one thing that republicans and democrats agree about is that we need health care reform and we ought to cover everybody in some way. 3, the way that we pay for health care in this country leads us to do a lot of things that are not necessary. there is an enormous amount of stuff that we do to people at all ages from the oldest to the on this that we do because we do

them. in many systems of health care around the world, they have a different kind of payment system which leads the country to develop what we call 8 "ole miss model" rather than "elisse model -- call "a wellness model" rather than an "illness model." we would rather pay to keep people healthy than pay when we are sick. we spend too much and we want to be in line with other countries. we have a lot of people who do not have health insurance, or do not have the through no fault of their own. >> do not let him speak -- >> why i believe so strongly in this -- while i was practicing medicine, this is probably about 20 years ago.

a woman who was about 35 years old came to me who was healthy but i had known for a little while. she said she was increasingly thursday, losing weight, urinating all lot. it turned out it was diabetes. that was february. by me her insurance had discontinued reinsurance. i do not think that is right. someone needs to do something about that. the last thing that time ago -- that i am going to say which will undoubtedly sinbad the way that i came man is that i support president obama's health care plan, including the public auction. [cheers and applause] [boos] [cheers and applause] jim has told you all the reason why. not that i have dropped that hot

potato, i am going to sit down the same way that i stood up and get it back to the guy whose district this is and to has done an outstanding job. >> all right, governor, now the fun begins. gail -- my office manager/scheduler. you hear her voice when you call our office. we have 3 boxes here. we will pick the first question and then announce the second so people can make their way to the microphone. now, the question says --

[unintelligible shouting] the first question is, my brother lived in france for 10 years. oh, there it is. sarah stott. sarah stott? there's sarah stott. read it or paraphrases of yourself. that me just read the second name so the second person can start coming up. the second person will be bryan lawson. >> my brother lived in france for 10 years and his medical bills and prescription repaid through the system and he did not have to wait in line to see a doctor.

why are people in the u.s. afraid to have such a system? [applause] >> changes hard. -- change is hard. their reason they have that system is health care was destroyed in world war ii and it was put back together by the government. the system in britain was put in by the most print -- the most conservative prime minister in history, winston churchill. when the mitt -- when the system was destroyed they commandeered this systems. they started from a different place. we started from an employee- based system. we were only attack twice, in the illusions and the hawaiian islands, the system was not destroyed. the recent the system is the way

it is today is a lot of employers were prevented from giving their employees wage increases during world war ii because of inflation and wage and price controls and they made it up to their employees by giving benefits. we evolved a system in this country because of different circumstances. it is hard to change. a lot of this debate is about change. the one thing any doctor can tell you about changes that you never make real changes until the pain of staying the same exceeds the fear of change. i think the pain best in the same has exceeded the fear of change. -- pain of staying the same has exceeded the fear of change. >> and articulate response. -- an articulate response.

bryan lawson? jessica is helping us with the microphones. go ahead. sorry. excuse me. >> i am a pharmacist by trade. my question is, do you support medication services that will help the health-care team to help manage the care of patients with chronic illness? >> yes. yes. [laughter] governor dean responded. in a comprehensive way. yes. >> one of the deals here is that there are a lot of people who practice medicine in this country beside physicians. we are going to keep the cost down. you -- we have to use a nurse

practitioners -- use nurse practitioners. >> mr. williams? anybody who gets here first can do the question. alexander -- alexandra broadman? are they coming? >> congressman? >> where? >> congressman, thank you for doing this tonight. >> and there is clear mcintyre. >> my question is, do you think that a system involving co-ops is an acceptable compromise? >> i personally do not and i

will explain why. there's nothing wrong with health care cooperatives. many states allow them and some states have them. but there is not a substitute for a public auction. it is very difficult for enough people to get together to put it together themselves. for one thing, you need about 500,000 people to be competitive with the private insurance industry and you need a lot of startup money. that is why if the government was able to kickstart that with money, that would be repaid, said that it could eventually pay for itself, but the government has the expertise running medicare that they can do this. health care cooperatives frankly do not.

well i would encourage people who want them to go ahead and put them together, that is fine, the problem is there is no real profit incentive for anybody to invest a substantial amount of capital in setting them up. you're not going to get repaid in the form of dividends or profits. it is not comparable, but it is not a bad thing. yes? williams, yes. go ahead. we need a microphone. we did not know where you were. jessica? clarire? >> would like to know, are you in your family willing to go on the same health care, and have

you or any of your family lived under so-called socialist medicine as i call it? i have and i have relatives on that, and trust may -- [cheers and applause] >> as soon as the crowd comes down, i will respond. yes and no. of course i am prepared -- i live under -- i am insured by the federal help employees plan. it is a full family plan.

i paid a substantial amount every month, several thousands of dollars per year, almost $6,000 per year. it is a good plan and i want to preserve it for federal employees and retirees. this is alicia h? to you want to get the microphone over there? claire is coming with a microphone. this woman has been very animated. she must have -- >> actually, it is the same question. are you willing to take the plan? you did not answer id. >> the answer is yes. >> i just had the microphone taken away. >> i am not going to ask him

right now. >> chris appleton? and then gail. [laughter] chris first and then dennis sawyer. chris appleton? where is chris? right there. appleton? jessica? do you know -- >> i have a simple question and that might be something everyone can agree on. why don't we take the 23 trillion dollars -- in line >> that is not a question. that is not right. you are not appleton.

that is not appropriate. go back to your seat. madam, please go back to your seat. the problem is that if other people can do that i asked for a name and they come up and report to be that person, then a lot of people are going to do that and it is going to get completely out of order so we are not going to allow that. where is mess -- miss appleton? let's try dennis sawyer. dennis sawyer?

claire? >> my question was answered when you were going through your fax, but i have come up with a different one. what but the reform of medicare part b look like? right now we have the situation where privatized health insurance is more in control of providing and determining what kind of medications older patients can take. how is this going to change with this reform? >> i will share with you my understanding of a deal that was made at the white house with the pharmaceutical industry. in return for the pharmaceutical industry producing bad donut hole gap -- reducing that gap, by being able to purchase drugs

at less cost, and returned the government would not repeal that provision that prohibits the federal government from negotiating with pharmaceutical companies on behalf of medicare beneficiaries in the same way that we negotiate with the veterans administration. i would not have made that deal personally, but i was not there. i do not know the particulars. sometimes you will pay 1/3 -- one-third to one-half of the brand-name drugs because they can negotiate. if we were able to negotiate, we could get the price of drugs down substantially, but we are not allowed to do that, nor by drugs from canada. at this point, the only thing that i am aware that would change is the doan that gap would be narrowed.

-- donut gap would be narrowed. governor? is there a toliver? spelled -- sir? there is a microphone right there. >> is a similar question to what everyone else has asked. i have an unusual name. >> is it pronounced toliver? >> it is in virginia.

knowing that congress and the executives as well as the other branches of government will find ways to get themselves off of this government-run plan, i know, i know, but the question is, if it is so good for all of us can do not be on it with us? >> i am. since there have been a lot of people that have asked is, let me try to address it once more. i am going to address a dan thank you for your question. 85% of people, approximately, are not going to see any change in their health insurance coverage. their reason for that -- the reason for that is that most

plants have adequate coverage, particularly in northern virginia. i have private insurance coverage under blue quashed -- blue cross/blue shield. i pay the highest option for my family coverage. it is about $500 per month approximately. i should have checked before it left. about $6,000 per year. the federal government matches that at 72%, the same applies to all several million employees and in the agency of the federal government. you get federal employees health benefits. that is the plan that i have. that is what almost all members of congress have. it is in the same plan as the executive branch.

>> the question is from maureen mitchell. jessica has the microphone. >> to questions. i have to of demand there. -- two qusetions, i have two of them in there. can you explain how we can insure everyone without the public plan? maybe the governor dean can? is there a way to ensure everyone without the public plan? >> there are two countries -- to end the half -- i will leave the house alone, which is germany, there are two countries that have universal health care plans. in order to do that, the treaty

insurance industry as a utility. they tell them what they can charge and how much they can earn and what their ceo salaries are. i have to say that i have been tempted to ask congress to put in their system and see how fast the insurance industry would embrace the public option. let me give you the next one, too. the next one is jeff verhoff. we will hear from roland tolino.

first, jeff verhoff. where are you? >> over here. to your left. >> i am sorry. >> please answer this. you have ducked the hard questions. you said medicare is run by experts. to are these people? a program that is $39 a trillion in the red -- $39 trillion in the red. help from howard. i asked you to answer. you are my congressmen. howard dean is not my congressmen. >> all those in favor of getting

rid of medicare, raise your hand. all those in favor of getting rid of medicare, raise your hand. thank you. [unintelligible shouting] >> answer the question. >> medicare is not in the red. [booing] we do not use general funds. it is true that we are going to run out of money sooner than social security because the cost of medical care is going up. i do not know anyone over the age of 65 who wants to give up their medicare. the reality is that medicare costs have gone up at a much slower rate than private

insurance company cost and medicare use is 3% of the trust fund money for a ministry of costs, whereas in the private system is 30%. medicare is operating at much less cost. we need to figure out a way to pay for it. in the long run, this is one of the ways that we intend to do that. the experts -- there are federal employees who have spent much if not all of their adult life running medicare. the fact is they do a very good job. they are in baltimore, maryland. i am proud that they work for the federal government. [cheers and applause] roland tolino?

what? you are not roland? sir -- [shouting] >> what does this say? [shouting] >> let me see your id. you are the imposter. >> do we have a microphone? >> mike rounds genesse -- >> who wants to share a question with us? >> mr. tolino, let's get a microphone so everyone can hear you. it is not fair you do not have a microphone. >> there are $200 million in

savings if we have tort reform and no one loses but the lawyers. why have we not consider that - - considered that? tell the american people that. >> this is the answer from a doctor and a politician. here is why tort reform is not in the bill. when you go to pass an enormous bill, the more things you put an end the war and amaze you make. the reason it is not in the bill is because they did not want to take on the trial lawyers in addition to everyone else. that is the plain and simple truth. now, taht is the t -- that is the truth.

what is a reasonable possibility -- first of all, i think most people would agree that most people who get injured eye to get something that is reasonable. -- ought to get something reasonable. we do not want frivolous lawsuits. creating an atmosphere in which we cost doctors to more -- to do more things than they need to in case of a jury. but i say is not authorized by anybody. i have tried it out on doctors and lawyers and neither of them liked it. here is what i think we ought to do. it is not going to happen in this bill. this bill has enough enemies. the more crooks you take on the more enemies you make and we do not need any more right now. here is a reasonable solution.

if you did support tort reform i do not think we would get a vote in the house. here is what i think is reasonable and fair to patients and physicians and hospitals and so on. you cannot take away the right to read jury trial. that is unconstitutional and not fair. what i think ought to happen -- this is going to be a hot line -- i think research will be a great help in reforming tort. comparative research is ultimately going to study what works and what does not and it will create a national standard of practice. in national standard is a defense in a court of law that you have done the things you should have done and you cannot

be sued. if you have an action dutch you are going to bring against the medical practitioner -- that you are going to bring against the practitioner, it goes to arbitration, if the patient is on satisfied and believed he is not treated fairly, you can have a trial and have been submitted as evidence. >> that is a very honest answer. before we go further, where is mr. tolino? because i noticed you just during and yelling -- gesturing and yelling, i suspect you were not who you are, so i apologize for doubting. number two, it is a good

question and an appropriate question. it's got an answer is -- an honest answer. pau-- it got an honest answer. it would generate a lot of opposition from lawyers. there's one other does not seem -- that does not seem important but matters. that is that the bill would have to go through the judiciary committee as well. in the judiciary committee, it would have politicized it all the more because that committee as perhaps the most partisan of all committees. the judiciary committee would never have permitted tort reform. that is the reality. both of us gave you an honest answer. but thank you for the question, a good question.

maureen mitchell? i thought we already asked? you are only going to get on. -- one. how about william burkson? sir. jessica? do you want your car? >> i am concerned about the quality of the debate. not only the screaming of misrepresentation, but also the fact that the press does not want to seem to cover politics. i am very disappointed. i would like all of the press to cover the policies. i would also like to hear my

beloved democratic party also arguing some basic things. one, i do not understand why philosophically you think the policy of health care cannot be solved by free enterprise. the school that my kids went to end the state of virginia, many of the kids in high school could not go here of this were private. there would not have the education. the same is true work -- true for health care. the government has to be involved. i do not see why we do not start with -- [cheers and applause] [boos] the other thing i wish you would address in detail is i know that some government programs are good and some are bad and you do, too. i would like to know why specifically this program is going to be a good one as

compared to options. i would like to know how it is going to operate. thank you very much. >> i do not fully agree with the first thing you said. i think it is true, as massachusetts is finding out, which has gone on an incredibly noble experiment in the private sector and they got their uninsured rate down to 2% but they are going broke. i would argue that you do need the public auction in order to make that work. but here is why i think it is true that in the health insurance business, for-profit means taking more money out of the health insurance system and

less money spent on health care. i also believe -- this will be a switch because my folks are not going to like this but the opposition may -- there are some parts of the health care system that do better for profit and one is the health care -- and one is the drug industry. hear me out. here is why i am going to say this. the drug industry gets beat up a lot, and for some reason, because i do not think the tv advertisements are helpful at all. this is an industry that consumes 10% of health-care and an industry that does not make such big profits anymore but they used to hang people resented that. this industry reduces your time in the hospital. that is a fact. a lot of people hate the drug industry, but that is a fact. the other fact is i happen to go on a tour this morning in

maryland. the first one makes a product that enables new born premature babies were they previously died, and it saves billions of dollars. that is a for-profit company. the second one is likely to have the first--- the first real improvement in sickle cell anemia which will save hundreds of millions of dollars in hospitalization. i do not believe profit and health care is always bad. i do think it is unhelpful in the insurance industry. that is why i like obama's bill. it is a choice. if you want to be a single payer in medicare, your choice. if you like your insurance, that is your choice. that is why i think it is the best health care bill.

[boos] [whistles] >> elizabeth? >> this is the undecided box. >> i am a medical student and a proud member of the american medical association and i went to medical school and because i want to serve patients and not fight to served -- to serve care. i want to robust public auction. but there is the alternative, the wiener amendment that offers the single-payer option. i wonder if you might support that?

>> i do not know. it will depend on what it takes to get the best bill we can out of the house. i am sorry i cannot be more specific than that. i am going to work with the leadership to get the best bill we can. i used to be a sponsor of chairman -- of the judiciary committee. i used to be a co-sponsor of the bill. not that we have a bill that the white house has endorsed, my inclination is to support that bill. bob, from alexandria? i think this is the "anti" box. we are only going to have time for two or three more questions. >> t want to check -- do you

want to check my id? just because i sit over there does not mean i agree with everything. thank you. [applause] >> thank you. >> i want to point out it is part of your job and it is what we send you to washington to do. quite sure. >> anyway, i appreciate it. >> i am not complaining. i am honored to represent this area. >> as one of your constituents, i wish you would have held this closer to my house or something like that, but understanding the way things are, i will ask my question. >> most of my town hall meetings are held there and i am trying to be fair to the rest of my constituents as well.

>> ok. congress deals with the medicare costs by cutting fees to physicians and cannot otherwise control the cost. the question about the deficit of medicare -- if you require the government to do the same accounting methods that you require public companies to do for their pension system, it would be in the red. why should i trust congress and the government to run the national health care plan and be able to control the cost? [cheers and applause] >> there are clearly going to be people who do not trust that the government is going to be able to operate the public plan option.

to be effective and efficient. but they do not need to enroll in the public plan. the public plan will be paid for. that is the way that it is set up, the revenues that come and will pay for the expenditures. it will be self-supporting. people like you who do not trust the government to do that, i would not think you would want to enroll in the public plan. there is a gentleman here you has made a point -- name one government program that has been well-run. the fact is, when i go, when i have an opportunity to visit other countries, unless it is the first world, europe, canada,

other countries'governments are relatively corrupt. they run the gamut. the fact is, we have the largest civil service system that is the least corruptible. [boos] let me give you an example of government programs we run -- the military is a government program. [cheers and applause] when, over the last eight years, there was a decided effort to privatize military operations -- sir, come on, we don't want that. maybe you want to move the chair.

when we try to privatize, we find there are many government contractors in iraq as there were military and civilian employees and it cost us more and most of the abuses were committed by contractors. [cheers and applause] i worked with the contractors closely because we have a lot of them in northern virginia, but the reality is that firms like blackwater and halliburton ripped off the government. when soldiers come home, i do not know any family -- ma'am, please -- i do not know any family who has a wounded warrior who does not want them going through the administration. the v.a. is not perfect, but

because we put a lot of money and we have good people, it provides good medical care for our veterans. and that is a socialized medicine system. [cheers and applause] [boos] i am not suggesting that government can pull off perfection, but i am suggesting that there needs to be some balance and i am suggesting that there needs to be more competition as governor dean has so well articulated right now because we are overweighted in terms of dependency on the insurance companies for making the most crucial life-and-death decisions. i think we need to intervene and to rectify that balance to provide more affordable, more accessible, and in some cases, higher quality health care. we are just -- i think this will be the last question, actually.

av -- ravina? gail? we do not have much time. people probably made plans to get out of here by 9:00. .

>> windows reform itself become more important than coal -- when does reform itself become more important in cooperation? >> i am sorry. i do not understand the question. let's go with peggy conner. >> i work for anova. >> the health-care system. >> i do health care for the disadvantaged. >we have friends in france that

have a medical card, and it has that jet that has all their medical information on it. that scares me, frankly, because i suspect -- do you want the government knowing all of your business? i believe our country was founded on independence and i think you can agree with this, whether democrat or republican, it is important that we have privacy between our doctor in our health records. it should not be shared with the government. >> governor dean? [cheers and applause] , and it did tell me under what moral jurisdiction the constitution allows you to do this? >> let me thank you all on both sides. i think everyone behaved pretty well.

this has been a spirited american tradition and i appreciated. i think you ever met -- i thank you very much, all of you. the interesting thing about this, one of the biggest problems in medicine is in the last question. this is a huge issue and much more in this health care bill. this is just not about health care. you do not want the government knowing your help defamation. you are not crazy about your insurance company and your bank knowing all of your information as well. privacy is a much bigger issue than health care. here is what folks are struggling with and i don't think this one is cut. -- cooked. we want records to be complete

and patients get better care if the doctors know that the records are complete. the president put in a lot money into the stimulus package to advance medical records. if you get sick and some place that is 1,000 miles from your home -- in some place that is 1,000 miles from your mom, if you have a chip, they can know all of your situation. if you are in a terrible car accident, and you cannot tell them anything, if they can learn your information. that is important. what the guards for your privacy? there is something called hi pa. but it is not enough. and this is a private sector problem as well as a government problem. just the other day, someone

hacked into a credit card company and stole 130 million credit card informations, that are now in some crypts hands. there are no good answers to this. in this information age there already is more information available than most of us would ever be comfortable with and having in other people's hands. but on the other hand, the more information at your health care professionals have a, it is better. this is an open question because i don't think anyone knows the right answer to this. how are we going to build a wall particularly between the government and corporate america and ourselves so that our private information stays private but there are people who need to know it? one of them is the health care professionals taking care of us. unfortunately there is no perfect answer. i am sorry to leave on that kind

of a note. let me thank you again. i actually enjoyed this and i hope jim has, too. [cheers and applause] >> let me begin by thanking all of you. this is important. as with every major transformative struggle that howrah assignment -- that our society and economy has gone through, whether such as social security in the 1930's, what of the civil-rights struggles of the 1960's, this should be difficult because it is important. it affects everyone and we are certainly not going to get it right unless we hear from all sides. i think all of you for coming. thank you for participating. and it was helpful. and it was certainly helpful to me. thank you.

now those of you who did not get a chance to ask a question, i am sorry. i hope that some of the answers -- the questions that were asked represented those that you would have passed. [captioning performed by national captioning institute] [captions copyright national cable satellite corp. 2009] >> nice to see you, charlie. [inaudible] >> i appreciate the bipartisan effort. all they had as tom delay on "dancing with the stars." >> it is nice to see you. [inaudible]

>> i will take a look at it. >> it is a wonderful bipartisan effort. it is a noble effort but it takes two to tango. >> it would be helpful if we had another plan to compare it with. you are absolutely right. thank you. thanks for coming to this. >> thank you for your wounded warriors support. >> thank you, sir. >> thank you for coming out here and doing this. it was obviously difficult with the crowd.

although less on the presentation in a little more for the public. we only had 45 minutes. [inaudible] that the meaning of's as a party -- >> i have not used that term. -- the domiemeaning of oz as a party -- >> i have not used that term. thank you, sir. nice to see you. [inaudible] they should have. that is unfortunate.

i did not know that. [inaudible] >> i like to know about the basic standard plan. everyone is going to be required offer the same thing, whether public or private. >> well, they are not, really. it is a basic package and in private insurers add to that as they choose to to be competitive. [inaudible] >> thank you. good to see you again. [unintelligible]

>> i know that it is. it is a good bill, actually. >> are they changing the system for the better? there is no more money. [inaudible] >> as we continue to watch the scene here in reston, va., we want to hear from you. 3885. democrats call to 02-585-3886.

and all others call 2 02-585- 3887. we just heard a town hall with congressman jim moran, a democrat. in 20 minutes we will hear from our republican, lissome rakowski. our first call is from frank in indiana. what did you think of tonight? >> i thought it was great. i love howard dean. i am cool with jim moran. the opposition is running out of gas. i died and probably 20 minutes into it and i heard randall terrperry talking about not fing murder.

they have already have 11 in at that prohibits federal money to grant abortions. but i do not see randall terry going out to private insurers and boycotting them, because they fund abortions. i feel like this -- the opposition is running out of gas. we did not find -- the republicans issued two different wars, tax cuts, they issued medicare parts b and d, with no way to pay for it. the republicans need to come to a realization. you want to be fundamentally or ideologically against president obama? that is fine but the facts are the facts. i think howard dean is a very credible witness when it comes to health care. lucky said in the beginning, he was dealing with the woman that

had diabetes. and her insurance got cut. you do not hear the republicans talking about that. >> a republican next, karen, you are from virginia. the home of congressman iran. -- moran. dollars that is right. if we're putting 47 million people into the health care system, how can we do this with the facilities that we currently have. i know that family care practice, those physicians, their numbers are dwindling. it is hard to get into a doctor. for those of us who have insurance, is our level of care going to go down? >> james from california. >> thank you for taking my call. i want to say that i support the prior call and what was said in the town hall mauling -- town

hall meeting, with all the money paid out to israel. we are spending millions of dollars in a war against terror that happens because we support what is robust palestinians but we cannot take care of health care here in america. ron paul has said that if we stop paying for these wars in the middle east, all of these wars for israel, we would have money at home for health care. >> what did you learn from watching these town hall meetings? >> i appreciate c-span a great deal. you really get a sense of what is going on. i think that the right-wing radio has really encourages people to come out and it is a marked an issue where they are trying to distract what is being presented with regard to policy. by watching the fall town hall meeting on c-span you can see exactly what is going on. i think that congressman

moran and howard dean present it fully on both sides. the way to address it is a single payer plan with a private auction. until we stop paying for these wars for israel and the middle east we don't have the money. >> the dnc is planning a hold of 500 health care events before congressional lawmakers come back on september 8. it ranges from organized fun banks and rallies. next up, eric in indiana. >> thank you for taking my call. in a lot set because if you look at 30 years ago, there were 25 companies or corporations that were working on vaccines and yours. there are now three. the reason that there are three is because you cannot make money once you to our something. the whole system is based on profit. -- you cannot make money once

you cure something. if you look at the statistics into thousand five, 81% of those drugs that came into the market were labeled by the fda and were not better than the existing drugs on the market. all they had to do was compared to a placebo. these big farm a company's -- pharma companies, it is all about profit. some true breakthroughs come from the universities. they are funded by the government. if people want to call that socialism, it really upsets me. anyone who says something like that should ask their

congressman to come to the floor of the house and bring about a bill that will repealed medicare, social security, privatize the military -- the list goes on. are we going to privatize the teachers of america, but firefighters, a cops -- in the 1800's, the british had a private fire company. >> we have a health care how here is c-span that includes -- a health care hub here at c-span that includes videos. you can read proposals from house members and senators. the next is from ohio. >> i am sitting here listening to these people with good intentions, from the left and from the right. i want to convey to your audience right now i might be the only person speaking out on this issue under the general welfare clause, article 1,

section eight. what this administration has captured, the sense to provide for they general welfare of the united states. our constitution is a political compact, not a social one. we think a lot about the monetary system. this country is beyond broke, deficit spending as far as the eye can see. we simply cannot do what these politicians and plutocrats are trying to persuade -- this country is broke. the only thing that is left is that government debt credit card, an energy card, and health card. i wanted to think about those three things. and this is about total control. these false flag operations that in contrive to persuade people to take a shot. we are living what diabolical agenda from some of the most

diabolical people and they are using our own constitution against we the people. i think you c-span for the time. >> a couple of the chance that we heard. no socialized health care! what do think about that, roger? >> people keep going over the same thing all the time. i thought it was ridiculous but the tight chanting about abortion which has nothing to do with health care issue, really. what i think i would like to see more of is paying for this. back in the past, 20 years ago before the internet, people used to buy stocks. when you bought stocks, if you would pay at. you could pay $1 to buy a share of stock.

i had been wanting someone to talk about how we're going to pay for this and not have a deficit. i came up with a 1% charge on stock trades, now one buying a stock to make just 1%. that could raise $150 billion a year. it would not only pay for health care but cover the money in medicare and stuff like that. if we paid more attention for how we are going to pay for this, and there are emergency things. i actually went a couple of weeks, i got very dizzy, i felt like i was going to fall apart. my head was not sending me the signals to walk across the street. all i wanted to know was about the busyness. by the way they put me on an

electric cart a scrim -- cardiogram. you're getting bills for $4,000 for that one hour that i was in there. i never saw a neurologist. all they said was that you did not have a stroke. i wasn't trying to be checked for a stroke. that is why some of the high costs are coming and that we have to get our control. now is talking about how to pay for this. they talk about taxing the rich a couple of percentages, but a 1% tax on stock trades, cheaper than people used to pay in the past, and it is discretionary spending. that would take care of the problem. >> roger, thank you for calling in. we want to get to some more callers. i want to let you know that "washington journal" will have a three part series on medicare beginning tomorrow morning. at first focused tomorrow is medicare part a, hospital insurance, and that is with the

former director of the s centers for medicare and medicaid. and then part b on thursday, and then on friday, both guests talking about medicare part c, the supplemental medical insurance. "washington journal" starts every morning at 7:00 a.m. eastern time here on c-span. i next call from a virginia resident, melissa. >> i heard a lot tonight, but i did not hear some details toward these plans and what their intentions are or how they work. is it going to be a group of physicians and specialists that will be assigned to patients and that will instruct them on their care and what drugs they say they should have? none of that was discussed. >> tell me about the experiences you have had in the health care

system. what did you see? >> i look in -- i worked in a large -- i worked in a large health care system in virginia for six years. -- for 12 years. physicians are told to see patients and 15 minute increments. they are pushed in and pushed out. you do not get good detailed health care. you get fast, let's get them through, let's get them out. what is bothering you? let's just take it that. health care is not what it should be. the new plant -- how is it going to be structured? >> we are watching video from earlier in the town hall at reston. in 26 minutes, we're going to see center lisa -- senator lisa

murkowski and her town hall meeting. >> i am a young republican. they did not make clear how it was going to be paid for. my social security is already going to be limited. the real problem is the need for tort reform. need to realize that if we cap losses at $50,000, we would save $50 billion. we cannot just try and work with that view. there are a very select few that will profit off of this. >> what to think about competition in the health-care system? do we need more or less? >> i think competition is great. it does not to be expanded or decreased.

it is taking the government away from where they need to go with it. >>-from connecticut, go ahead. -- ivan from connecticut, the majority. >> these politicians are fooling the majority of people and it is not working on the intellect. if they want that fix all of these debt problems, they should get rid of the federal reserve system that owns the country. they take every single dollar and printed out. they are the only people that print the money. it is absolutely ridiculous that we can get 300 million people to abide by these laws that are word magic to people who do not even know the system, they don't know enough about the world have an opinion. just the fact that they have opinion, my opinion is that you cannot be serious about this. we are all going downhill and we're going to drag every single

one of us, holding onto each other scholars, and it is going to cut down. -- each other's collars, and it is going to go down. is going to be revolution and it is not going to be pretty. the man speaking before me talking about the masters of industry and all of the secret people be on the government that have all of this say, they pay no taxes, and they make all the money. they are the richest people in the world. there is 5% that makes up how this country is. that is the right. >> a democratic caller from tennessee, betsy. >> betsy can and. i am calling because -- cannon. i am calling because i wonder the people who are against this health care system understand

about competition? i am health care provider. people complaining about control which is already in place. yet the government cannot be in control, what we have right now is the insurance companies in control. i don't know one physician that says that they make their decision simply based on the patient condition. those decisions are influenced by the payers with a facility they are working in. most of these things are in place but it is not necessarily in their benefit. >> far less cost tonight is from karen from california. >> i am are recently new republican. a democrat all my life. i have watched town halls here

in california. what i sought tonight, i was appalled. being a democrat and changing to republican recently, i saw prescreen questions. i have never seen that before. my congressman asked questions in the august -- is answered questions just from the audience, out of the blue. he wanted to throw a whole group people out until he realized it was just one person. our representative is nancy pelosi, i heard it in the last call. i heard them not answering questions. he called up and had dr. dean come up. dr. dean is not a person in congress. he is not the one that is going to be butting -- a voting with but that is going to affect me, seriously.

and then i saw something -- free speech is something that we all fight for. and my mom, i see my mom's social security check not being increased for the next two years. how can people not see things disappear underneath their nose? you know what? i am completely appalled with what i saw in this town hall tonight. i saw people wanting to be thrown out, i saw prescreened questions that i thought i would never see in my lifetime, from the democratic party that i was a member of for a long time that i just recently changed to republican. i am very proud of that. from what i saw on c-span tonight, it's time that they needed to-do's and -- to answer those questions and not call up another person's answer those questions for his constituents who are voting for him. thank you for taking my call and i love c-span.

[no audio] >> that was our last call of the night from karen in california. c-span will continue to cover these health care town hall meetings. if you are attending what in your community, we want to hear it from you. tell us about your proposal or ideas about health care one video. go to c-span.org/citizenvideo. members of congress had been holding meetings with constituents in their districts. we just saw one with congressman jim moran. up next, congresswoman leeisa

rakowmurkowski. after that, an update on afghanistan's elections. >> health care hub -- and share your information.

>> now that town hall meeting promptly sent murkowski -- from lisa murkowski. it is from anchorage, alaska, and is about two hours. >> i thank you for doing this. i can only represent you well in washington, d.c. when i feel i know well what it is you're looking for what you are seeking. this town hall meeting tonight, as we discuss health care, health care reform, health care insurance, this is important for

you to be here but much more important for me to listen to you. as much as i would love to stand here and spend the next two hours telling you about everything that is in the health community bill or not in the house bill, we can do that at another time. what i would like tonight is to hear your comments. so i am going to put a leash on myself because i have a tendency to want to tell you everything that is in it. if i am going to do that, i will not hear as much for you -- from you. dennis has given you the ground rules in terms of how much time we would like you to spend in terms of your comments and questions. i'm going to try exercise a little restrained here. i want to give you the information that i think you are seeking. i want to thank you not only for your presence here tonight, but all the comments that i have received from alaskans all over

the state these past few months over the summer. i probably receive 5000 e-mails, and written letters, phone calls, and so many of you have expressed a great deal of concern with rushing health care reform through congress. at one point in time the president said he wanted a bill to sign before the 15th of october. he said a deadline neared. i have heard from many of you who were concerned about the massive spending by our federal government. it is putting that on our children and our grandchildren's generation -- future generations at risk of trillions of dollars in federal debt. many of you may not have an opinion on government plans, but you are concerned about the cost of your premiums, seeing

double digit increases every year, and want to know -- what is this bill going to do to help reduce that? how is this going to help me? how will i be able to keep the insurance that i have? i have heard from many who support the actions that have already been taken by congress and that the president is supporting. wherever you are coming from tonight, i really want to hear from you, even those who may said at least it is coming at this from a completely different perspective. i need to hear that voice but you need to be respectful about how we deliver those opinions. i hope that everyone has received a copy of the materials that were presented to you. it is a packet of information that i want to take just a minute with you tonight before we go to your questions, because these will provide you with a little bit of background in terms of where i am coming from

and how i have formed might thinking on some of these issues. the first picture there, the first graph shows the exponential growth in rates of health care costs. the president has stated it, every member of congress has stated it, the growth curve is not sustainable when we talk about health care costs. part of the reason for this is many people are living longer. our technology allows for that, but also we recognize that much of this is unnecessary costs. we got duplication of tests, the practice of defensive medicine, and we have certainly here in california alaska's primary care a day results in greater utilization of specialty care. to understand why our premiums are rising so much, we need to look at how we're spending money

on health care. we have gone from $250 billion in the early 1970's, to over $2 trillion in mid-2000's. i will repeat, we are on an unsustainable path and a half to be addressed in what better health care reform legislation we pursue. the second graph on the bottom of the first page is the medicare cost growth projections. includes the story macaque -- medicare costs back to 1985 that shows -- cbo is the congressional budget office, a nonpartisan budget office -- this is how much they predict medicare cost will grow without any policy changes over the next 50 years of. look at that, the increase is astronomical. but the current line indicates the net balance of the medicare trust fund.

in 2018, that trust fund balance goes to $0. we have a system with medicare at that is also unsustainable. it is broken. living to the back of that page, this is the federal spending less. the reason i have put this here is that i have travelled across the state, and as i talk to people about what is going on with healthcare, oftentimes what i am finding is that it is not i do not like what you have in the health care are right to like what you have in it, there is a great deal of emotion about where our federal government is going. what are you guys in washington, d.c. doing anyway? and when you put it in the context in terms of our federal spending and the national debt, you look at yet and it is unprecedented what we have seen in the past, basically, 19 months when we spent $3

trillion. how can you possibly spend that? when you think about the first mls in february, just in january of the seven and $87 billion. we bailed out fannie and freddie and aig. we have that part fun at $700 billion. -- we have that tarp fund at $700 billion. we have the cash for clunkers program. and now health care proposals that could be in excess of $1 trillion. on top of everything else? tell me that you are going to do it right. tell me that you know is going to work. and by the way, we are dealing with climate change legislation. we do not know how much that is going to cost. i put these in as one of the slides to put into context what we are dealing with in terms of federal spending.

our budget deficit is predicted to be close to $1.80 trillion at the end of this fiscal year. it is substantial. it is out of control. cbo, on the bottom half of the page here, is the neutral government scorekeeper. this is who we rely on in congress to assess, to analyze the legislation that we have in front of us in terms of what it would cost. they made the comments that you have before us about health care bills before the congress. i will not read them. i want you to do it because i want to get through these slides. the next one is speaking to the needs and why we are talking so much about increasing access to health care. to better understand how we're talking about -- new we're

talking about when we define the number of uninsured. we have identified 47 million people that are uninsured in this country. if you look at the pie chart, if you will see that in fact some categories of those who earn more than $75,000, 19%, but choose not to purchase health care. you have those eligible for government programs such as s- chip and medicaid that are not enrolled, and those eligible for employer-sponsored plans but have not chosen. those that are without all affordable insurance options, that is around $13 million. that helps to put that into perspective. you then have some comments from the institute of social and economic research here in anchorage, which speaks to some

of the issues that we face here in the state of alaska when it comes to access for those who are medicare beneficiaries. we have got a situation here in anchorage, the largest city in this state, where you have only 13 out of 75 doctors who will see new medicare beneficiaries. this is an issue that -- without discussion, it comes to mean more often than anyone else. they tell me, my mother cannot get in to see a doctor. i do not know where to go. i brought my parents up from outside. i cannot get a doctor for them. at the health care meeting we had an affair banks last week, i had a woman stand up and -- in fairbanks last week, a woman stood up and said her mother as a great doctor, but this woman is talking about moving down to anchorage, and her doctor in fairbanks said, don't do it. you will not be able to get

doctor to see your mother. this is a huge, huge problem for us when we talk about access. the next light on the back there -- slide on the back there it talks about medicaid and medicaid costs. the projection from the government says that here in the state of alaska, we spend a billion dollars on the medicaid currently. under this proposal, if we pass that version, medicaid would be expanded. the cost to the state would be somewhere between $90 million every year and $130 million every year, depending on how much the federal expansion would be. this would be a cost that is passed straight onto the state. there have been discussions -- on the federal and, we would pick it up -- but ultimately it

comes back to the state and is a state expense. it is something that we need to keep in context. the last slide are some thoughts about how i believe we can advance health care reform. we must have a system that guarantees insurance coverage to those with pre-existing conditions, whether diabetes or heart disease or mental illness or very generic conditions. we must deal with this. we must keep insurance companies from denying claims or canceling coverage because of newly detected condition. those who like their health insurance must be able to keep it. we have to guarantee that help decisions that are made by you and your doctor are made by you and your doctor, and not the insurance and not the federal government. we need to make sure that we are equitably reimbursing our

providers for the care they provide you and your family. we need to prohibit financing health care reform on the backs of our small businesses. here in alaska, we have many small businesses. imposing an employer mandate, in my opinion, it is very difficult for us to impose this on our small businesses. we must keep them from pacing -- placing caps on how much they would treat. and we must focus on the prevention and wellness aspect, those that would reward and facilitate healthy behavior and lifestyle changes. we would create a program that would shift millions of americans from private to public coverage and eliminate the private insurance system as we know it. the president has stated that the status quo in health care is

unsustainable, and i think if you look at the first page of your handout, you will agree with that. but we must recognize that building health care reform on the backs of a broken medicare system is also unacceptable. we need that structural reform that moves us away from the first services -- fee-for services. we have a great will -- a great deal of work to do in washington, it is absolutely necessary and an imperative for your congress to address health care reform that gives us a system that we are proud of, but that also gives us a government that is affordable. with that, i would like to open it up for questions. i think that dennis has laid out

the ground rules. we have microphones and he will be calling on you so i am not playing favorites with anybody. but thank you for your attention for right now. [applause] >> two more comments. when we ask someone to speak and they don't get everything they want to have said said, all of you should have picked up one of these cards at the front. please give us your comments on the cards. those of you that choose not to speak publicly, please give us your comments were visit the center on the internet and e- mail her. the one other housekeeping item, this particular brochure that the senator was going through is the only one sanctioned by senator murkowski. other materials were passed out which was fine but those were not her materials. those were of different groups.

nike. yes, ma'am? just stand up. as soon as i sit down, your time starts. and please tell us your name and in the time starts. >> my name is joanne. my question is, if you talk about the bureaucrats that are going to be making the decisions, how are they going to be chosen? are they going to be chosen by i s, the people? are they going to be chosen by the president? are they going to be chosen by congress? are they going to be representative of all the 50 states? are they going to part of each ethnic group? how was this going happened and at that desk? what say are we going have? >> an excellent question, one that anyone who cares about their health care for themselves or their families should be asking.

i will speak to what we have laid out in the senate bill. and when i speak about the senate bill, one caveat. there is a bill that mr. the senate health education labor and pension committee, the committee i sit down. it passed out about a month ago. there is another senate version that is being crafted or worked on within the senate finance committee by a few core individuals. there is nothing of detail yet. the house has its own version of health care reform legislation. but let me just be to the senate version, because i spent about 60 hours with members of the committee going through that proposed legislation. he would basically have, for lack of a better term, a medical board that would be composed of individuals that would be selected by the secretary of health and social services.

i do not believe that the president has any oversight over the selection, who might be on the medical panel. it is through the secretary. there is a great deal that is assigned to that secretary in terms of directives and how individuals are appointed or how decisions are made. again, it goes back to my comment that it is me and my health care that we're talking about, i want to know that it is me and my doctor who are talking about it, or if i need have other family members in on the consoles, that that is where it is.

quite honestly, i don't think that having a group of nameless, faceless individuals that are telling my doctor what he should be doing for my health care is where i want to be. [applause] >> the gentleman with the glasses, that road back. yes, sir. could you please introduce yourself? >> senator murkowski, my name is darryl. would you support a public option if it saved the overall economy in the long run? what i mean by that, $100 billion a year federal increase but it would save the economy. there is now a hidden tax on insured people, about $1,900 for each in chirred worker in alaska -- ensured -- insured

worker and alaska. it rivals are in come taxes, $3,800 between the two of us. also, a 50% of bankruptcies, 62% of foreclosures -- those are costs to society and they are due to medical bills. if you took the long run and saw that the overall economy would help, which he did support a public option? -- would you then support a public option? [applause] >> i had been asked many times, would you support a public option, a government-run plan? it is not so much that the government-run plan is in and of itself a bad thing. we have government-run health care right now.

medicare and medicaid and the da system in the ihl system -- and the va system and need ihs system. i am not upset -- absolutely saying we cannot have a government-run plant. but we have had a government plan that actually works. and let me tell you -- [cheers and applause] to take the model of the broken system, a system that does not work -- and in the state of alaska, medicaid does not work. if you cannot get in to see a provider, it does not work. so if we're going to move toward any kind of a government- run plan, that devil is clearly going to be in the details. if you cannot get in to see a

provider, all we're doing with a government plan is giving you a new card. someone described it as giving someone a bus ticket, knowing that there is no boss. -- no bus. that is wrong. i am not just say no to a government plan. >> as go back to the gentleman in the brown shirt, about halfway back on the right. >> thank you, senator. >> please introduce years -- yourself. >> my name is ray and i am one of your center -- senior citizens. not your fellow senator nor are president nor many members of congress have something that you have, our credibility -- your credibility in our trust. -- and our trust. [applause]

britney when i say that high and many of our fellow senior citizens are terrified at what can happen to us if this hurriedly and haphazardly written bill is jammed down our throats. i went down to my doctor yesterday. i got extra hour -- x-rays and an mri. it was so comforting to know that i was covered by medicare and i did not have to get to that government alpanel to telle whether i can have it or not. they know i can have it or wait like so many other countries. the bottom line, and my question to you is this, because i cannot believe the smoke and mirrors and the bait and switch signals coming from the white house. how can you add 40 million people to 50 million people to medicare, cut $500 billion from

the program, without rationing and giving people like me and the elderly any of these other services that we're going to need? it sounds like they're going to be doing a lot of rationing, denying and deferring. medicare does need to be fixed, but much of it works right now. you had mentioned what needs to be fixed. why throw the baby out with the bath water? why we fix what is wrong -- why don't we fix what is wrong? [applause] >> i appreciate the comments and what you have expressed is what i have heard from so many. why for the baby out with the bath water? well, i will tell you -- and it goes back to my comments to the last gentleman. we have got a system here and alaska that is failing our

seniors if you cannot get in to see a provider. you're going to hear me say that many times tonight. i have got to figure out a way where we can address the concerns and alaskans and people all of the country about the rising cost of health care, the rising cost of premiums, while at the same time providing new access to a doctor, somebody who can write your prescriptions and heal your body, fix you up, and our reality is right now we are not doing that. the legislation you have suggested has been rushed through. i will tell you. we have a process in the event -- a senate health committee -- in the senate help committee, it was not a good way to deal with the bill. we had at thousand page bill,

presented to us for the first time on thursday night, and we were told that we would markup on tuesday morning, have your amendments in by the week ended and the section on the government option was not even included because it had not yet been written. we spent four weeks going through all aspects of the bill, but it was a process that in fairness was not a real effort to work through the tough issues in a bipartisan way to make a bill better. the pressure on us was to get the bill at committee yesterday. when you set an arbitrary date for the accomplishment of something, and you do not set as your priority adapting good

policy, what you what it is something that moves out of committee that is not good policy. i am not willing to support anything that is not good policy. [applause] . i wish i had more details about it. i make contact with the senate finance committee just today to say, do you have any more in terms of where you are with the specifics of a co-op?

the people of looking at this. is this a way for us to go? what i was told today is that in fact there was a great deal of discussion about the concept, that it may be something that can advance through this group of six after working and be presented to us. -- that are working and be presented to us. right now it is more of a concept. i wish i could share more with the. there are some who had said that we cannot go with a co op, that we need to stick with a public option there are. others said they cannot go with the co often because it is nothing more than a trojan horse for the public option plan. we are going to have a clashing in the meeting. right now we do not know what it is. here and alaska, we have familiarity with our rural

electoral co-ops. how would that work within the health-care field? i do not know that we know yet. is this something that is worthy of discussion? why should we not talk about it? why should we not take the time to look at all of the options and all of the issues incident saying this is the path that we must take and we must take it by the state? let us put it out on the table. [applause] >> the woman with the blond hair, blue, about half way back. this way. this side. right in front of you. right there. with that lady. predicted that lady. >> i work for a medical billing office. my concern is that we will get into the same situation we have with medicare with the reimbursement late -- rate so

low and people cannot stay in business with the amount they reimbursed. if we do go for something from the federal government, are they planning to cap fees and push doctors out of business and then we will lose all of our doctors? >> i wish that the gift is something comforting their credit -- i wish that i could give you something comforting there. the reality laid out by the director of the cbo is that in order for the health care plan that was moved to the health care committee, in order for that to cancel out, the reimbursement rates under a public auction would have to be set at medicare rates in order to work. at one point in time, we were talking about medicare plus tender.

i met the group of doctors. i said, if we did have this plan and that was the reimbursement rate, what would it mean to you? to a number, the also, i could not do it. i could not do it. you not only -- you would have doctors who are not only opting out of medicare, but would opt out of the government plan. whether it is the senate bill or the house a bill that we are looking at, the house bill put it at medicare plus 5%. doctors in alaska are saying we simply cannot do it. again, we are trying to -- the structure that has been built in the senate health committee and house side is one that is built too similar to a system that is not working for a rural states like alaska and will not work for other rural states. it might be working just fine if

you are in washington, d.c. are in boston or in a big urban center. it is not working for us. >> excuse me. this way. the woman right there. she has a gauge-ish ---- eight beigish -- >> i am here representing 16 family practice doctors, which is 20% of the family practice doctors in anchorage. we went from 180 down to 70 because of a medicare reimbursement rates. if the bill that is currently proposed, we would all be out of business by 2014. this is a very serious problem we all enjoy seeing our patients. right now for a $150 office visit, i am paid $14 by

medicare. $40 by medicare. they made $3 billion lester. what we need to do is allow our seniors to take $300 that they are paying right now to the secondary insurance, put it in savings, so they can pay us, hearing aids, other medical devices without a bunch of government bureaucracy. people should be allowed to do help savings accounts but if that is one of the things we need to change. [unintelligible] several of my colleagues have dropped of the medicare. there are other different things i would like to see. one is business offices for patients that cannot afford the health savings account to allow us as physicians to write off

these losses as business losses. none of these things will cost the federal government a penny. it would pit the control back in the hands of the patient and of the physician. we also need to reform malpractice. that is not addressed in any of these issues. [cheers] i have already been built -- >> thank you very much for your comments. you reached your two minutes. that was great. >> on this side. the gentlemen three rows back. >> before we go, what i want to do is acknowledge your and thank you as a family practice doctor. you are, unfortunately, almost a dying breed in our state. what is happening is the

government is driving those out of practice. it is people like those in the room and those that are listening and watching that suffer the consequences. you offered some good suggestions. i thank you for them. >> now down to the front. third row back. you with the glasses. thank you. >> thank you. i am a small business owner here in anchorage. i provide health care for my employees. i they have a health -- they have a coke a. the most inefficient part of my company is dealing with the government. municipal, state, and federal. every part of the government that i deal with is inefficient down to the post office. [laughter] [cheers]

why would we want to allow the government to be in charge of health care in the united states when they cannot do anything right as it is? thank you. >> you run a small business. do you know what it is like to making business judgment decisions for your family and business? many of us recognize that when you lose control of that, whether it is a three-year state government where federal government -- through a your state government or federal government, it may be more than what you are able to deal with. i do not believe that we in the federal government should be running health care. i do not believe that we should be building automobiles. [applause] the government is good that some

things. do not ask me to tell you what they are right now. [laughter] that is a completely different issue. healthcare, and i think this is what has driven you out here today, is personal. it is often times emotional. for us at the government level to impose more than a one size fits all standard, i do not think you get the level of decision making that you want and the ability to choose that you want for you and your family. the direction that we are taking great now, i think we need to fall back, revisit how we can make meaningful changes that do not cost this country and provide better health care for all americans. >> i have another comment from the folks out side. this is one -- how will we prevent insurance companies from

placing financial limitations or caps on how much they will pay if we have not been able to do that already? >how can we actually do that? >> i want to acknowledge the people that are in the back of the room. i do hope that most of the a able to sit. i see some standing. the good news for you is the air is probably a little bit settling on the outside. you may have had the better end of the deal. as far as how we reckon with and deal with the insurance companies, i will tell you. so many of the proposals that are out there, whether on the house side or on the senate side, and what the president is talking about, many of these issues that relate to health insurance reform our reforms of the insurance companies are willing to take on. we are talking about the

requirements that the preceding conditions -- if you have lost a job and to have lost your insurance and you have to move to another insurance plan, you have a pre-existing condition. i think there is a recognition. this is something that shelby and will be addressed. -- shelby and will be addressed. -- shall be and will be addressed. that is one of the issues. there is another area i think we will see a bipartisan result on. it is because the demands from the american public is such that we -- why would you stick with your insurance? why would you continue with a program that you do not know if they are going to -- if they will say sorry, you have now

covered a new love. we are no longer a going to be covering you. these are some of the reforms that, again, are areas where republicans and democrats are an agreement that we need to resolve. [applause] >> in the back of the room, i think it is a lady with a green shirt and hat. yes, thank you. >> thank you for having us tonight. i just wanted to give my 2 cents. i feel like this plan, the president, the house, the senate is a recent visit of socialism. -- rep of socialism. i am very afraid of that. i think they are trying to come in softly through the back door. i just wanted to say that this is not the country that i want to the then it goes to that bit of [applause] [cheers}

>> your comment is one that i have heard expressed. it is not specific to this health care bill that we have in front of us. it is a concern about a draft that we may be seeing in the nation. i think it should concern us. >> over undecided the room in the back. the gentleman with the hat in the back. >> can you wait for the microphone? but it is the gentle man with the brown hat. thank you. >> hello. i may be beating a dead horse to death. i am hard of hearing and have not heard all the answers. i do have something to say about

the medicare reimbursement rate. if you are not on medicare, for your information, if your doctor charges you a thousand dollars, medicare will probably reimburse him possibly $250 for the payment. this is one of the region's -- reasons doctors are not seeing older patients and medicare. i do not what predict i do not know what you will do about this, because the few increase the rate and the amount of spending that the government option will go up. if you go pass a law ordering them to see these patients, i have no idea what is going to happen. my other comment is that i kind of see this as we are driving along in our automobile and up the road there is a big fogbank. it is complicated by the

medicare payment system, by the poor people not having enough coverage, by rich people being able to get whatever they want, and i feel like it is as though we do not know where we are going. it is going to take a lot of working together on both sides of the aisle from the republicans and democrats to find the solution to this problem. i have not seen a lot of positive things come out from the republican side other than some negative comments, we do not want that, we do not want this. i would like to see more working together. we need it. it is going to take something like this to solve it. [applause] >> i agree wholeheartedly with you.

it'll take more working together. it is going to take more time. this is complicated. this is complex. it is not going to happen because i say that we have to have it by this date. think about what we are doing. this is 1/6 of the nation's economy that we are talking about. we are talking about health care reform. this affects you with your democrat or republican, urban or rural or live in alaska or maine. this process is everything. let's take the time to get it right and if it takes us a few extra months, it takes a few extra months. you mentioned that we need to be working together. this cannot be just a democrat solution, because it is not a democrat problem. it is not a republican problem or a republican solution. we have got to figure out how we

address this issue that affects all americans. we are very divided in the congress right now. in order to get to solutions that are workable, we have got to figure out how we come together to have a good discussion, a good debate, and work through these issues. there are a couple of good bills i think that are out there on the table that had been procured by republicans. there is a bill from oregon and utah that they have put on the table a year or so ago. that particular one has 13 co- sponsors on it, pretty much even in terms of a republican vs. democrat. there are things in it that i do not like, but is the meat of is

something that we can be working off of and talking on it? yes. this is where we need to be going, not necessarily saying it has to be this bill or it has to be this plan. we have got to be sitting down and we have to be doing the hard work. there are six men and women in the finance committee that have said i am going to hold off all the pressure i am getting from republican leadership or democratic leadership or the president and they are saying that we have to plow through and work on this. will they do it? i do not know. i am sure hoping that they have the collective will between those six to continue it. i think americans want a solution. they do not want to see the partisans disagreeing and bickering and name-calling. they want to see solutions. that is our job, to deliver solutions that work for the country. i agree.

>> the lady sitting at about 6 rows back with glasses. this way. thank you. >> thank you for being here. i have several questions. i am a 44-year-old disabled person. i am on social security disability. i am on medicare, they are for. as the gentleman stated in the back, medicare only pays between 2% and 20% of what the physicians bill. it is incredible. 1200 other bill and they will pay $47 or less. in some cases, and they pay nothing. that is the reason why our doctors are opting out of medicare. i do not blame them. as far as what you are saying you will support about health

care reform, i would like to know who guarantees that i can even see a doctor? i would also like to know who and how will it be decided whether my life style is help althy and my behavior's arm healthy i will be reworded by that by continuing to get health care? as far as our small business employers, hawaii, which i lived in for 12 years, is the only state with mandatory employer coverage. if your job is 20 hours a week or more, your employer must provide you with healthcare. what that has done is hawaii is it has for small businesses to hire twice the number of people and have them work only 19 hours a week so that the small businesses do not have to pay for their health insurance.

that is why most people in hawaii work three jobs. who is going to tell the employers how many hours a week a person has to work for them to pay for their health insurance? >> thank you for your comment. but that is a good comment. let me address the last one. in the senate health bill, there is a requirement that all employers who employ over 25 employees, they are required to have health care coverage offered to their employees. the year to do so will result in a $750 per employee penalty. if you are a seasonal worker or a part-time worker, the penalty per employee is $350. it goes back to -- he said u.s.

small-business men. i do not know via more than 25 employees. one of the concerns that we have is if you have this employer mandate with the penalties on it, as a small business, you may but at what it costs you to provide for that level of coverage and say, you know what that's $750 as a penalty per employee, even though that is a top hit may be less than what i would be providing for coverage for them as is. i think i'm just going to stop offering my employer base plan and let them go to a government option. there is discussion about a government auction ultimately resulting in a shift of 80 million americans from private insurance to a public plan. you ask an excellent question about -- had to guaranteed to

get health care. -- how to guarantee that to get health care. that is part of the problem. what is the guarantee? the guarantee as -- if you are an individual with disabilities and you have -- maybe i should not use you as an example. how do we guarantee that people get health care? what we might be able to do is guarantee that you have access to health care insurance. it goes back to what was stated by the doctor earlier.

if you do not have doctors that are seeing these individuals, if they are not want to take medicare or be on the government plan, we have given me the best ticket without the best. we have guaranteed access if you will because we said you now have insurance, but if we have to fix the other side of it, witches of getting you in the door to see a provider to help you, how have we helped you? again, to go back to building a system of reform on a system that has failed this year in alaska with medicare, it goes back to the reimbursement issue. it is just not going to work. we will not be able to guarantee you health care. we might deal to guarantee you the card that says you can get it. but if you are living in the wrong spot, [unintelligible]

>> this the thing compared to the size of the federal government. but that is true. >> that is what is unsustainable. i do not want this to the federal government grow, i want to see it shrink. i just went to technical school for major airline. we have people from my company from all over the world. i was sitting next to a guy from england. he had an emergency operation on a hernia. they put him on a six month waiting list. six month waiting list.

he had to hobble onto a plane and fly to new york and got the operation the next. what are we even thinking? the government is not one to be able to do this. [applause] >> when i went to fairbanks for the town hall meeting last week, i talked to a man whose family lives in canada. he said, please, do not use this as a model. he said let me tell you about my uncle who had in issued with his

knee. he said the made him wait for six months before -- excuse me, four years -- it was a long time. it obviously was not as pressing as this individual you address. they made him wait for four years. it was not because there were not the doctors or the providers to care for him. he said they wanted him to wait until he hit 60, because they estimate that a knee is a good for about 20 years and it did not want to have to do two knees. that is not the kind of health care that i want. >> down in the front. the gentlemen on the second row with glass. >> first of all, something we can all agree on is mortality is not 100%. other than that, why do not we tail of the profit and bonus vaulters to run this country's

healthcare now and give them an average 3 year price for their stocks and a credit for their income taxes or their capital gains taxes, buy all their stocks, and make health care and health care delivery profitless, cooperative, and a mutually owned? i had usaaq insurance for my home and my car and i get returned on my premiums every year. i have an saa account which people in the u.s. they do not know about. the $400 that i can take with me. i could take with me. my premiums have gone up may be 1% in the past 20 years. i have the $400 in the bank. i get a return to my premium dollars every year. that is what we need in healthcare. i use to the physician, but i quit because of health reasons

and because of medicare and insurance reimbursement procedures and road blocks. i could not take it anymore. i am sure there a lot of people who are out there who would not mind a nonprofit, patient oriented health care system funded by the premium dollars of the patient. i estimate that if you charge $4 a day for people who love nothing wrong with them, $6 for 50% of the people who of wonder to problems and $8 a day for people have 34 problems, you could raise $650 billion a year. >> your time is up. >> i will just pick up on your comments about a co-op in a non- profit entity. that is something that is out there in subject for discussion is a reasonable?

absolutely. will it work? who knows. i think these of the types of things that we ought not be afraid to have out there on the table and give them due consideration. i'm sorry you left the practice. we need more of the. >> thank you. >> another question from the back. this is a number of the card questions. they want to know about tort reform and is the part of the discussion? [applause] in my opinion, tort reform has got to be part of the discussion in. it must be part of the discussion. you talk with the doctors out there. we have one that is a family practice. we will have one that left the practice. all those that i have had an opportunity to speak with admit that there is defensive medicine that is being practiced every

single day in all parts of the country where you have a doctor's. it is because of the fear of being sued, the medical malpractice and the liability. the doctors know what it is he or she should be doing, but because of the threat -- there is going to be extra careful and ordered just one more test to be sure. when in fact, these men and women and professional but have been trained, they know what they are doing, but the way our system works -- where the most litigious society in the world -- we put our providers in a box. we say, you should have done that or you should have done that it has. if they are ordering perhaps unnecessary tense that cost all

of us. it must be part of the discussion. the estimates that are out there have turned from the cost to the health care system, put it in the range of $100 billion. we have to be realistic that when -- if we are going to meaningfully address the ever rising cost of health care, we have to look at tort reform as one of the issues. it is not part of the bill that we have coming out of the senate tried now. it is not part of the house package of the polka i think it is neat -- part of the package. i think it needs to be.

>> three thirds of the way back. a woman in an orange shirt. >> you are pretty good at spotting them. >> why is it part of the discussion -- one thing i'm going to ed is this mentality they you do not have to abide by the laws you pass. if you pass something, you better have to abide by it. [cheers] >> i am with you on that. we should not have our own special program. right now as a federal employee, and member of the federal employees health benefit program. my program at the united states senator is exactly the same as the 17,000 other federal employees that are here in the state of alaska. here is the deal. if we were to pass a government

run option, i believe that we as members of congress and those who work for us, should also be part of that plan. there is no reason that we should not. [applause] that is part of the bill. it came out of the health committee. it came out on a narrow vote, 12-11. it was interesting how partisan it was. it was interesting how partisan tort reform is. we cannot seem to get our democratic colleagues to come with us in agreeing that tort reform must be part of the equation. we have to work on that. >> the gentlemen in the yellow shirt over their standing up.

>> everyone, please introduce yourself. >> thank you very much. i have been in the insurance business for 19 years. i have a stake in this discussion as a result -- discussion, and as a result, i want you to know that i am on here on behalf of my clients. there was a meeting that went on with the senator hollis back in january or february. he had a similar discussion. 90% of the room was people who were affiliated with the health insurance business, doctors, and nurses. i made this suggestion at that time to him. i think that reform is a huge part of this. the litigious society that we are has stepped up the pace for

the cost of the health insurance to the people at large as a result of their increasing premiums. there is also the research and development that we paid for as a society that does not get passed back to us. it gets passed on to us at a cost item. if we were to take the research and development for the prescription medications that are necessary for everyone involved, especially our elderly now, that would be something to look at as far as a reform. we need to look at the manufacturers of the equipment that is used in the doctors' offices and make sure that that is positioned correctly on the cost basis of the doctors can afford to get it. the cost of the buildings that they have to build, the on and on, if you take it step by step, i think what we are doing is looking at a reform for health

insurance, but we really need to look at the basic costs and drive those down. one thing that is really missing is taking our children and offering them an education -- >> your time is up. >> the gentlemen at touched on an interesting point. i actually asked this this morning. what exactly are we talking about when we talking about health care reform? it is something that we need to better -- refine. are we referring health care insurance? that is one aspect of it. do we need to reform medicare so that it works in states like alaska? absolutely. do we need to the reforming the

delivery system and how for instance -- how procedures are reimbursed. i mentioned at the outset that we need to be working toward reimbursing for quality as opposed to quantity. we need to be looking to the medical home model where you have a fool on the service coordinated care. we can be looking to how we deliver our health care costs and thus reduce those costs. these are all very different. health care insurance reform is perhaps the difference then what we need to do with medicare reform. it is perhaps different than what we need to do reform and restructuring of the delete -- delivery system here. this is very complicated.

it is as -- mike oginski who is the ranking member on the senate health committee has said -- every title of his health care bill that we have gone through could be its own stand-alone legislation. it is that detailed. it is that complex. ladies and gentlemen, we need to get it right. we owe it to you to get it right. [applause] >> over on this side. the gentle man with the light blue shirt. thank you. >> my name is john. thank you for being with us today. i appreciate that. it seems to me that basically it is a foregone conclusion that there is going to be some kind of bill eventually passed. -- past regarding health care. it seems that the democrats

already have the numbered to pass the bill without any republican support. my question is, if we have a medicare system that currently allows doctors to withdraw, to not be a part of it, will the doctors still have that sort of an option we have a federal government mandated health care system, and if they are allowed to withdraw, and we have the same thing happen with this new system as we have had happened with the medicare, what is going to happen? >> that is my question. [applause] >> in the very back. a gentle man with a longer hair and glasses. in the middle. >> i hope he did not take that as a flip response. it is not.

it is a very legitimate question. we do not have the answer. the fact of the matter is, those providers with opt out. >> ibm and uninsured americans. i know you are aware that we already provided nationalized and the single payer -- [unintelligible] it is in the firm of the ihs, the indian health service. they are usually critical of this. it gives the ihs good reading, reading moderately are fully effective. the only place with the ihs still isn't tradition of services to native americans to leave tribal lands or reservations to find employment or education elsewhere. it can only be fixed by nationally covering plant.

firstly, if we as americans feel that the ihs service is good enough for people to whom we owe so much, people to whom we are making up for crimes that were committed a been spent, why is it not good enough for the rest of americans to have government help services? [cheers] secondly, if we feel that it is necessary that it is a moral duty to provide this help service to these people as the restitution for the crimes committed against them, why should we not feel as incumbent upon us to provide them to african americans or other form of the oppressed person kiddie groups who do not receive it? how is not a form of institutionalized racism? >> let us talk about theihs,

because we do have here an increase particularly -- in anchorage reticulate, it is a first-rate facility. i think that we are proud of what they have been able to do. i have been on the indian affairs committee since i got to the senate. i have had an opportunity to really spend some time understanding being i systemhs, how it is working and how it is not working. we chronically underfunded ihs which has led -- you want to talk about rationing care, you go and talk to some of those who live on reservations in the lower 48. it pretty much if you have -- if you have injured yourself after july, you are out of luck, because the money in is out in terms of what is available to be paid. it is a pretty dismal situation.

i think we look at ihs and say that there are -- that it is a system that when allowed to work with the appropriate financial backing and support, it is ok. it is not a model of government efficiency. i will speak to another form government health care we know about in this state, that is the v.a > i can tell ian that if you happen to be -- i can tell you if you happen to be a veteran who happens to live in an area where you have access to v.a. services, that is good for you. far too many of our alaskan veterans, whether they live -- they are basically is no access. they are given the promise that they earned when they signed up to serve, that of health care,

but only if they happen to live in the right place. is that what we want to be doing? i had an e-mail from a woman who said, i am on medicare, my husband is a bet. i cannot get him to see a doctor and my husband has been waiting for three months for the be 8 to sign off on a prescription drug that his doctor has ordered that he take, but the v.a. cannot decide whether or not this is something they will be paying for. we have some issues with a government run systems. again, if you are going to go down that road, you better figure out how you do it right, whether it is standing by the obligation to american indians and alaskan natives. >> the person in the middle with the green shirt. >> is nancy here?

>> no. >> my point of talking is that i had something done to me directly i had my cataracts removed. they said i needed the skin from the inside of my eyes removed because i had no side. they gave me list some doctors. i took the first one. i went over there. i saw him. he said that he could fix it. they pulled of the muscles from my eyes and removed the skin on the side and pulled them up. i went in for the operation, was unconscious while he was operating. he did 21 things wrong to me. i tried to get to the insurance to not pay him.

they paid him. then i went to its 34 attorneys and they will not go against the doctor. even out a separate did i went to lower 48 to get some doctors to pass judgment on the operation. they called the doctor up here and said, they could not help me. what we have here in alaska is that the insurance companies, the medical malpractice -- there is no help for people who have medical malpractice. as far as the v.a. is concerned, i have a printer is in the air force. he was held prisoner overseas. she was being treated for posttraumatic stress disorder. the v.a. here was treating her. then they stopped and said that she had to pay full payment because it was her choice.

>> on the issue of tort reform. there are many who have concern that if we were to institute a level of tort reform that the doctors did act negligently that they escaped free. that is not what the tort reform is about. it is not designed to let doctors fail in their practice. again, it is making sure that the protection is there for the patient. -- patient, while ensuring that at the same time we do not have a practice of defensive medicine that unnecessarily costs people across this country. >> of the gentlemen in the red shirt on the front row. >> my name is ed.

i was wondering, how come -- senate and house cannot get their act together into maybe put a levy or higher tax pay for our medicine from the imports we are getting in from communist countries? why do not we give america back to america? [cheers] >> i tell you. i am not one that what my health care shipped overseas. i am not one that once we did i want to make sure the drugs that i am taking part are safe. they are the drugs that my doctor has believe he has prescribed for me and the medication that denny. you are talking about a bigger picture, which is keeping the local and bringing it home and supporting americans. that is a tough one to argue.

>> back out to the -- there are a number of questions having to do with the providers with the shortage of physicians of practitioners and other providers. is there anything in the proposals that discusses that? >> in both the senate bill and the house a bill, there is a recognition that we do have a shortage of providers, particularly in the primary care area. some of the proposals that are out there are ways that we can in sent individuals to go into practice, whether it is payment of student loans so that they can be encouraged to come back. we need to do more to get more providers. it is not just here. there are 17 states across the country where right now there

are simply not enough providers available to accept specifically those on medicare. it is states oregon, washington, colorado, new mexico -- this is an issue that must be addressed with how we deal. it hurts us more markedly in rural places and in a state like alaska where we do not have our own medical school. we are not growing our own. one of the things that we know is that typically an individual will and a practicing within about 100 mile radius of where they have been training and established their residency. we are kind of out of luck in terms of that. we are working with the university of washington. we are working with providence -- they have a training program. our reality is that we are at a

disadvantage. we do have things in the legislation that does focus some incentives to encourage more to go into the practice. one of the things that i think we need to do is recognize that it does not have to be just and senses to be a doctor. we need to have more mid-levels. we need to have the nurse practitioners. we need to have the p.a's. we know that so many communities you will never have a doctor out here. let's make sure that when be talking about reimbursement that those mid-levels are covered as well. we need to do much more to encourage those to go into the primary care as opposed to the specialists. right now the incentives are not there. when you talk to a cardiologists

about what they get reimbursed for a procedure purses a family care doctor is going to get, it is no wonder that people go into specialties. we need to turn that on its head as well. there is a lot that we can do to provide for the appropriate incentives to the we get more practitioners of providers out in the field. [applause] >> the baby in the back, second row from the back, on this side. -- the lady in the back, the second row from the back, on this side of the >> i would like to make an observation. it seems as soon as the american public becomes familiar with the definitions of healthcare, insurance reform and what it stands for is, you change it to a different name, such as health insurance. which is it?

is it health care or is it health insurance or is it health care insurance reform or is a public option or is it co-op? it is it? [applause] >> that is the process. it is. it is difficult to follow. we are all smiling and laughing, but she is right on. right now i think what you need to understand is this is still in process, a legislative process. and they describe it as sausage making. that is probably an acpt description for the you do not know what goes into, but you want to know that the allen goes good. is it a government option, is it co-op?

that is why i am out here listening to you and getting your input. >> over on this side. stand up. >> we are making these guys get their exercise. so much for the prevention and wellness. it is not working. click the button? >> palin? thank you for coming. thank you for having the courage to come here and in person rather than by teleconference? i have a couple of comments to make about what the definition i believe of health care should be. i hear a lot about money and profits and want to remind you we are talking about lives,

health, our grandparents, family members, and our communities. profit and money is one thing. we are talking about human beings. the second thing is along the lines, i think that profits and health care are morally -- a morally should not be connected. period. they are not together. you cannot have profits associated with making the right decision of the time. when you have a profit in there, you'll never make the right decision. maybe sometimes, but not always. i want to ask you how you like your healthcare. >> i am fortunate. i have health care. i am fortunate. i have health care. it is the same health care that

other federal employees around the state capital of the thing that is great about my health care. -- i had a couple of dozen plants as i can choose from. by more than a couple of dozen. i have p a i havelans that i can choose from. -- i have a lot of plans that i can choose from. i think this is what people want. when my kids were younger, i wanted to make sure that we had something in the plan that was either able to put aside something in n saa or you are dealing with the means that we planned for as a family. when my husband and i first got married, we were not making a lot of money between the two of us. we wanted to make sure we had coverage provided maternity benefits. you just figure it out. you spend money on your healthcare then you want.

the point that i am making here is that i have, as a federal employee, i got choices within a suite of options that is offered to me. i think that is what people want with bill healthcare. they want choice and they want to be able to streamline it to their needs and to their families need. as you change and grow and family grows, you change your plan. you want to have portability. how many people do you know that are stuck in a job that they do not like that they do not dare leave because of the health insurance? they are stuck there. that is wrong. when we talk about those things that we must fix -- that is one that we must fix. >> over on this side with the blue shirt next to the lady with the red shirt.