only pays between 2% and 20% of what the physicians bill. and it's incredible. $1,200 bill and they will pay $47 or less in some cases, they pay nothing. that's the reason why our doctors are opting out of medicare and i don't blame them. and as far as what you are saying that you will support about health care reform, i'd like to know who guarantees that i can even see a doctor? i'd also like to know who and how will it be decided whether my lifestyle is healthy and my behaviors are healthy so that i will be rewarded for that by a continuing to get health care? and 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 health care. what that's done in hawaii is it's forced 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. so that's why most people in hawaii work three jobs. who is going to tell the employer how many hours a week a person has to work for them to pay for their health insurance? >> thank you for your comments. .

if you are a seasonal worker or part-time worker, the fine is $350 per employee. it goes back to, tom, you said you were a small businessman. i don't know if you have more than 25 employees but one of the concerns that we have is that if, in fact, you have this employer mandate with the penalties on it, as a small businessman, you may look at what it costs you to provide for that level of coverage, and you say well, you know what? $750 as a penalty per employee, even though it is a tough hit, it is less than what i would be providing for coverage for them as is, so i think i'm just going

to stop offering my employer-based plan and let them go to a government option, so when there is discussion about a government option could ultimately result in a shift of some 88 million americans from private insurance plans that they have through their employer who to a public plan, that's what we're talking about. you say, lisa, in your list of strategies or things that you will support that you want to know well, who is going to guarantee that you get -- i'm looking for that -- guarantee that you get healthcare. well, that's part of the problem. what is the guarantee here? the guarantee as to if you're an individual with disabilities, and you have issues that --

well, you're on medicare, so maybe i shouldn't use you as a specific example. let's go to how do we guarantee that people get healthcare? what we might be able to do is guarantee that you have access to healthcare insurance, but it goes back to what was stated by dr. farr earlier that if you don't have doctors that are seeing these individuals, if they're not going to take medicare, they're not going to be on the government plan, we have given you the bus ticket without the bus. we have guaranteed access, if you will, because we said, ok, well, you now have insurance but if we haven't fixed the other side of it, which is getting you in the door to see a provider to help you, how have we helped you

so, again, to go back to building a system of reform on a system that has failed us here in alaska with medicare, and it goes back to the reimbursement issue, it's just not going to work. we won't be able to guarantee you healthcare. we might be able to guarantee you the card that says you can get there but if you're living in the wrong spot -- >> the gentleman in the second row with the brown shirt and glasses. >> two things. first thing, this line is scary. >> which one? the curve of the medicare growing, but it's nothing compared to the size of the federal government growing over this time. >> that's true.

>> i don't want to see the federal government grow. i want to see it shrink. thank you. i just went to technical school. i'm an aircraft mechanic for a major airline. we have people from my company from all over are the world. i was sitting next to a guy from england. he had an emergency operation. he had a hernia. they put him on a six-month waiting list. six month waiting list. he had to hobble on to a plane the next day and nigh to new york and got the operation the next day. what the -- are we even thinking? the government is not going to be able to do this. thank you. >> i don't know that i need to take time to respond to you because i'm not convinced that we want to go the way of the health systems in the united kingdom or in canada.

when i went up to fairbanks --. [applause] i went up to fairbanks for the town hall meeting last week, and talked to a man whose family had six members of his family that live in canada, and he says, please, don't use this as a model. he said, let me tell you about my uncle who had an issue, i believe it was with his knee, an he said they mate him wait four years, a long time, and it obviously wasn't as pressing as this individual that you have addressed, but they made him wait for four years, and it wasn't because there weren't 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 good

about 20 years and they didn't want to do two knees. now, that's not the kind of healthcare i want. >> down in the front, the gentleman in the second row with the glasses. yes, sir. >> ok. first of all, something we can all agree on, mortality is 100%, so nobody gets out of life alive, but other than that, why don't we simply pay off the profit and bonus vultures who run this country's healthcare now, give them an average three-year price of their stock, and a credit for their income taxes or their capital gains taxes if it's mutual fund or pension fund, buy all their stock and make healthcare and healthcare delivery profitless, non-profit cooperative mutually owned! i have usa insurance on my home and my car and i get returns on my premiums every year and i

have a s.s.a. subscribers savings account, of $5400 that i can take with me but i would never do it because it's such a great plan. my premiums have stayed level or gone up maybe 1% in the past 20 years and i have $5,400 in the bank and i get a return every year. that is what we need in healthcare. i used to be a physician and i quit because of health reasons and because of medicare an medicaid roadblocks and i couldn't take it anymore. i'm sure there are a lot of physicians who would not mind a non-profit patient-oriented healthcare system funded by the dollar, the premium dollars of the patient, and i estimate that if you charge $4 a day for people who have nothing wrong with them, $6 a day for 50% of the people who have one or two problems and $8 a day for people who have three or four problems,

we could raise $657 billion a year! >> thank you, sir. your time is up. >> i'll just pick up on your comment about a co-op and a non-profit entity. again, that's something that is out there and subject for discussion, and is it reasonable that we're discussing it? absolutely. will it work? who knows? these are the types of things that we ought not to be afraid to have out there on the table, and give them due consideration. i'm sorry that you left the practice. we need more of you. >> thank you. another question from the back, and this is actually a number of the cards have the same question, wanting to know about tort reform, and is that part of the discussion.

[applause] in my opinion, tort reform has to be part of the discussion. it must be part of the discussion. you talk with the doctors out there. we've got one that is in family practice now. we 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 doctors, and it is because the fear of being sued, the medical malpractice and the liability, and so the doctor knows what it is that he or she should be doing, but because. of the threat, they're just going to be extra careful and just order one more test, and just to be sure, when, in fact, these men and women, these p

professionals have been trained. they know what they are doing, but the way our system works, we are the most litigious society in the world and we put our providers in a box when we say you know, you should have done that test or should have done that test, and so they are ordering perhaps unnecessary tests that cost all of us so it must be part of the discussion. the estimates that are out there in terms of the cost to the healthcare system, put it in the range of, you know, $100 billion. we have to be realistic that when if we're going to meaningfully address the ever rising costs of healthcare, we have to look at tort reform as

one of the issues. now, it is not part of the bill that we have coming out of the senate right now. it is not part of the house package of bills. i think it needs to be. >> about 2/3's. way -- about 2/3's of the way back, the woman with the red hair in the red shirt. >> why isn't it part of the discussion? and one little thing i want to ask is this mentality that you don't have to abide by the laws you pass. if you pass something, you better have to abide by it. [applause]

>> i'm with you on that. i'm with you on that. we should not have our own special program. right now, as a federal employee, i'm a member of the federal employees health benefits program, but my program as a united states senator is exactly the same as the 17,000 federal employees here in the state of alaska, but here is the deal. if we were to pass a government-run plan, a government option, i believe that we and the 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 senate bill. it came out of the health committee on a very narrow vote. i believe it was 12-11, and it

was interesting how partisan it was. it is also interesting how partisan tort he reform is. we can't seem to get our democratic colleagues to come with us in agreeing that tort reform must be part. of the equation. we got to work on that. >> the gentleman with the yellow shirt standing up. >> again, everyone, please introduce yourselves. >> thank you very much. my name is rob barrett. i have been in the insurance business for 19 years. i have a stake in this discussion as a result of it, as many of the people in the audience' clients, i want you to know i'm here on behalf of my clients, not just myself.

that being said, there was a meeting that went on with senator hollis, i believe it was back in january or february and he had a similar discussion. 90% of the room was people affiliated with the health insurance business, doctors and nurses, et cetera. i made the suggestion to him at that point and i think tort reform is a huge part of this, but the litigious society that we are has definite hi stepped up the pace for the cost of the health insurance to the people at large as a result of their increase in premiums. there is also the research and development that we pay for as a society that does not get passed back to us. it gets passed on to us as a cost item, so if we were to take the research and development that's done 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 goes. we need to look at the manufacturers of the equipment that's used in the doctor's offices and make sure that that's positioned correctly on a cost basis so the doctors can afford to get it, the insurance that the doctors have to pay for has to be addressed. the cost of the buildings that they have to build. on and on. if you take it step by step, i think what we're doing is trying to look at a reform for health insurance but we need to look at the basic costs an drive those down, and one thing we're really missing is taking our children and offering them an education in the medical field to help us out. >> thank you, sir. [applause] >> the gentleman has touched on an interesting point here, and i was actually asked this this morning at an editorial board meeting at the anchorage daily news. what exactly are we talking about when we're talking about

healthcare reform? it's something that we need to better refine. are we talking about reforming healthcare insurance? i think that's certainly one aspect of it. do we need to reform medicare so that it works in states like alaska? absolutely. do we need to be reforming the delivery system and how, for instance, procedures are reimbursed. i mentioned at the outset we need to be working towards reimbursing for quality as opposed to quantity. we need to be hooking to the medical home model where you have basically a full-on service coordinated care. we can be looking to how we deliver our healthcare costs,

and thus reduce those costs, but these are all very different pockets. healthcare insurance reform is prps different -- perhaps different than what we need to do with medicare reform and is perhaps different than what we need to do with reform and restructuring of the delivery systems here, so again, this is very complicated. it is as as mike enzi, the ranking member on the senate health committee has said, it is every title of this healthcare bill that we have gone through could be its own stand-alone legislation. it's that detailed. it's that complex. ladies and gentlemen, we've got to get it right. we owe it to you to get it right. [applause] >> over on this side, the

gentleman with the light blue shirt, glasses in the middle. thank you. my name is john, and thank you for being with us today. i appreciate that. it seems to me that basically it's a foregone conclusion that there's going to be some kind of bill eventually passed regarding healthcare. if we do the math, it seems that the democrats had already have the numbers 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 part of it, will the doctors still have that sort of an option if we have a federal government mandated healthcare system, and if they are allowed to with daw, and and we have

the same thing happen with this new system as we have had happen with medicare, what's going to happen? >> that's my question. >> in the very back, the gentleman with the longer hair and glasses in the middle. >> i hope you don't take that as a flip response, because it's not, but i think it's a very legitimate question that we don't have an answer to. the fact of the matter is that those providers could opt out. where were we? >> thank you, senator? i'm an uninsured american. i know you are aware but i think many are not that we already provide nationalized and not just single payer national insurance but national health coverage in the form of the ihs in the form of the indian health service. even the u.s. office of budget and management of federal

agencies which is usually critical of the health offerings of the department of health and human services generally gives the ihs a good rating, rating everything moderately or wholly effective their top category. the only place ihs fails is the provision to native americans who leave tribal reservations to find employment or education elsewhere, a problem that can only be fixed by a nationally covering plan. i have two questions to you -- 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 we are making up for crimes committed against them, why is it not good enough for the rest of americans to have government health service, and secondly -- [applause] and secondly, senator, if we feel that it is necessary that it is a moral duty incumbent upon us to provide this health service to these people as a

restitution for the crimes committed against them, why do we not feel it is incumbent upon us to provide it to african-americans or to other formerly oppressed and persecuted groups who do not receive it? how is that not a form of institutionalized racism? [applause] >> let's talk about the ihs system, because we do have here in anchorage, particularly, with the indian medical center, i think we would agree it is a first-rate facility, and 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 and have had an opportunity to really spend some time understanding the ihs system, how it is working and how it is not working. i will tell you that we chronically underfund ihs, which

has led to -- you want to talk about rationing of care, you go and talk to some of those who h.i.v. on the reservations in the lower 48, and pretty much and if you have injured yourself after july, you're out of luck, because the money is out in terms of what is available to be paid. it is a pretty dismal situation, so i think we look at ihs and say that there are -- it is a system that when allowed to work with the appropriate financial backing and support, it's ok. it's not a model of government efficiency, though. i will speak to another form of government healthcare that we know a lot about here in this state and that's the v.a. i can tell you if you happen to

be one of our country's veterans who happen to live in an area where you have access to s.a. services, that's good for you -- to v.a. services, that's good for you, but far too many of our alaskan veterans, whether they're not living on the road system, basically there is no access, so they are given the promise that they earned when they signed up to serve, that of healthcare, government-run healthcare, but only if they happen to live in the right place, so it's -- is that what we want to be doing? i had an e-mail from a woman who said i'm on medicare. my husband is a vet. i can't get in to see a doctor and my husband has been waiting three months for the v.a. to finally sign off on a prescription drug that his doctor has ordered that he take, has prescribed that he take but the v.a. can't decide whether or not this is something that

they're going to be paying for, so we've got issues with government-run systems, and again, if you're going to go down that road, we better figure out how we do it right, whether it's standing by the obligation to american indians and alaska natives or to our veterans. >> the person in the middle, green shirt. yes. >> hi, lisa. is nancy here? >> no. >> my point of talking is that i had something done to me directly. i had my cataracts removed, and they said that i needed the skin from my side of my eyes removed because i had no side vision. they gave me a list of some doctors. i took the first one, dr. dwight

ellerbee atlas ska regional and i went to him and he said yes, we can fix that, remove the skin on the side and i went in for the operation and he did 21 things wrong to me. i tried to get the insurance, the social security insurance to not pay him. they paid him, and then i went to 34 attorneys and they will not go against a doctor, even outside, i went to the lower 48 to get some doctors to pass judgment on the operation, and they called the doctor up here, and said, sorry, they couldn't help me. now, what we have here in alaska is that they are working, the insurance companies, the medical

malpractice is there is no help for people who have medical malpractice. as far as the v.a. is concerned, i have a friend who is in the air force overseas and held prisoner, and she was being treated for post-traumatic stress disorder, and the v.a. here was treating her. then they stopped, and said she had to pay full payment because it was her choice. >> on the issue of tort reform, i think there are many who are concerned that if we were to institute some level of tort reform, the doctors who did act negligently or did commit malpractice, that somehow or another they skate free, and that is not what tort reform is about at all. it is not designed to let doctors fail in their practice, so, again, it's making sure that

the protection is there for the patient while at the same time ensuring that we don't have a practice, if you will, of defensive medicine that unnecessarily costs people across this country. >> the gentleman in the red shirt in the front row. >> my name is ed. i was wondering, how come -- first of all, how come the senate and the house can't get their act together and maybe tax -- put a levy, a higher tax pay or medicine from the imports from getting in from communist countries? why don't we give america back to america? >> well, i tell you, i'm not one

that wants my healthcare shipped overseas. i'm not one that -- i want to make sure that the drugs that i'm taking are safe and are -- they're the drugs that my doctor believes he has prescribed for me and that they are the medication that i need. you're talking about a bigger picture, which is keeping it local, bringing it home an supporting americans. that's a tough one to argue against. >> there are a number of questions having to do with providers with the shortage of physicians, nurse practitioners, physicians assistants and other providers. is there anything in the proposals that discusses that? >> well, in both the senate bill and the house bill as well, there is a recognition that we do have a shortage of providers

and particularly in the priel airy primary care area, and there is a ways that we can insent individuals to go into the 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, and again, it's not just here in alaska, but there is some 17 states across the country where right now, there are simply not enough providers available to accept specifically those on medicare in states like, in addition to alaska and states like oregon, washington, colorado, new mexico. this is an issue that must be addressed is how we deal with this as a national shortage, but it hurts us more perhaps markedly in world places an particularly a state like alaska where we don't have our own medical school.

we're not growing our own. one of the things that we know is that typically an individual will end up practicing within about 100-mile aid yus of where they have been trained, where they have established their residency so we're out of luck in terms of that. we're working with the university of washington. providence has attaining program, but our reality is that we're at a disadvantage. we have things in the legislation that focuses on incentives to encourage more to go into the practice. one of the things that i think we need to do is recognize that it doesn't have to be just incentives to be a doctor. we need to have more mid levels. we need to have nurse practitioners and the p.a. he's. we know in alaska in so many communities you're never going

to have a doctor out there. a nurse practitioner works great a p.a. works great. when we're talking about reism burstments, that those mid levels are crofferred as well. we need to do much more to encourage those to to go into the primary care as opposed to the specialists and right now, the incentives aren't there when you talk to, say, a cardologist about what they get reimbursed for a procedure versus what a family care doc is going to get, you know, it's no wonder that people go into the specialties. we need to turn that on its head as well. there's a lot we can do to provide for the appropriate incentives so we get more providers out in the field. >> ok. a lady in the back, second row from the back on this side on your left in the blue shirt.

>> greetings, senator murkowski. i would like to make an observation rather than make a comment or ask a question. it seems that as soon as the american public becomes familiar with what the definitions of, like, healthcare, insurance reform stands for, you guys morph it and change it to a different name, such as health insurance. now, which is it? is it healthcare, or is it health insurance? or is it healthcare insurance reform? and is it public option or is it co-op? which is it? thank you. >> [applause] >> that, my friend is the process. it is difficult to follow, and we're all kind of smiling and laughing, but she's right on, but right now, i think what we you all need to understand is

this is still a process, a legislative process. they describe it as sausage making, and that is probably an apt description of it. you don't want to see what goes into it but you darn well to know the outcome will be good. right now, we're still working on, you know, our definitions. is it government option? is it co-op? is it not? we don't know. that's why i'm out here listening to you and getting your input. >> ok. over on this side. yes, stand up. we're making these guys get their exercise so much. for the prevention and wellness. it's not working? no. is there a button?

>> hello. thank you, senator, for coming and thank you for having the courage to come here in p person. i hear some of the senators across the country are doing it by teleconference. [applause] >> anyways, i have a couple of comments to make about what the definition i believe healthcare should be, health reform should be as well. i hear a lot about money and profit and i want to remind you we're talking about people's lives. we're talking about health. we're talking about our grand parents, our family members, our community, and profit and money is one thing, but we are talking about human beings, and the second thing is along that line, i think that profit and healthcare, we're talking about, are morally should not be connected, period. you cannot have profit associated with making the right decision all the time, and when you have profit associated and

in part of your mind, you're never going to make the right decision. maybe sometimes but not always, and not when it really matters, and the last thing i want to ask you, how you like your healthcare? >> well, i am fortunate. i have healthcare. i'm fortunate i have healthcare, and as i said, it's the same healthcare that other federal employees around the state have, but the thing that's great about my healthcare, and i will say it's great. i have a couple dozen plans that i can choose from. i've got more than a couple dozen. i've got a lot of plans that i can choose from, and so for me and my family, you know, this is what i think people want. i mean, when my kids were younger, you know, i wanted to make sure that we had something in the plan, whether it was able to put aside something in an

h.s.a. or we were dealing with bases and we were dealing with things that we planned for as a family. when my husband i first got married, we weren't making a lot of money between the two of us but we wanted to make sure we had coverage that provided for maternity benefits, and so you just figure it out and you spend more, far more on your healthcare than you want. the point that i'm making here is that i have, as a federal employee, i've got choice within a suite of options that is offered to me, and i think that's what people want with their healthcare. they want to have choice, and they want to be able to cater it to their needs and to their family's needs, and as you change and grow and your family grows, you change your plans. your want portability with that.

how many people do you know that are stuck in a job that they don't like that they don't dare leave because of the health insurance? they are stuck there and that is wong wrong. when we talk about those things that we must fix, this one we got to fix. >> over on this side, a gentleman with the blue shirt next to the lady in a red shirt. >> my name is ben dan carpenter and i appreciate you showing up today. it is a neat thing that we as alaskans can come together and we don't look like any other state yelling, fighting screaming, bickering. i try -- i'm a former marine,

so i like to keep things as simple as possible. my problem and my concerns with this plan is we have been told that our system is completely broken and we got to fix it right now, because by, i believe what you wrote is probably true, that 88% of americans are satisfied with their current healthcare plan. it doesn't make sense to he me that you can have that large of a number that has access to it, have it, and by these numbers that you put here, are happy with it, or satisfied with it. doesn't it seem more logical, easier to manage, and quicker to get done if we deal with those that don't instead of trying to take such a large portion and saying you can no honger have what you have worked for. i don'ten. i'm only 40. i've got a wife and two kids. i go to work and work as hard as

i can. if i become rich or what somebody says is rich, how do i then become the villain? because i have worked to attain what my family needs. we can't continue to try and work both sides of the fence, pulling on both ends and having a middle class that's torn between two sides. if we can deal with that percentage that isn't happy or can't get it and struggling to get it and leave us to have what we have, work for better or continue to keep what we have, i don't understand how you can say that it has completely been destroyed and we need to fix it right now. [applause] >> well, first of all, i thank you for your service. second of all, i thank you for articulating what so much of our problem is. if you look to the chart i have

provided you in terms of the 47 million uninsured, we have been talking collectively in the congress and this is the group we need to address and need to provide insurance. i will take you around the pie chart. what you get down to is 12 million, 13 million that are really those without affordable insurance options. they just don't have anywhere else to go. their employer doesn't offer a plan and they are legal citizens in this country and they don't have the income that that would allow them, so we are talking about that 12 milt million, still a lot of people that we need to help address, but it is not something -- it is not something that, again, in order to address that need, you would throw out everything else that

is working for 177 million people, so here is the balance and the challenge that we have before us, and that's not my statement about whether or not, you know, 89% of americans have health coverage and 88% are satisfied with their current health plan. that's something we took from the "time" magazine poll, and placed it there. it's not unlike what we're seeing with other sta statistic. there is grave concern when we talk about healthcare reform and are trying to reform it for those who truly do not have options for affordable insurance. they really don't have it, but you and your family have been working hard and are satisfied with where you are and summary concern is why are you messing

with what i have? this is the great tension trying to figure out how we address with those who are truly without, those who are messing it up for those who like where they are, and want to continue with their current coverage. it's a very difficult issue. >> about ten rows back, a young man in a blue shirt. >> hello. thank you for coming. my ime is harry reid and the majority whip, dick durbin both stated that they would not be opposed to passing healthcare reform if they don't have the 60 votes necessary to bypass the filibuster and that they would pass it using a budget reconciliation. i'm wondering what you think

about that and whether or not that would be a feasible solution if they don't have the votes. i don't think that's a good idea, for the record. >> the process known as budget reconciliation is a procedural mechanism unique to the senate that would allow for a way to get around a filibuster. filibuster requires 60 to bake it. when something is moved through reconciliation, it just requires 51 votes, so it is a process that is available. it is a process, however is subject to technical rules within the senate in terms of what may be considered under reconciliation and without getting too much into the weeds, there is so much contained in the healthcare bill that came out of the health committee that

would not be subject to reconciliation, for instance, the wellness and prevention pieces. what could be subject to reconciliation would be the tax piece. so here's the question to you, if you're a democrat and you're saying well, you got to move this plan because our leadership has directed that we should, if all you're going to be able to move is the tax piece, without the what most would consider the good things in the bill, which i believe that the prevention and wellness pieces are good and important and necessary, is that where you're going to be as a member representing your constituency? so, i think, the republicans don't like it. i can tell you that for a fact. we feel that we need to be working together on a bipartisan bill, and moving a bill that you can get 70 or 80 members

support. it is an option for the democrats. they are in the majority. they have got a sizable majority. they got 60. they got some options that are salable to them, but i don't know. i'm not in the other states during the august break. i'm in alaska. i'm listening to what alaskans are telling me. if i were a representative in some of the other states where people are expressing their concerns about this, you know, it's one thing to go ahead and follow your leader. it's another to be listening carefully to your constituents so i think there is a dilemma out there. about in the same position, this lady on this side in black-and-blue.

>> hi. people aren't nearly as concerned about the money we're spending at war. >> can you just slow down a little bit. we've got time. >> now, like, when the healthcare is coming up -- we went to war and people weren't nearly as concerned with the huge amounts of money we were spending at war hurting people, but now when a healthcare reform bill that will help americans with their health and lives, money is not a huge issue. [applause] are the youth going to have to pay all this money? i would rather pay off debt and help people rather than cure them. [applause]

everyone keeps saying americans are creating a huge debt that they will have to pay off, so why not ask us? [applause] >> i appreciate you being here, and i appreciate your statement. we all need to be cognizant that what is happening in our federal government in terms of our level of spending, whether it is on the men and women serving us in iraq an afghanistan, whether on healthcare or on cash for clunkers, the fact of the matter is that that debt is passed on to you and so the choices that we make and the issues that we advance, we darn better well make sure that we're doing right and we're doingite by all americans. i appreciate your input and your comments and i wish we had more young people like you willing to stand up.

>> the woman up here, red shirt, about 7th row back. >> well, my speech has chiendz kind of changed. you have been good to us all, but we're scared. we're scared of what this administration is doing to us. they're taking away a good republic and replacing it with a socialism. stand firm against cap and trade and stop card check. the unions is got too much control over this government already. through our apathy, some say we deserve the government we have, and they might be right, but no more. the silent majority is speaking up with a roar, and we are not going to calm down. we won't calm down when you go back to d.c.

we're mad. i would like to see -- i appreciate everything you have talked to us but i'm concerned about so many things, this green movement, and we're spending $10 billion in brazil for them to drill and they won't even let us drill in our own country! we're really mad! [applause] >> excuse me, we need to stick to healthcare issues. >> i'm getting back to it. you work for us. you got to fight for us. tort reform is the first thing we need right now. that is the most best thing toward healthcare than anything you come up with. we need to stop illegal immigration. that will help healthcare, too. >> she has hit on too many

issues and i'm supposed to stick to healthcare. i agree you with on tort reform and that must be part of our solution here as we move forward with healthcare. >> the woman in the dark black sweater standing there, yes. >> thank you for taking my question. welcome back home, senator murkowski. i would like to express my gratitude to the young woman from diamond high. go lynx! my daughter graduated in '91. i'm very proud of her. i really appreciated her question. my question is actually two -- one is, do you have any idea of what senator begich's ideas are on this issue? i'm just asking, has she at least talked to him and tried to find out what his ideas are on

this issue? and i am a registered nurse. i just got back from a seminar today on finding out what medicare does and doesn't pay for on some of the things that i do as far as care for my patients. now, i understand all this stuff about insurance and who pays for this and who does that, and the whole business, but i guess my argument has and always will be, for me, patients come first. now, as far as this whole business on healthcare is concerned, i have oh, one question, and that is how long is it going to take you to figure out how long it's going to take you to do this? we've had -- no, i'm serious. we have had president clinton who tried to introduce it, whose wife did a little something. we had bush come in, and what is

this, like, 8, 16 years or -- well, 8 and 8 is what,? 16 and we're still not getting some kind of idea of who is going to do what? i just would like to know, what are we going to do? >> time. thank you for your question. >> i tell you what i'm not going to do. i'm not going to sign on to an arbitrary date and say we must have it by this day. what we've got to do is set as a priority, we've got to get the best policy, and if that means that we focus on insurance reforms first, and then delivery systems and then medicare, i'm not quite sure that we need to say, well, this one has to go first chronologically or we have

to do them all together. what concerns me is that we say it must be done by this date. i will tell you. we had a conner conversation, fr of us invited to the white house to talk to the president about what some of our ideas were, and i said to sign on to an arbitrary date is difficult, and he reminded us that we in congress are not unlike your kids in school. we respond better with a deadline. he is right there, but you said an arbitrary date and push it and get something that doesn't work for this country, we live with that for a long time, folks, and here's one thing. somebody asked me this morning, they said, well, you know, it's just money. no, it's not just money. the stimulus bill was just money. healthcare reform is entirely

different, and if we do what is proposed out of the health bill ar what is proposed out of the house bill, it is reform. the last time we did significant reform like this was back in 1965 and we have been living with that ever since. we have to make sure that we get it right an as far as my colleague, you're going to have to ask him for his specifics. >> up here, the gentleman in the middle, fifth row back, white shirt. >> i guess i should thank you for being here, first of all, but you know, my name is paul. i'm not scared. i'm really kind of -- i'm upset, quite frankly and i & i want my old america back. i want my old values back. i want the families back. and again, i want to be a free american. now, i'm not a republican. i'm not a democrat.

i'm revolutionist because that's what my forefathers did to establish this great country. the problem is you and the other leaders. i have never seen such disconnected leadership in my entire life. the process -- >> could you, please, this is about healthcare reform. >> yes, it is. >> ok. thank you. >> because you're limiting my two minutes i have to make a broader statement. the point is this, ms. murkowski, the process is broken. the process is broken. my question question and statement is this -- will you ask begich and young to join you in a three-day on-camera agenda where we can do probing and interrogating questioning, because you people are not standing before us for accountability, and as long as we have this disconnect and just popcorn moments, we're going nowhere. thank you for the opportunity to make a comment. thank you.

>> we've got -- we have lost a few people up front here but when we started out this evening, we had about 690 people that were seated in this auditorium. i don't know how many we have in the overflow. this is my small attempt here in anchorage to reach out to hear from my constituents. i have done the same up in fairbanks. we had 600 people up there. we're going to be down on the penninsula next weekend and i'm going to be up in the valley friday, i believe it is, not this friday, the following friday. we have to have a level of communication with our constituents. we fail to do that, we get disconnected. we get bumped out. that's the way it works. you need to hold us accountable. i'm not afraid of accountability. if i am, i shouldn't be in this job, so let me stand before you and take the hard questions. i'm willing to do that. i think we need to have this level of discussion and debate

and i need to hear the ones that are rang gi and the ones that are just really saddened. this helps me, aciform late how i can best represent you back in washington. you don't need to offer apologies for calls us out. have at it. [applause] >> ok. the lady on the front with the pink. >> thank you, senator. i'm glad you're here. welcome home. i'm a supporter of health insurance reform. i see your support in voting for a bill. i believe that there is no bill, there is no reform. one of the things i'm concerned about is if you lose your job, you lose your health insurance. if you keep your job, and you get sick, you could run into a

cap and not have health insurance take place. if you keep your job and you go and are healthy and go for preventive care, that's not covered by some health insurance companies, and if you actually get really sick, you might be able to not be covered at all because it costs too much money. . >> you have articulated so many of the issues that alaskans and americans are really concerned about when it comes to health care. as far as to list -- as far as

doing something now, i do not need to tell you, i've been to know that congress has a short attention span. [laughter] again, i should not be flip, but our reality is this is the moment, this is what we're working on right now. last year will was everyone in this country focused on? energy and what was happening with a high price of energy. what happens? the price of oil goes down and everyone is happy again. then there is no pressure for us to move on energy legislation. health care is right and center. i believe we must be working toward some kind of reform. again, the devil is in the details here, because i have already had one opportunity to vote against the senate health bill. i do not think that would help

alaska or the country. i am not one of those who said we need to will this away, if we waited out, it will go away and we will not have to deal with it. it is not going to go away. i take you back to the graft that you have all been presented with. the national health expenditure pitcher kirk will keep going up. -- national health expenditure curve and will keep going up. i do not think we have an option to just say if we hold our breath london of the american public is going to forget about this. -- i do not think we had an option to just say if we hold our breath long enough's the american public is going to forget about this. the last time we really tackled this was the clinton administration. we did not pick it up again for many years.

i do not know -- i would be afraid of that scenario if we were to put five years beyond where we are now and say do nothing, do nothing at all and then wait at a couple more administrations. i am one to believe that we have a really tough job to do, but that is why you elected us to do it. it is not easy. we're not going to make everyone happy, but we cannot just said if we wait this out, the american public will lose interest with it. i simply have a responsibility here. it is very difficult. we will not make everyone happy, but i do believe we must work toward some bipartisan product when it comes to health care. [applause] >> ok, so the time is upon us.

there are so many questions that have yet to be asked or statements made. please fill out your cards and leave them. there will be staffers outside. we're not stopped yet, i am just telling you we're getting close. i want to reiterate what my marine friend back there said. i had certain people that were warning about what could happen with rancor in the room. i want to thank all of you as my fellow alaskans for keeping civil, for voicing your opinion, and helping this poor volunteer on the state should keep some sort of control. one last question that came from outside. i think it is a good closing question. at this point, what way would to be leaning on what is the best way to make sure we have more of

the people in the united states covered with some sort of affordable health care? >> we are talking about access to care right now. i will take us back to where we started this discussion this evening. we can go ahead and promise you a card and say you are now covered, but if we have not giving you the care you need, if you cannot get in to see a doctor, we have not helped you. one of the places that i have to start representing a rural states like alaska, i have to make sure that the incentives are put in place for our providers, that they will have reimbursement that is reasonable and meaningful, absolutely.

it has to be there. and that we do more to and said individuals to answer the profession, the primary care field, it did those into the areas that we need, let's move towards some of the examples that we see are working in terms of access and in terms of reducing our costs. this is the medical home model. we have a great example and encourage. -- we have a great example in anchorage. we have clinics like the mayo clinic''s approach. what it comes down to my perspective is making sure that we have the providers to provide the care it because if all we have done is provided you with the insurance card, i have not

helped to. that is where i think we have to start first. with that, i think you for your attention. i think you for your input. health care is so personal and can be so emotional because we all have our stories. it is not with you directly it is with a family member or co- worker, and i think that is why we see the level of interest and thanks to other where we're going as a nation when it comes to health care. we have a heavy lift, that is why you elected us to go back there and do it. we cannot run from the tough issues, but the input you have given, and there have been good successions -- good suggestions. there are forms you can fill out and ask me more questions. go on my web site, please

submit e-mails to me. give me your ideas. tell me your story skeleto. this helps me. hopefully this will result in a better outcome for all of us back in washington. i think you -- thank you, and thank you for being such a respectful audience. thank you very much. [applause] [captioning performed by national captioning institute] [captions copyright national cable satellite corp. 2009] >> flags flying at half staff over the u.s. capitol again today in tribute to senator edward kennedy who died on tuesday. our coverage of his funeral services will continue in just over an hour and a half. we understand the plane carrying his bottle -- body left boston.

and after arriving at andrews air force the motorcade will leave for the u.s. capitol were there will be a brief ceremony and a prayer. we will have live coverage of that starting at 4:30 p.m. eastern time. they will then head down to arlington national cemetery for the burial. senator kennedy will be laid to rest next to his brothers john and robert. watch c-span for live coverage at 4:30 eastern. >> this month, the ninth circuit court of appeals heard the issues with veterans of posttraumatic stress and brain injury. what's the argument today on c- span. -- watch the argument today on c-span. today we will talk about dealing with the h1n1 swine flu virus

with dr. thomas friedman. on tuesday, a look inside the u.s. hospital system with dr. john garrett. now a health care town hall meeting with don edwards of maryland. she is a member of the congressional progressive caucus. many have said they will not vote for health care without a government-run insurance plan. this took place in germantown, maryland. it is about 1 hour 40 minutes. >> how is everyone this evening? [applause] excellent. well, ok, first of all, an introduction because i know some of you but i do not know all of you. i am congresswoman donna edwards. i represent maryland's fourth

district. it is good to be able to read we did welcome you all this evening. i see a special crowd of people who are interested and excited to talk about health care reform. and i am glad to be here with you this evening. i am glad you chose to spend your evenings year as well some of you know that i have been having conversations about health care and health care reform for a couple of years across our congressional district. those have been very invigorating conversations and spirited conversations as well. we have had an opportunity over the course of this last month to see on television and reported in the newspapers that there is an engaging conversation going on across the country. what i want to share with you this evening, we're going to have a chance to talk about this. we're going to have a chance to

have you ask questions, and i will do my best to be responsive to them. the one thing that i would ask of you, and i know that you can do it because you are from maryland. i am going to ask you to be as respectful to me as i am going to be to you. i am going to ask you to be respectful of your peers and your neighbors, because it is and what i expect, and i think at the end of this we will demonstrate that we can have a conversation and not something of which many of us feel very passionately and that moves so many of us, and this the reason this community center is still almost to capacity. -- silva almost to capacity. -- filled almost to capacity.

i see council members from montgomery county, might not -- mike knapp. hello. [applause] we have our good friend 10 bikers. -- ken rikers. if there is anyone i left out, consider yourself will come and join our family. i want to share with you that i note that each of us experience is the health care system in many different kinds of ways. part of the reason we feel so strongly and passionately about health care actually has to do with each of us, our own frame of reference.

whether it is the experience we have had as a patient, a provider, as a family member, as a neighbor and friend and colleague, each of us experience the health-care system and away, and helps us framed the way we think about what we need to do to make change. with the system works and where it fails. first of all, you do know that across the country, every single day 14,000 people lose their health care insurance. over the course of the time that congress has been in recess, and until we get back after labor day, something like 518,000 people will have lost their health insurance. we know the current system that we have is not working for millions and millions of people. i want to tell you about how i see this health care system, because i think it is important

for you to understand my frame of reference. some of you know i grew up in a military family. my father was in the air force. we had the experience as a family of six children of having great health-care service. we went to the doctors at whichever facility my father happened to be stationed at. i left my appendix at wright- patterson air force base in ohio. we had a year-end, nose, and throw appointments -- in your nose and throat appointments -- ear nose and throat appointments and work greatly treated in the government's system. as i got older, i had to get private insurance. i work for an employer and had

insurance. it was not a great commen. when i received my health benefit, at one point i thought maybe i will not even keep my health insurance, because it cost me a lot and i do not ever get sick. then i went there right time where i said i wanted health insurance, but i had changed and lawyers. my new employer did not provide health insurance. i was able to buy a plan for my son. he was a toddler at the time. i did not buy it for myself. i crossed my fingers, i put them behind my back and said i do not get sick. guess what? got really sick. i was in the grocery store and passed out. i had been sick for some time but did not want to go to the

doctor because i could not afford it. i passed out. an ambulance came to get me into the to the emergency room. they gave me great care o and i got well and it cost me a bundle. i tried to pay it back. it was a real struggle. just a couple of days ago i was cleaning out my house and found a folder. it had the bills from the collection agencies and the foreclosure notice from my home that i almost lost and had all the bills from the hospital. i am going to tell you something, it brought chills back to me all over again. just the pain of the experience of not having health care. fortunately i was able to get through that and pay it back and moved will work, -- and move

forward, but i do understand what it is like to not have health insurance. then i went to work for an employer and had a great help insurance. they paid all of their premium, they pay the deductible, they did everything. i got my laser eye surgery done and did not have to pay a dime. that was great. and it taught me what it would be like to have a premium health insurance. now i am in the congress and we are part of the federal benefit structure. we get a choice of multiple kinds of plans for health insurance. that is really great. we have these plans that are lined up against each other and what provisions are and to get to make a choice. i liked having that choice. well, part of the reason we're having this very big risk conversation about health care reform is because we also want to talk about the details of how

we can cover millions of americans who do not have health care coverage, how we can lower costs for all of us who do, how we can create competition were markets are very concentrated, and how we can provide accountability and transparency so we can make the entire system work for people. i happen to believe that we have a great opportunity to do that with this president, obama, who has set up a goal of those things that i just outlined. a congress that has said we have to come up -- our job is to come up with the legislation that is going to achieve those goals so that we can get a bill that is ready for the president to sign, that really has a chance of truly reforming in a comprehensive way, at this health care system. i do not think any of this is

easy, because it said had been easy, it would have been done. and our job is to get the hard work done, not just for ourselves and for our children and their children, leave a legacy of the health-care system that really works for them. i know just recently we actually commemorated the 44th anniversary of medicare. how many of you receive medicare? raise your hands. how many want to give it up? i knew that. medicare is one of those systems, where we began the debate about medicare, there were a lot of people who said the same things and are being repeated in this debate. you know what? right now there are a few people who would say, let's just their rid of medicare.

we do not want to do that. we want to make sure we provide greater benefits, but it is a system we learned a lot of back over the -- learned a lot about. part of what we want to do is to make sure we create a system where we wake up 44 years from now and says that this is a system that was created and we know there were a lot of challenges in terms of moving it forward, but it actually worked for the american people. that is what we challenged to understand right now. in the house of representatives and the senate we have multiple bills. you of all heard that. there are lots of similarities, but there are differences. one of the things i think is important that we do whether it is in the house or senate, eliminate exclusions for pre- existing conditions. how many of you have been

rejected? [applause] 8 you have not been identified with a pre-existing condition now, live long enough, you will have one. and that is really important. the other thing that we do and all of these bills is we say, sometimes there are actually caps, limits on the amounts that you recall -- recover from that limit. after that you have to pay of of your pocket the cost to be your care. -- after that you have to pay out of your pocket the cost to meet your care. there are many other things. i see the students from john hopkins university, medical students. [applause]

i once more of these medical students making a decision about -- i want more of these medical students making a decision about going into primary care. many of us in congress know that in order to sustain a primary practice in this economic environment that we need to give you hell. we want to incentivize you to go into primary practice. we want to make sure you get loan forgiveness if you say you're going to go into primary practice. we want to make sure we are educating more nurses and physician's assistants who are providing the kind of care in the places that people need that kind of care. and i am looking forward to seeing these young medical students as practicing physicians providing the kind of care that americans need in a way that can afford it in no way

that allows you to sustain yourself and your family. that has to be a goal as well. and there are many other items that are through this health care plan. let's go to the thing that has drawn so much contention. there are a number of things. some are truth and some are fiction. part of what we're doing this evening is we're going to separate the truth from the fiction. [applause] let's deal with one of them. i will use an example from my life. i want you to know there are a set of experiences when i talk about health care. my father died of kidney

disease. it was a difficult disease he had lived with for a long time. at the end of his life, toward the end of his life, he began to have conversations with us as a family and with his positions. he was under the care of the veterans administration and we began to talk about what he wanted at the end of his life. as his daughter, and i know that my mother and my sisters feel the same way, my brother, that it was really important for us to have that conversation as a family. it was important for his positions to be in that conversation as well, because that meant that by the time he reached the end of his life, all of us were on the same page, not about what we wanted individually, but what about -- but about what he wanted. and i think it is a good thing that that is part of what we unable to happen, those respectful conversations at the end of life.

[applause] platts talk about the other fiction stuff. if you are in medicare, medicare will get better. medicare is great. -- let's talk about other fiction stuff. we're going to create savings where we take those savings and then we make investments into medicare to strengthen benefits, to strengthen medicare so that it truly does worked for all of the participants that like medicare. before i came here, i visited senior homes before coming here this evening. i ask those seniors about medicare, and i will tell you something, they were likely my medicare alone. i said that is exactly what we're going to do. that is another myth we're going to clean up. then there are others.

we have created in this plan, what i described as an exchange, a marketplace for insurance. remember i talked about small businesses that are struggling to pay health care? individuals whose for whatever reason are not able to get health care on their own? we're going to create what has been described as a health exchange. it is like the marketplace. think about going to the grocery store and you see the show ended is lined up. we have health care reform x, health care plan y, health care plan z. [applause]

those people who are able to get into the exchange because they work for a small employer, you can look at this array and save there is plan x and that looks interesting. you, not anyone else, not me, not some government know at all, no one gets to choose among these people in exchange except you. you can make a decision that you want anything that is on the shelf right here. the public health insurance option is one of those choices. that is what we aimed to create -- aim to create. [applause]

dunst that is what we are creating in this plan, choices. if you work for a large employer where the employee gets to choose our range of options that had been negotiated by the employer, but for most of us, you only have the one twice. it's not an array of choices. if you are among the limited number of people who are able to be part of this exchange, you actually will get multiple choices. what does that do? think about the marketplace when you have multiple choices on the shelf, and each one of them looking at you, me, the consumer, the patient, then you will say i want to compete for you. we have a marketplace of 40 million people out there that these people commit these

insurance providers, including the public option 12 compete for. -- including the public option that people want to compete for. competition will drive costs down. [applause] not just for the people who are private -- who are part of the exchange, but for all the rest of us as well. that is why i liked the idea of including a public health insurance option as one of the choices -- [applause] i get the idea that there are a number of supporters of the public insurance option and a group -- in the group, but this

is important because if you are currently provided health insurance by your employer, there is nothing in this legislation that says employer, dropped these people. nothing like that. remember, -- weight. -- wait. one of our roles as that we are really going to be respectful in this room. i mean that. and [applause] there will be a time for questions and for answers, but we have all committed to each other as members of a community that we're going to be respectful. what i was saying is that among the options, if you have health insurance, you will be able to keep your health insurance. if you want to make a choice that the market private

insurance plan, you will be able to make that choice. if you decide you want to make the choice of the public option, you would be able to do that as well. there will be affordability credits provided to the employees and the participants in the exchange based on where you fall in the party range. -- poverty range. you get an affordability credit that makes you -- that allows you to make a contribution so you can meet the cost of your health care coverage. your employer's would also receive a tax credits for their participation as well. we want to make sure that our small employers are not bearing the brunt of paying for their health-care coverage. even though we know the

participating person needs to be able to make a contribution. all of us will make a contribution. i know there have been a lot of questions about how we pay for this. the estimate is that health care reform is about 1.3 trillion dollar costs over 10 years. we know we will derive in savings about $500 billion in savings. the question is, how to make up for the rest? -- how do you make up for the rest? the president is committed and the congress is committed to make sure this bill is revenue neutral. one of the ways we have tried to do that, in addition to savings in medicare and medicaid, is to make sure you are making a contribution as an employee to your own premium cost and your employer is doing the same, and

-- i will ask this question -- how many of you have an adjusted gross income over $500,000? you are lucky. i know you work hard. i know you work hard for that. the point is that for any amount over $500,000, and we're putting together another provision on the house side that would move that threshold of 2 $1 million of adjusted gross income, then you would make a contribution of 1.2% of the amount over $500,000 adjusted gross income. [applause] this would fall proportionately on about 2% of the income earners in the country.

keep in mind, right now -- remember how i described how i had to go to prince george's hospital and i was uncompensated care. i want to thank you all- powerful -- thank you because of you and the contribution you already make, you pay the cost of my going to the emergency room. i would rather you not do that. because those -- those costs are actually being absorbed by the 85 percent of us who already have health insurance. it would have been better for me to pay the cost of $150 or so to a health-care provider to get $20 worth of medication so that

i did not have to use the emergency room has a primary health-care provider. i with like no one else to have that kind of experience that i had. -- i would like no one else to have that kind of experience that i had. [applause] there are probably many more things that i could cover right now, but i know my staff are giving me s signal of 1 minute, so i have exhausted more than that. what i would like to do now is have the opportunity to take your questions. the way we're going to handle questions is that these microphones are right here. you can line up behind the microphones to ask the question, and out of respect for everyone in the room, it would be great if you use your one minute for a question.

as you can see, a lot of people came from proceeds -- from the seats in . and tried to be respectful of your peers. you were there first. go ahead. >> my name is michael cunningham. i want to thank you for coming year. it shows me you are a stand-up person. basically i have a question i would like to preface that as well. i believe unlimited -- and limited government. -- in ltd. government. there has been a personal crusade saying how national debt is unsustainable.

and between the post office, the $7 billion in debt, the stories of the walter reed hospital, supposed to be the crown jewel, the bad things that happened there, social security, and we had this huge debt. if we're going to embark upon a more expansive and more expensive program, how could we sustain an even bigger debt than we have now if we cannot pay the current debt we have? how are things going to be different? >> that is an important question. first of all, in terms of the cost we are entering now with the health-care system, the system that we have right now is actually and sustainable.

-- unsustainable. let me finish. i am would have a chance to respond to your question. the system i believe we have now is really an unsustainable. -- over the next decade to run the risk of more people losing their health scare, -- health care, because employers cannot afford to provide it? it is having a deep impact on our economic competitiveness globally and we cannot sustain that either. i believe it is actually imperative for us to do health care reform, not another year, not an ad in this decade, but right now. -- not in another decade, but right now. [applause]

bayh also think -- i also think with the existing health care system that we are actually -- the point of making reform to medicare and medicaid and seriously going after waste, fraud, and abuse in the system, you also have waste, fraud, and abuse in the private insurance system as well. [applause] one element of the legislation is actually to put $100 million towards the investigatory work that is needed to clean out the waste, fraud, and abuse in the system. i think that is a good expenditure for tax payer money. we will alternate microphones. >> i just had my father died from medicare.

it really was not so much anything other than the lack of money. i can see unintended consequences of poor people taking the lower cost option and being a second-class citizen like my dad was. what we really have is a loss of money. people should be able to go out and get a job and earn this. when the bankers have sold 20 trillion dollars for us -- from us, and you are not focus on putting them in jail. because we're sinking deeper and deeper and we're borrowing money from the bank is to put band- aids on health care and other issues, pretty soon this will come down on us.

can you please fight for local control, small co-ops as opposed to these big monolithic ones? >> let me respond. i am sorry to hear about your father. i do think we have in this health care system -- one of the things that happened in medicare is this idea that you go in for one treatment and then you come out and you have to go back for another treatment because there is not really at continue up care and service. i think it is really important in medicare to look at the way the payment system is adjusted so we ensure the the patient is being treated for the entire complexity of what their medical circumstance is.

i think a lot of people who take advantage of and beneficiaries of medicare now have had those kinds of experiences that really impact the kind of care that they receive. overall, obviously both in the private insurance market and also in medicare and what we envision and health insurance exchange is we're looking at things like quality of care. that we begin to figure of how it is we woulreward quality and efficiency. looking at these payment structures will be important in the long haul. think you again for your question. and-- thank you again for your

question. >> i am nancy and from baltimore. >> i do not think the microphone is on. just go to the of the microphone. >> i am nancy and i am from baltimore. [inaudible] that is why this picture has become famous around the nation. [inaudible] >> thank you. thank you very much, nancy. and >> [inaudible]

>> it is really difficult to gear. -- to hear. >> i just want to -- i just wondered how the government can keep spending? when my wife and i go get a house we get a mortgage and maybe we will save up our money and buy another house. we wcannot keep buying stuff unless we earn it. and what is the loss in the government that we make it so we are going to spend trillions of dollars that we do not have? how does that work? [applause] >> hai appreciate your concern. i think it is precisely the

concern that the president has expressed. it is a concern that i share, and many members of congress share as well. it is why when you go through the details of what the congressional budget office has ordered the cost over 10 years for health care reform that we are absolutely certain that we will be paying for this so we do not put the cost on to future generations, so that we create a system where each of us is making a contribution to our own health care. i think that what has been demonstrated in the legislation in front of us is great attention to exactly the concern that you raised, that we do not want future generations. the cost of any of these systems, and in a particular, you had an opportunity -- in

particular i think it has been very important that although the congressional budget office has not attached of value, each of us know that when you make an invention -- investment, that over time that that is a savings in the system. well as 1.3 trillion dollars -- while the 1.3 trillion dollars has a lot of savings built in, what is not attached is any value to savings. i believe we will see down the line. i think we of the question at this microphone. >> i have been a decision for 42 years. -- i have been the position -- a

physician for 42 years. i understand where this is coming from. i think the biggest problem we have is the insurance carriers have basically stopped trillions of dollars out of our health care. -- basically sucked trillions of dollars of our health care. it seems to me that the single payer system should never have been taken off of the table. [applause] i think part of the reason it was is everyone assumed that it is a government program. why don't we simply said at a private company that is a highly regulated monopoly in terms of what it can do and covers 230 million people? removing the private insurance companies from the system and putting more into it. why can't we have a single payer system that is not a government

run? those costs will no longer be part of the deficit. [applause] >> in some ways you are preaching to the quieter. -- preaching to the choir. i have to add because as you described we are not now at a place we are having a conversation about a single payer health care system. i realize that, and my colleagues realize that. many of us were looking at other ways that we could embrace the idea that the president has, that we have a system that does have private insurers as part of our system, where we have examples of the government facilitating health care,

whether it is the armed forces or the veterans services or medicare, and how do we send look at that system and try to figure out a way that we really can ensure -- insure the people that do not have health insurance? so as a result many of us began focusing in working on the public health insurance option as one mechanism in a marketplace of competitors who are actually in fact competing to get those 40 million people or so sign up, whether it is in the public interest option, or it is one of these others

insurance companies in the marketplace. right now we do not have a system that is competitive at all. in maryland, just like across the country, usually there are one or two insurance companies that dominate the market. that is true in this state as well. if you have a market that has more insurance providers who are able to participate and compete, i think that is something that while it is a a single payer system, it embraces the idea that we want to encourage the marketplace to be competitive and provide affordability by offering a health insurance option as a choice that consumers can make. we're going to have to go right away. i am long winded. >> i have two sons with severe

cerebral palsy. i am a small business owner. and i see it from both sides. we currently provide our employees choices. we paid 100% of the cost of a single family coverage. [applause] under the bill, if we pay less than 8% of the total compensation we pay a penalty. right now we paid less than that. the bill gives us an incentive to hold down salary increases so we can meet a% requirement that is in the bill, which is a perverse incentive. second, if i was to retire, my wife and i are not going to have any more kids, the house bill requires we would have to pay premiums to provide maternity

coverage and will baby care, even if they will not use it. if you would offer different plans for the premiums would be less, you can control the costs. finally, i am very opposed to is the single payer plan because we have had no choice. i was wondering if you agree with your fellow democrats that the public plan is a cut for the single payer? >> there are lots of questions wrapped up in there. thank you for your questions and comments. if you have health insurance now, as long as it meets the standard set of benefits, you can continue to provide that health insurance? e. there are many employers -- if you look at the legislation, if you currently provide health insurance and to meet the

standard set of benefits, i believe -- there are many employers to provide health insurance to already meet that standard set of benefits and you will be just fine. i would be happy after this forum if my staff and i could work with you and show you the provisions in the bill with that would apply. i would be happy to do that. as much as i am very supportive of a single payer health care system, and i understand the dynamics of where we are now. i do not think this is the first up towards anything. i think this is the first thing we can and should do right now that both anchorages -- anchorages reform -- encourages reform in the health-care industry and provide stress is for americans, especially those

who work for small employers./ think ines your employees had you -- thank goodness your employees have you. i do not think this is a first step toward single payer, i think it is a step we can make so that we meet the goals set in front of us of providing competition of lowering costs and providing accountability and efficiency in the system. >> my name is scott. i am an american and had the experience of dealing with national health care in canada. >> can you speak up. >> in 1990 [inaudible] i experience national health care. i think my experience is valuable to share. during training camp i was hit in the back.

i had complications. they found out i was missing a kidney from birth. the federal health care system would not allow me back on the health care if we did back on the field until i signed a waiver. the waiver said if i wanted to play golf ball i would have to pay for any kidney related injury. i paid into the health-care system for disability and they sent me home with $180 and a plane ticket home. my opinion is, national health care, public option, or anything you want to call it will be where government can tell you what job you can have and what job you cannot. [applause] >> i appreciate you sharing your experience. i appreciate your sharing your experience, but the fact of the matter is, and i want to be very

clear about this, we are not nationalizing the health-care system. [applause] that is not what we're doing. i would think it would be much more productive to talk about what we're doing, as opposed to what we are assuming we're doing, or what our vision is about what might happen down the line, because clearly if we are creating a national health care system, you would not create a structure that embraces the private insurance market. we have created a structure that is very uniquely american, especially given the way we have started out where we have private insurers in the system of creating a public option that can compete alongside the private insurers. if you were eligible in the exchange in do not want to choose the public option, you do not have to. [applause] >> my name is marilyn.

i live in germantown. thank you for coming tonight. one of the things i want to talk about is employer-based health care. we have seen through the recession that having the employer pay for health care does not work. with the recession we have seen a lot of people lose their jobs and health care. we have also seen that small business have to cut back. one of the things they have to cut back its health care. do i think we need this reform. we need all americans need access to health care. the question is, how can we get past this debate and move this process forward? we need all americans to have health care coverage. [applause] >> thank you. i share your sentiments.

the fact of the matter is we're going to get past this debate. i think it is important we do that. it is important for us to engage in all of the questions and comments and concerns and experiences that people have had with the current system so that we can move forward. i am looking forward to september when congress gets back into session. where we have had this experience where what we have heard from you really informs how we go forward, but the important thing is that we actually have to go forward. we really do. i very strongly supports the fact that president obama has sent out of gold -- set out a goal. the congress's job is to come up with the details. i think we are a long way down the line right now.

we will reconciled -- reconcile the three bills we have in the house of representatives so that we have one bill that each of us as members of congress, considering what we have heard from our districts, considering what this will mean from the country, will have an opportunity to vote on that. i cannot tell you how much i am looking forward to that vote and the hard work at getting us from sheer to there. i share your concerns. . .

>> when the hospital goes to code red, we cannot accept anybody. whatever else is going on. with everyone having insurance, then we would be able to see -- people are actually healed first. do you think you are coming today and you have insurance and you do not care about anyone else out there who does not have insurance -- you think again. because you do not have insurance. what happens is that 30 years ago i was in a situation where a female had an accident. the insurance refused to pay for the rehab until the physical

therapy had been videotaped. they wanted to see the progress. that is all i have to say. >> that is quite a story. of course, the untold story of the health care system is that insurance companies are making those a choices for you every single day. [applause] so we least want to create some opportunities in the system for you to make some health care choices on your own. >> hello. i am my name -- my name is liz. i was recently diagnosed with multiple sclerosis. i was diagnosed three months

later because my private health insurance did not want to pay for an mri. despite the fact that my father has multiple sclerosis, which multiplies my chances of getting no by 20. they did not want to do an mri. and now i will consult a neurologist and find out if i can afford to monitor my disease. my question is -- how can anybody say that public health insurance would ration care? would delay care? private insurance has done that to me and is continuing to do that to me. [applause]

>> thank you. again, i know that many of you have questions and comments and your prepared to share your stories and the stories of your family members and your neighbors. again, it is so important to what informs what we are doing. there are no other words to say other than -- this is about why we need not just change around the fringes, but we need comprehensive reform of our health care system because i wanted to work for -- i want it to work for all this. the president wants it to work for all of us. we do not want to jeopardize the good health insurance that many of you received to date. we want to make sure that you are able to receive that and get medicare and make sure it is

sustainable. thank you again. [applause] >> i am it a physical therapist of 23 years. i have worked in about 40 facilities. i guess my question is -- i appreciate you doing this. i kind of wonder what other avenues can you offer people to truly communicate? it seems like the debate is more having people listen to each other. i recently was in vermont. we saw canadians, of the border for health. however, 18 years later, i have a private practice where i do not take insurance. i tell every patient that comes in that it is not about the money. how do we help people know --

the hot examples would be back pain, which is the primary reason people see their family practitioner. it might be $100 billion a year. in our present system, we do not identify the cause of back pain 85% of the time. that is a problem with our system. the other problem with that is -- the real broken system is that we have a way that looks at back pain. but that means nothing to the layperson because you cannot change the system. so how do you get people to actually hear each other? >> again, thank you for your comments and experience as a physical therapist. when we think about health care, so often we're talking about doctors and nurses and

hospitals, and there are a whole range of health-care providers in this system that provide quality health care that needs to be affordable and accessible. one of the interesting things that we try to do in the legislation is to begin to identify best practices. for example, so physicians can actually share with each other best practices and treatment protocols to improve the delivery of health care. i think the crux of what we are all interested in, and i do not want to cast aspersions about why people support one thing compared to another thing, because i think -- you know, if i went around this room, there is not one of us that does not want everyone to receive quality affordable health care. the question is not about that. it is about the pathway to get there. that is where we have push and pull and tug in this debate.

that is a healthy thing to happen. we want to try to get it -- try to get at best practices. looking at what is medical home and provision of services for a patient so there is coordination. if you're seeing multiple practitioners -- looking at family practice, and there's almost a family practice that goes on any more. looking at family practice because we can examine things like multiple sclerosis in a family, and we know what history -- we now history. the family practice physician knows that history. you and your experience of health care is being guided by the best practices in the field

and by your medical provider. when it is all said and done, and the summer is finished and it is fall and the president has signed a comprehensive health care into law, that is not the end. it really is the beginning. we will learn a lot, just as we did at the beginning of medicare. we'll learn a lot about health care. there'll be many tweaks over the course of the years -- not just because we want to be efficient, but because it is important to get that right for health care for all americans. thank you for the work that you do. [applause] >> congresswoman, i am from potomac, maryland. if health care does pass, will

you endorse the public sector plan? [applause] >> that is always a question. i did this question a lot about whether members of congress will opt out of our health care plan. members of congress are part of the federal health-care program. it is important that we trees employers who currently provide health care in a way that we do not mention, though we are not pushing people over to move cost over on the exchange system. the exchange has been limited for a reason. it is limited to small employers. [applause] [jeering] >> let me just finish. i am actually not one to talking more unless i can do without the

hissing. so the federal employer is being treated like the other employers. i actually paid a lot less for my health care when i was employed with the department of human services that you currently. i think there was an amendment for federal employees to opt in to the exchange. i do not have a problem with that. i think the exchange will be the kind of marketplace we described -- were you will have multiple private insurers and the public auction to choose from. -- the public option to choose from. but we want to ensure that employers currently providing health-care coverage continue to do so. i think those of you who are afraid of the language of a government takeover -- the last thing you would want is for

private employers to say they are not providing health care insurance anymore. [applause] that suggestion is counter intuitive to the goal of trying to ensure that we have both a marketplace and the public insurance option. >> my name is david. i live in clarksburg. everything that you said sounds great, in theory. my question as i look at the three bills and analyze what is there, it seems they are weak in substance and lack a lot of details and appears to give room for government control as the system continues. [applause] my question is everything that you said tonight sounds wonderful, as i said, in theory.

government is not the solution. government is the problem. [jeering] we are actually not -- >> we are actually not going to have that, please. can you let him finish? >> my question is, as much as -- my question to you, congresswoman -- why should i trust you? why should i trust elected officials? what can you do to restore the trust in government? >> thank you. first of all, we actually share competing views about the role of government. i think that is true in this room. there are some people whose share the view -- there are some in this room probably share the view that no government, no way,

nothing. there are others of us to share the view that government has a role and responsibility in our lives and it is up to us through our elected officials to define the parameters of that responsibility. i am of the latter. in terms of how you trust me -- if you are speaking about me, donna edwards, representing the fourth congressional district, i realize i have to earn your trust. just like i realized when i was not an elected member of congress that the person holding office had to earn my trust. that is the relationship that we have as constituents with our elected officials. the same is true of the relationship you have and that we all have with the president of the united states, that we have with our governor.

i will work to earn your trust. you get to decide at the end of the day -- sometimes that is election day -- whether i have met the mark or not. i am happy to engage in that over the course of the remainder of my term to make sure that i am earning your trust. part of the way that we do that is that we can gather like this in a roomful of people that come from some many different places to express our viewpoint about our health care system and issues that confront us. that is part of the trust- gaining mechanism. i do not just want to hear from people who agree with me. at the end of that conversation, we may have to agree to disagree, but on something as important as health care, it is at least important to engage. >> hello. i am from maryland.

i am of public analyst. this is so important. we need to revamp medical education and produce more primary care providers. the second point is that i am originally from north carolina. we have a great public educational system. greek universities there. i went to a private college. there was no reason -- we had a public university. no reason that we cannot have a great public auction and still have private insurance companies, as long as they provide some value for the money. and finally -- [applause] medicaid, which is on the whole rotten system, one that put everyone who is on medicaid into the insurance exchange with some money so they can choose one of those programs like working

americans? >> thank you for your comments. that is an interesting point about medicaid, which we are not revamping in this reform, although we do change some of the eligibility requirements. that is going to require a whole set of other work that is actually not fully part of this process, even though some of the savings better gained are actually came out of the medicaid system. there will be a small proportion of adults -- i think 133% of the poverty level -- who are medicaid-eligible who will be eligible to make a choice within the health insurance exchange. that is a very limited part of the population that is eligible. i know you have been waiting for a long time. >> i am of physician assistants,

practicing for about 20 years >> [unintelligible] >> i did not get to finish my question. >> i remember. >> i read the bill and it is an unpleasant thing to read. my question is -- we have evidence that they do not cover external wounds after surgery. how are you going to cover all of these people when you are going to cut medicare by $500 billion, which is the projection? the president wants to stop the medicare advantage program. it has an unfunded liability which requires our medicare recipients to carry a co-pay make ends meet. he wants to abolish that at $17

billion. how're you going to not ration care tax in the bill, a number of events will continue -- how are you not going to ration care? in the bill, a number of events will continue -- >> speaking to the seniors who are the beneficiaries of health care -- we are not reducing your health care benefits. it is not happening. [applause] in fact, although there are $500 billion in identified savings in medicare, $340 billion of that is back in the medicare system. that is the legislation. we can probably have an argument about this. but i am not going to do that. you ask a question, and i am going to tell you in plain

language so everyone gets it -- we are not reducing your medicare benefits. we are not reducing your medicare benefits. [applause] >> my name is deborah. [inaudible] i am from germantown. just so the public gets an idea -- we are not all on welfare. we have worked hard. my husband, my parents, my grandparents. but the moment -- i have had only one surgery in my life, and it was three weeks after i got laid off. i lost insurance that day, and having paid premiums for years. paid cobra for three months. the next thing i know -- my

insurance company backdates 30 days all the procedures i had. they are not covered although i already sent the money. they sent me have a check and said that was no longer cover. i do not have a job. out on surgery disability. no coverage. it basically ruined my family financially. in 2000, lost -- in 2000, insurance, job, all those things. people have to understand. we are regular people. i am not looking for anybody to give me anything. i am looking for an option. [applause] >> how are you going to help us convinced the blue dogs?

everyone wants to trashed this thing. make it happen. >> thank you. i just want to say to you -- this is exactly the reason that there is not a single day that goes by, not an hour that goes by that i am not thinking about health care. it is precisely for people like you who are in the system of quality, which is not quality for so many others. it is just not fair. i am committed to working with our president, our leadership. your point to get from here to there. part of this is part of the process. come september, it is getting down to the grunt work of getting a bill done that lower costs, provides competition, and ensures accountability and transparency, and i believe are

robust public auction as part of on marketplace insurance provisions is part of the way that we get from here to there. thank you for sharing your experience with us. again -- no one should have to work and work and pay premium after premium and even the expense of coker which is sometimes more than your more -- even expense of cobra which is sometimes more than your mortgage payment and come up with nothing. we are willing to fix the system for you and everybody else in that circumstance. thank you again. yes, sir. >> baby. thank you. i am from a german town. my concerns are twofold. -- i am from germantown.

i have concerns about transparency, inequities because usually when there are a lot of choices, some of us have to shop at the lower end of the spectrum. so i would like to see some kind of provision to address these inequities in the system. secondly, we seem to have removed universal health care from the debate. identify the problem of health care as being a cost, and then we have to look at the fact that the system that is being proposed right now, there is still a large segment of the population and will be excluded. i know a lot of people do not want to think about it, but we have to think about everything that falls on both sides, and if we exclude immigrants and not

provide health care or the opportunity to purchase it, i think we are missing the mark and reducing health-care costs. -- on in reducing health-care costs. >> there are a couple points at one to get to. one is there is a standard set of benefits. i know is really complicated. i know in my own plan, when you look at several different plants back up against each other, it is like apples and oranges. the idea is to provide a standard set of benefits of that you know at the outset but can be included in the plan. then, if you wanted to go to a premium plan, you could do that. but the standard benefits package would ensure you at the kinds of things that you expect to be covered in preventive care and the rest would be covered

under your health insurance plan, which everyone would make a choice to take. as to reject i saw a sign outside -- as to -- i saw the sign outside having to do with immigrants in this country. we did have this whole discussion about whether we should do that, but the fact of the matter is -- and let's talk about facts -- this legislation does not cover people who are in this country illegally without documents. another is a lot written and said about that. it does not. we could have a completely different debate about whether we should, but for the purposes of describing what is in the legislation, let's just be clear. it does not.

overall, the goal for universal coverage could be met with a single payer plan. this plan is projected to cover 97% of the american public. probably 3% of people who for what ever reason opt out or are still seeking emergency room care -- that is a far cry from where we are now. getting to 97% gets us really to universal coverage. i am taking these two questions right here. i am getting instructions. these two questions at the microsoft -- microtome right now. -- microphone right now. you have question and answer

cards. you are welcome to write your questions on there. our staff will endeavor to get back to you. if we can take this microphone and this one. thank you. >> my name is -- and i am on medical student. first call, i would like to say i am currently supportive of the health care reform efforts. i applaud you for fighting the good fight. when the problems i see is that there is a lot of ambivalence on the part of physicians and medical professionals about reform benefits, and i think a good policy option to bring them on board would be some kind of tort reform. a lot of physicians are really struggling. [applause] that is under the fear of a

lawsuit. even though it is not always warranted. a good way of solving that would be public care corps. -- courts. so people who are harmed their adequately compensated but doctors do not have to fear of lawsuits. [applause] >> thank you. again, that is another important comment. this has come up in a couple of town hall meetings i have done. it has sparked some additional consideration and debate. what i want you just mentioned people -- what i want to just mention to people, literally, there are a handful of doctors

across the country. they move from one jurisdiction to the next, and never by now, and i think we have to get to the transparency of systems in states that allow for sharing of animation about that dr. -- the sharing of information about the doctor. this has been around forever. we have such advances in technology. surely we can do this. states will be able to share information about doctors so they are not allowed to create that harm. it is driving up the costs and making it difficult to practice for a lot of physicians in some of the most difficult kind of practice. i appreciate your sharing now. we just have time for the final question. [unintelligible] that is right. >> thank you forthcoming.

>> you will have to speak up a little bed -- a little bit. by thank you for coming. most of us want change. i would appreciate president obama reaching across the aisle to get people to work together to solve this problem, but the republicans seem adamant about not cooperating, not helping, not having anything to do with it. so i wanted to know where you stood as far as supporting the delegation to get this done. [applause] >> that is an important question and comment. an important way to end in terms of talking about where we are in the debate and how we move forward. i believe president obama -- he is a terrific president. he has tried above and beyond

the call -- [applause] and i think that at almost every single turn, he has been rebuffed. given that he was elected for the kind of change that you articulated and then i believe in as well, that sometimes means that we kind of have to take the bull by the horns. and we have to move forward. and if on the senate side -- and i am not in the senate -- but it's part of the processes reconciliation and in order to move forward, i think that needs to have been -- but if part of

that process is reconciliation in order to move forward, i think that needs to happen. we democrats were elected for a reason as well. we hold a majority in the house of representatives and the senate for a reason. it is important to embrace our leadership. to embrace our majority. to move forward for the american people. [applause] now -- [applause] now, as a closeout, -- as we

close out, allow to sit a couple things. i know that everyone shares my view point. i do you know how much i appreciate that you took time of year evening to spend with each other and with me, and that we're going to move forward, and they're going to be many other issues that we will bring, and we will agree and disagree. it is possible to have a civilized, substantive, intelligence -- intelligent conversation about a tough issue. i want to thank you. [applause] and lastly -- i know there are those of you who question whether you trust elected officials.

you do not have to trust me. take the binder and read the bill. gold look at the section by section -- go look at the section by section analysis. one thing i would urge you not to do -- don't just listen to talk radio and chatter on television about what is in this bill and what you think about reform. thank you for being here. [applause] ? can i ask you a question -- >> hello. how are you? >> i cannot get to the microphone. >> i am sorry. >> my dad was a life master in bridge, which requires an awful lot of dedication and common sense, for thought --

>> strategic thinking. >> exactly. he was a democrat. 72% of the people in in the united states like their health care. with 47,000 people that you have alluded to -- >> 47 million. >> excuse me. and i am giving you the way to get this through. part of them, as you already know our people who do not want health care. my aunt was one of those folks. 20 million. >> probably 3% of the population. >> ok. if you take the 2007 census, and you whittle that down -- like debra over here. and you devise a program and the government loves to subsidize things.

and you make it mandatory that the private health care have to take people with pre-existing conditions, have to do this, and the government will substitute those folks, and it is much cheaper. within minutes -- wait a minute. just a minute. the problem is that everything that has been going on -- the representatives in new york, they say that they do not care what it is. and you wonder why we are upset? we are upset because we do not think you're going to listen. >> can i just say something about the public auction? >> i was sitting back here, in your listing to everybody what everybody said. you are loquacious, however -- you deserve a position. i am trying to encourage you to go back to congress and come up with something different. there have to be other plans. that is all i am asking.

>> i appreciate it. i am going to give you four pages to read. the public health insurance option. >> but i do not want to read that, honey. >> my point is -- at this point [inaudible] i am reminded of the fable of the fisherman's wife. when she wanted this, she got that. until she went too far, and the fish went back and said we are back to square one. this is what you will have. some may be his time to just look at it. try to find -- if we have the majority and its in the best interests of the american people, is time to do what's

best for them and let the chips fall where they may. >> i appreciate you communicating that. i think the frustration of the last several days have been the challenge of communicating that. thank you. >> donna, thank you so much. you're doing a wonderful job. >> we appreciate you very much. >> thank you very much. >> stick to your guns. you're doing a beautiful job. >> this last and woman was here. >> a 47 million without insurance -- i am in favor of the individual mandates. the problem s roughly -- the problem is roughly a third of those without insurance, they are exempt from the individual mandate, but they are still going to show up at the emergency room. they're still going to need

health care. they will just not end up paying for health insurance. they are being treated better than those subject to the individual mandate. it is selling not in favor of giving them affordability credits -- u.s. -- i am not in favor of giving them affordability credits. >> it is an important point. [unintelligible] it is not a question of covering or not covering people who have access to the system. >> the people -- but people on both sides said they do not want to be covered. >> the assonance the zero -- the estimates th zeroough, --

though, the as demands are that it is 3%. currently, our system is an absorbing far more. as i said, this is not in in. it is really something to keep in mind. >> can i follow a by e-mail? >> please do. >> i have a question about the public health exchange. [unintelligible] >> there is a provision that could enable a state to set up a health plan [inaudible] >> of public health exchange. why can we do that without the public option? -- why can we do that without

the public auction -- why can't we do that without the public auction -- option. some people it said removing the antitrust provisions will open and up to competition -- >> some people have said that removing the antitrust provisions will open it up to competition. it will not bring down cost. >> but foreign exchange is the same thing. >> no, it is not. there are multiple insurance providers in that exchange, and in addition to 1 -- >> we cannot have those without the public auction -- option? one way you can do that is with public savings accounts.

>> ok. the private health care -- the public health care is not in the senate bill, right? >> right. >> if it is defeated, ok -- and i wish it would not be -- in what way can a co-op be successful if we have to subsidize it? it is so difficult to get the same amount people to get the public option? >> there are co-ops that have taken 30 years [inaudible] millions and millions of people [inaudible]

>> can they operate across state lines? >> there is one that provides some health care coverage to folks in idaho. >> but legally, it is allowed? >> across state lines. the provider is in wednesday, and the person -- >> they are in our rural area. that is probably the reason why. >> there is data that co-ops can operate on the skill level need to provide health care. >> can they be together? does there have to be an overall management? >> i have not seen it, so i think that the challenge is that

we have to start a co-op in or around and find doctors. then you'd have to regulate the startup costs, and to imagine that happening in a number of regions, is difficult for me to see how that really is the kind of thing, the kind of choice that we would be able to provide -- >> ok. so you are for the public option. >> i believe in it. when you look at what you have to do to provide real competition, lower costs, i believe the public option is the way to do it. i am really confident in the house that we will trust the senate is what is the problem.

-- yes we really confident in the house that we will -- >> the senate is what is the problem. >> is blue cross and blue shield. -- it is blue cross and blue shield. [captioning performed by national captioning institute] [captions copyright national cable satellite corp. 2009] >> our live coverage of the funeral ceremonies of senator edward kennedy will continue lion 45 cents. plans have changed a little bit. we understand rough weather delayed the departure of the

plane carrying the senator's body. the plane has landed at andrews air force base. shortly, the motorcade will travel to the u.s. capital. -- the u.s. capitol. we will have live coverage that should start about 5:30 eastern.

>> again, looking at members of the congressional delegation gathered for the ceremony in the steps of the u.s. senate. live coverage starting at about 5:30. after that, there will be a motorcade down constitution avenue to arlington national cemetery for the burial which will take place about 6:30 where senator kennedy will be laid to rest. live coverage will start again at about 5:30 eastern.

and now a discussion on the legislative record of senator kennedy from today's "washington journal." in our next hour, a look at various pieces of legislation issues that was co-authored by senator kennedy just to give you an idea what he did legislatively during his career. to give you a sense of the time of circulation, the 1964 civil rights act, banning segregation in all public playses, in 1965, the hart-cellar act, apolicy ishing immigration quotas. in 1966 -- the community health care centers established ann in an eament amendment to the economic recovery act of 1964. 1968, the bilingual education act, in 1970, statute to lower

the voting age to 18, and 1972, title nine, in 1978, airline industry deregulation, allowing airlines to choose their, in 1990, ryan white act, 1991, the civil rights act. 1993, the health insurance affordability and accountability ability. in 1997, the state's children health insurance program, the schip program. 2001, no child left behind act, d the mental health pa rhythm ty act, that was in 2008 -- the mental health parity act. those are some of the legislations in which kennedy was involved. what do you see as a pattern in which senator kennedy was involved? guest: i guess i make a couple

points. most of those issues came within the per view of one or two of senator kennedy's principal committees where he was active, the first was the judiciary committee, which he chaired fr a couple years in the 1970's where he worked on civil rights, voting rights, and immigration and criminal code issues 1970's, then starting in the early 1980's, he was chairman or the ranking minority member when republicans were in charge of what were then called the labor and human resources committee where he dealt with health and education and some labor issues, and those were the two courses of his activity. he was a member of the armed services committee, never became chairman, looked after massachusetts' interests. the diversity that occurs, and i will make one other point and stop, is that a number of those you cited really were areas

where was -- issues in which he was busy and productive in the bulk of his career. in the 1960's, and 1970's. so some of the analysis for the last couple days have said, he really got active after his -- after he lost the presidential campaign to president carter. it changed in 1984, but he really was a very active legislator going on. host: what do you get from that list as far as his efforts and what he did? >> part of his philosophy was that the government should be there to help people. he strongly believed that, and that helped give him the kennedy liberal labor that he wanted to expand government to help people. you can see that in a lot of the legislation, something that he fought for until the very end, ways to help people through government, the schip for children, health care for children rg all those things were really part of his core

philosophy. you can see that throughout the whole list of bills he's passed. this is about helping people. when you hear everyone talk about senator kennedy today, that's one of the recurring themes is that as the legislature he wanted to help people, and that's what you see in a lot of these bills. >> host: you look at the scope, and a lot has been said about his reaching out to republicans, how willing were they to help him get this done? caller: in most cases they weren't willing, but kennedy had a reputation for getting things accomplished anyway. he maybe wouldn't get everything accomplished in one bill but he would get part of it done. and he learned that through his 47 years in the senate. you could see he was able to cut deals, and in some cases anger his own party by, you know, softening legislation in order

to get republicans to go along. you can see that. he passed many bills with hatch, republican, the two of them collaborated together, and nassy castle balm -- and nancy castlebaum. they were willing to work with him because he had the ability to really consult a deal, and that's how he -- to really cut a deal. that's how he got it done. host: so concessions were part of his effort? guest: yes. host: do you agree with that, rich cohen? guest: absolutely, he was a master. he learned it when he came to the senate at age 30. he had no experience here, and he was kind of a young pickup, -- he was kind of a young pup. we don't want to glore identify him. -- we don't want to glorify him. he was human.

he really applies himself and becomes -- i think it is valid to say that he was one of the giants in the history of the senate and probably the giant of the past 30 or 40 years. host: was he a policy wonk as you would describe it? guest: no he relied on his staff to be the real knowledge jinl wonks but he knew enough to get by and he encouraged them to work on these deals, and when he needed to be a wonk he did enough. i was talking to steny hoyer this week and he was talking about work on the americans disability act, and he said he knew a lot about the bill, it was hoyer's bill, but he said to me this week that senator kennedy knew as much about that bill as he did as the sponsorer

of the bill. hofere he was previously the chairman -- he was previously the chairman of the judiciary committee, he also served on the -- many other committees. i say all that to say as a leader how was he in getting not only his own efforts done legislatively but what other desms wanted to get done as well? guest: well, he was someone who was willing to help people move their priorities. i know that tom harkin was new to the senate at the time and kennedy pretty much put him in charge of the bill. harkin wanted experience on a big bill and kennedy was willing to hand that over to him and help him move an important priority for him. he did work with others also. he had a massive legislative output. he authored more than 2,500

bills and hundreds of them are now law. he was busy on his own getting his own legislation passed. guest: you asked about his being a leader. at one point in the 1960's, he became the senate majority whip, which is the number two leadership position, but then -- and i haven't seen this mentioned in the past few days, he lost that position. he was defeated by senator robert bird in jan -- janny 1971, not long after chappaquidic, which may have been why, and maybe it would have been different. no knows why. host: if you want to talk about the senator's legislative accomplishment, here is the number to do so -- 202-737-0001

for republicans, 202-737-0002 for democrats, 202-628-0205 for independentents. you can send us e-mail at journal@c-span.org. p.m. no child left behind is one of those pieces of legislation that has consistently come back over the years. we know his efforts, but especially what you were both talking about in reaching out to republicans, especially republicans at the time, to the president. guest: i think kennedy liked the idea of the legislation, which for viewers is a law that requires schools to test students to ensure they are passing certain threshholds as they move through their grade levels. part of the problem was that states complained that there was no money. they call it an unfunded mandate. how are we going to get this done without support from the

government. they have given us this requirement, but we don't have the money to get it done. so it was universally the -- unevergs versely not welcomed by educators, and he felt he had been duped by the bush administration. so he was still willing to work with the bush administration, and he did, and he also worked with a prescription drug bill, and i think that became controversial as well. controversial as well. bush needed him on that, he did work with republicans, sometimes to his detriment, but other times it benefited him. guest: some of those republicans working with him in the same room, they were not thrilled about working with kennedy. john kennedy -- the chairman of

the house education and labor committee in was john boehner. he was the house minority leader. he talked about how they worked together with each other. but boehner also said separately that a lot of his colleagues said never work with ted kennedy. he had to reassure them it would be ok. host: he spoke about what he got involved on this program in 2003. guest: on new child left behind, we had 11 million children, the neediest children in this country. in 1965, we made it a national priority to try and give it the poorest of the poor a level playing field so they would be able to achieve their potential. . . to do it

with no child left behind. we have a good blueprint, but we haven't got the back-up. that's a question of priorities. so many things we do in the congress are a question of priorities and values, and for me, funding that program to make sure re we have small class size, well trained teachers, supplement tri services, and supplement tri services, and help for those children, n the limited english speaking children, that is a national priority. host: again you have a chance to talk to both of our guests about those priorities legislatively and otherwise. bokia ra ton, charlotte, you are up first. go ahead. caller: first let me say i am a liberal democrat and have been for over 60 years and very proud. my mother was the only child of her family born in this country on the 4th of july. we were taught to love our country and love its people. and when i was younger, i asked

my parents why are we democrats? and why are we liberal democrats? and they said because somebody has to look out for the poor, the sick, and the elderly. what a loss to our country. i would like to know who is going to work as tirelessly and effectively as senator kennedy? who do your guests feel could pick up the mantle? host: susan ferrechio, why don't you go first. guest: a lot of people ask who could replace kennedy? and the answer is usually no one. he is an icon that will not be easily replaced. there are a lot of people in the senate who are liberal and fighting for those causes as well, but there has been sort of a shift into a new kind of democrat that's more progress ive.

kennedy's philosophy echoed the roosevelt era of government stepping in to help people. you see the obama administration stepping in that direction, but there has been real resistance to that kind of movement. so you wonder if in the senate really -- and in congress in gen general -- if there is really going to be a place for a lawmaker like that. guest: i had another point to get to this issue about how senator kennedy will be missed. it is one thing, susan was saying, that there are inevitably lots of members, democrats in the senate and the house who want to be active and staffed. they will be pushing them on various issues, but what kennedy brought that is not replaceable is a stature because he was "kennedy." because his brother had been president, because the family

history goes back. his father was in the new deal. there is no one who comes to the senate now with that stat tour. -- with that stature of the family name, the history. host: republican line. juliette. caller: yes, the statement i want to make takes a lot of explanation, so if you would allow me to complete my thought. the majority of your audience my impression is doesn't understand the form of government our founding fathers gave us and the form of government we're supposed to be living under. the 10th amendment to the bill of rights states that the power is not delegated to the united states, that's the federal government, are retained by the states or the people. and the legislation that you're discussing this morning, these social programs, are not given

-- that power is not given to the united states, the federal government, it is retained by the states. any of those programs can be done and should be done by the states, and when the people are caused to look to the government for the provision instead of to their own abilities, what the federal government does is makes slaves of the people to the states, it gives them -- host: and what is the question? caller: my question is -- or and the government school system has taught the people that the government is supposed to do these things and led the people to believe that they are entitled to these things. host: ma'am, what is the question? caller: well, the question should be what do we do to return our country to a

constitutional republic? host: mr. cohen. guest: well if we put it in the context of senator kennedy who we are here to talk about, there is no question that the caller makes valid points that there has been an expansion of government, and senator ted kennedy was an important part in that, in pushing it, and he was kind of step by step deliberately moved to expand government in a number of areas -- health, education, civil rights, et cetera. but one interesting point about ted kennedy is that most of the time -- most of his 47 years in the senate he served as a republican president -- he served in the senate there was a republican president. kennedy could have not done anything in those years without working with republican presidents and republican senators. so yes he expanded government, he was parts of efforts to expand government, but in

virtually all these cases, he found a way to go -- do it with republicans. host: you talked about a shifting among kennedy's presence -- many -- guest: the democrats who are here now making majorities in both the house and senate, they can't govern that way or they won't be re-elected. host: cape cod, massachusetts. andrew on our independent line. caller: i want to say first off this is the first time i ever tried to call c-span and i got through, so to all your viewers, keep trying. you can do it. in response to what mr. cohen said in regard to the kennedy name, although i live in cape

cod, i grew up in the rockies. the middle third of the country does not get the kennedy mystique. i -- that's juft what i called to say. there are a lot of people that just don't get the magic of that name. i will forever be grateful to something that he did that was not listed in your list of legislative achievements. the child sip act of 2000 which was -- citizenship act which was pro pushed through by winl delahunt, senator of massachusetts, was heavily supported by senator kennedy, and as a result of that, parents of foreign-born children now enjoy a much less complicated citizenship process. citizenship becomes final at the time they are adopted. we were at the middle of a big

labrynth of legislation that was curtailed beautifully by the package of this law which went in effect on midnight of that night, february 27, 2007, and for that reason, kennedy's agenda was not one who i supported largely, i will always be grateful to him for that. guest: interesting point about that, what i was saying about all the bills he authored. there were so many bills -- i don't think there will ever be someone who comes along who can amass that portfolio of legislation. i mean, six days before he was diagnosed with a tumor, he made his -- the house had just passed the genetic nondiscrimination act which prevents health companies from diagnosing you if you have a predisposition to the

bill. you say, oh, you're involved in that bill well he's the could sponsor of that bill as well. that's going to help a lot of people. not many people have genetic disorders like that, but there are thousands of people thousand who now are safe from losing their health care. he played a big role in that. not many people know about that. guest: i go back to the first initial call the caller was making. i grew up in massachusetts, and i'm fully aware -- i fully agree, frankly, with what the caller said that the kennedy mistier technique, which is very strong, remains, obviously, very strong in massachusetts. we have learned, we have known for a long time, that it doesn't extend all that far or strongly or as much as it used to be across the country, as it used to, as it did certainly in 1960, and the limits of that kennedy mystique were shown in senator

kennedy's unsuccessful campaign in 1980. so there are -- we don't want to go to -- we were talking mostly about kennedy as a wlor. -- legislator. certainly there are limits to that, no question. host: the caller mentioned immigration and that he backed some of the first pieces of immigration. it was the abolishment of quotas and then in 1968 it would be the bilingual education act that was mandating schools to provide bilingual education.@@@@@@@@r) guest: those lost helped to lead the way to major changes in the kinds of immigration patterns

into the united states. before those laws, most of the emigration before the 20's sentry was from europe. those laws encouraged immigration from latin america and from asia. and a little bit from africa. this was very controversial, and we have seen in recent years helped almost possible is to pass immigration reform. for kennedy to take on that issue in his very early years in the senate, obviously there were other members who were involved, but he showed with his interest it was something he worked on for decades. host: >> we are spending this half hour looking at center kennedy the center kennedy and his legislation. caller: we are talking about

kennedy. the man is dead now, and it is important for us to have a good perspective on the life he lived. can i just used a small passage in the bible? though he was a child [unintelligible] having suffered, he became the finisher of our fate. he redeemed his life by doing good. all he is doing is to make up for the imperfections in his life, and so he would for the black suffering, handicap suffering, and then to become a

king maker by helping obama to become president, and in appointing joe biden to be his vice president. 2006. the topic is civil rights. it is senator kennedy on the importance of equality and civil rights divisions. this going back to the justice department. >> i think you have the sense from these opening statements our strong belief, this committee, that we need a justice department, civil rights division, that's going to be dwrond beyond reproach in -- that's going to be beyond reproach in terms of administering the law. this has been the key and denie fining aspect in the last 50 years in our march toward progress in knocking down walls of discrimination, and this particular agency has been in the forefront of that. host: the larger topic of civil rights and adding to that his efforts on the justice department. guest: it was definitely

enormously important of his legislative career. you know, he talked about it all the time. and it came up very frequently. he vntwally -- he eventually left the judiciary committee, but it still became a big and important thing. i think again he was able to accomplish these things without alienating republicans. remember, civil rights in the 1960's was not a popular topic in the senate. he had to go head-to-head even as a young senator with some really big names in the senate, republican and democrat, who didn't want to deal with this. and he was able to do it without, you know, making enemies mple -- enemies. i read an anecdote that his brother was in the senate at the time, and his brother was making remarks that seemed just very, you know, inflamritri on the issue of human rights, and bobby kennedy ended up getting in an enormous shouting match whereas

ted kennedy was able to get the job done. the civil rights issue was a tough issue, and he dove in as a new senator and was able to get it done. .qqqqqqqqqqqqqqq >> we will leave this discussion to bring you more of our live coverage of his funeral ceremony. as we get a live picture from the grounds of the u.s. capitol, people are gathering to be the procession of the motorcade for senator kennedy. the motorcade moving from andrews air force base this afternoon for the capital for a short prayer service on the steps of the u.s. senate, where a congressional delegation has gathered for that ceremony. that to last about 15 to 20 minutes. after that, the progression down constitution avenue to -- to

pass the white house on its way to arlington national cemetery for the burial this afternoon. senator kennedy will be laid to rest near his brothers john and robert.

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