something that can be done about it. the money is there to make it happen and it shouldn't@@@@@@@@g >> if we have some clinics with m.r.i. or clinic, you can pay

out of your pocket. but this is a very, very small segment that exists in canada, and usually it's not that. usually you don't have to pay anything. money is not the first concern. and the lady that spoke that she said i was not sure if i wanted to go to the hospital because i had to pay so i had to make a choice, we don't have to make that choice. you can go to the hospital because you know you won't pay anything. this is something that you do and don't think about that. it's available and it's there and that's it. >> a final question as we continue the debate on this issue here in the u.s. what advisor observations would you give americans? >> i think you really need to look at your system and to look at those people that are uninsured, 46 million, and to try to find a way -- it's your

problem, but find a way to give health care services to those people. and i think it's a social debate but it's very important. call it the right, moral thing, call it whatever you want but i think that you have to find a way to improve your system to give health care to those people that are not receiving proper health care right now. that's my advice. >> former head of the canadian medical association joining us from montreal. thank you for your time this morning. >> thank you. >> tonight three doctors from arlington, virginia tell personal stories about treating patients and offer their views on health care legislation currently before congress. >> the charge is anywhere from $1,800 to $2,000. the payment is usually a

medicare reimbursement for a mastectomy, usually between $650 and $750. >> also an internist talks about issues surrounding patient care. >> patients have a tendency, when they have a symptom, to go to the internet examine try to figure out what's wrong with them. now, without medical background and grounding and experience that we have, they'ral getting it wrong and usually think that they have some horrible disease. so if there's anything i would say is that patients shouldn't be trying to make their diagnosis on the internet. >> join us tonight and watch all three doctors from virginia hospital center in arlington, virginia, share their personal stories about treating patients and their views on health care legislation. that begins at 8:00 p.m. eastern on c span. >> this week washington journal is live from virginia hospital center in arlington to examine the american health care system from a hospital's perspective

and that of its doctors. tomorrow morning, the chief financial officer and the chief information officer talk about hospital finances. that's live at 9:00 a.m. and wednesday the chief of american medicine, the i.c.u. director and the chief nursing officer, also live at 9:00 eastern here on c-span. we'll show you this morning's conversation with a hospital c.e.o. plus the chairman of the board who is also the chief of cardiac surgery. it's about an hour. >> we want to get a hospital's perspective on the hospital reform debate. this morning we're live in the emergency room, joined by the president and c.e.o., jim cole, and all the chief of cardiac surgery, dr. john garrett.

what are your responsibilities? >> well, in some ways it's -- it's analogous to being the general manager of a hotel but probably a more complex environment. we're responsible for ensure that go all of the support services are available for patients, for physicians and staff, but then also i work very closely with medical staff on our quality initiatives to improve quality and also in the financial management of the organization. >> what are the revenues of the hospital in a year? >> in the last year, 2008, it was about $288 million. >> how many employees? >> about 1,800. that is hospital employed staff. in addition, there are 800 members of the medical staff who are totally independent,

not employees but very integrally involved in the hospital, in the operation. >> do you have doctors on staff? >> we do. we employ about 30 to 35 physicians but as you can see, the overwhelming majority of physicians are independent practitioners who choose to bring their patients here. >> can any doctor in the united states, who is accredited in the united states, practice here? >> well, that would be the first step. but then each physician applies for privileges here. we have an office, several employees full time who vat credentials and then the physician goes through an interview process where he's interviewed by his peers here on the medical staff. that's further reviewed by a credential and committee of a medical staff and finally, reviewed by the board of directors who grants final approval. >> why are some doctors on staff and most not? but why are some on? >> well, i think we're seeing

that the independent practice of medicine for some physicians is becoming a less attractive due to economic pressures and lifestyle concerns and we're seeing primary care physicians that some specialists have an interest entering into an employment perspective. >> where do revenues come from? >> well, they come fundamentally from our insurers. roughly 46% of our revenue comes from medicare and medicaid. >> this is a relatively affluent area, probably a well insured area in arlington with the federal government as an employer in the area. what's the percentage of uninsured that come in your doors? >> probably in the neighborhood of 4%.

in addition there's about 5% patients who are medicaid. medicaid pays us only about 60%, 65% of what our actual costs of care are. that's not our charges. that's what it cost us to provide the care. >> could you explain, and dr. garrett said this last night, the chairman of the board of the virginia hospital center was the guest. and one of the comments that you made, dr. garrett, was that the virginia hospital center loses 20% on all medicare patients across the board. how do you dinner the cost of a procedure? how is that determined? >> well, perhaps i could address that. if we take a look what goes into determining cost, first of all, there's the staff, the nurses, the technicians, the support staff. they're here 24 hours a day,

seven days a week, 365 days a year so there's the expense of staffing. there's supply costs and then the equipment that's here and that's usually calculated by applying a depreciation expense for the equipment. we're very fortunate here to be extremely well equipped with the latest in diagnostic equipment, but all of that costs money. >> what are the economics of health care? is it a free market system? >> well, i would say it's a hybrid. it is a free market, but then a great deal is determined by the payers. and as i pointed out, the government today is one of our major payers. not only for this hospital but i think it's typical for most. >> also i want to reintroduce you to dr. john garrett and if

you didn't see "q & a" last night, you don't met him. we want to reintroduce him. dr. garrett, you talked last night about the importance of having the latest and greatest medical technology. why is that so important if it ups the cost? >> well, it's better. it's there for patient care. as i said last night, in the interview, i mean, every year things improve. yet, companies that make devices and drugs that are better than what's currently available. lots of things in the pipeline. and if you don't embrace those new technologies, then it doesn't take very long before you're practicing medicine that is five years outdated.

and that's not good for patients. >> we want to get our callers involved here. we have a chance to talk with a chairman of the board and the president of a hospital system. 202 is the area code for all numbers. we've divided them a little differently than we usually do. you can see there on the screen, if you are an insured person, we want to hear from you at 202-737-0001. if you're ininsured, 202-737-000 and we want to hear from medical professionals. gentlemen, this is a question for both of you. how closely are you following the health care debate currently on capital hill and in the white house and what concerns you the most? >> i'll talk to that first, if i may. i would say from a hospital perspective, one of the primary concerns is that the plans that

are proposed are looking to achieve savings or cuts in the next 10 years. from a hospital perspective, that number was derived by study called a dartmouth atlas of health care which showed significant variation in medicare costs per beneficiary. for example, in most of the metro areas in virginia, the cost for beneficiary is about $8,000 per year. yet, in south florida, the cost is about $16,000 per year. so you have -- so there's variation in costs per beneficiary. however, the proposed control in medicare expense is across the board percentage cuts.

so there are states like virginia, wisconsin, minnesota, iowa that have good quality and relatively low cost, and then there are parts of states like florida, texas, new york, massachusetts that have relatively high cost. so a simple across the board percentage reduction in medicare reimbursement applied the same. it penalizes relatively low cost states and in effect, rewards relatively high cost to states. and i don't think that's a very good way to help us to eliminate the excess. i would like to see an approach which provides some incentives for cost reduction, but doesn't penalize those who are already in effect doing a better job. >> does the public option worry you? >> is it does. as we discussed before, medicare is a public option.

medicaid is a public option. they, by design, pay hospitals less than the cost to provide the care. i see no reason to believe that another public option wouldn't follow that same approach. >> dr. garrett, same question. >> i wear two hats. as board chairman, just simply i worry about the hospital having less funds available to allow us to continue to lead in the forefront of our patient care. and then as a practicing doctor, i'm concerned about losing the independence of being able to be a doctor and have a relationship with a patient and offering what i think he or she needs in an

independent sort of way. i worry that that will be changed. and i think that that's really the key to what makes american medicine so wonderful is the ability to take care of your patients and send your patient to other physicians that you personally know will give them the care and not be limited as i think we're threatened to be. >> now, jim coal, as president and c.e.o., do you have an ongoing relationship or a letter writing relationship with jim merran, the local congressman here or with senators webb or warner? >> yes. i think we're open to dialogue. i've had the opportunity to visit recently with both senators ward and warner. and they're very willing to consider our views. >> let's take some calls. first call up for jim coal and

john garrett, new hampshire on the insured line. go ahead . caller: i listened to your interview with mr. lamb last night, and you were very informative. i learned a lot. two years ago my wife had a perforated ulcer in her stomach. she spent two months in i.c.u., four months after that, surgeries later. the bill, the medical bill was a little over a million dollars. my question is, if we didn't have insurance, in your honest opinion, doctor, because i find you an honest guy, in your honest opinion would she have received the same care if we didn't have insurance? mr. coal, chime in after him if you would, please. thank you. >> dr. garrett. >> yeah. i'm glad you asked that

question. i can tell you 100% that she would have received exactly the same care. i don't know how to say it any clearer. we do it all the time. million dollars is a lot of money, but i'll tell you as a practicing physician in a hospital, i don't check. i don't know if people have insurance or money or anything and all of the other physicians are just like that. we do what we do. we come to work, take care of sick patients. and so yes. in this hospital last year, we gave away $30 million in uncompensated care. it's part of our mission and so i hope your wife is doing ok but she would have gotten exactly the same care. >> i would agree. absolutely. as dr. garrett said, last year we provided over $30 million in

uncompensated care directly in the hospital. we also provide free diagnostic care to outpatients at the arlington free clinic and the arlington pediatric center. and i think that we -- the experience here is typical of america's nonprofit hospitals. that's why we're here. that's what we do. >> you're also a businessman with a business to run. where did that $30 million -- who did the $30 million go to? >> well, it went -- part of it was patients who simply cannot pay their bills. a part of it was subsidy of medicare and medicaid. around $5 million was toward medical education expenses that are not fully reimbursed. we're a teaching hospital. we provide training for

residents from georgetown primarily so there's a lot of expense that's not directly reimbursed. >> by law do you have to treat anyone who comes to the emergency room? >> we do. and as a nonprofit hospital, that's a part of our obligation, yes. >> is that federal or state law? >> i'm not sure to be honest. it's just what we do and we've never really checked the legalities of it. >> a physician has a choice. >> really? >> sure. a physician doesn't have to enter spew that relationship. but again, it's what physicians do and so it's not a problem. >> and that kind of brings into it a little bit the liability issue that you discussed a little bit last night on "q & a." but i wanted to ask you, how many lawsuits are pending

against the hospital at any given time? >> i would say perhaps one or two. >> is that a big concern for you, the liability issues? >> liability is a concern on two levels. one is the immediate effect of being sued and what goes with that. but perhaps even a larger concern is the cost of defensive medicine to try to be sure that the hospital and the individual physicians are in the best possible position to defend ourselves. we're fortunate in the state of virginia that we have a cap on malpractice awards. but i read a study recently and they're estimating $200 million per year. when we're in the midst of a discussion about national

health reform and obviously i think everyone wants to see everyone insured. but that costs money. and it's very disappointing to me to see that the proposals so far have not addressed the cost of defensive medicine. it's not so much the cost of the awards themselves or even the premiums. but when price warner house is estimating that $200 billion per year is spent in duplicateive testing, to make sure the best care is rendered, i think it's an issue that needs to be addressed. caller: good morning. first i want to say -- i want to answer the first caller's question about would he have gotten the same care. i am on medicare. i've had two heart attacks.

i have good doctors. perhaps the heart doctor may know dr. jabar, located in illinois. and i watched "q & a" last night. i want to make sure i hear him saying that the private insurance companies need competition. and thank you and have a good day. >> private insurance companies do need competition. it's my understanding that there's restrictions about competition across state lines and other restrictions. but i think xebt is good and i think competition would ultimately bring the price down. >> i would agree. i think, you know, one topic in reform is insurance reform. and i think one of the simple,

fairly straight forward things that could be attacked is to come up with appropriate regulation so that insurance companies can compete across state lines. i think that would -- it's been argued that there's 17,000 insurance companies or something like that but there are state regulations that are now down pretty dramatically and i think that regulation which opens up competition for insurance companies across state lines would be a big help. >> jim coal, would you rather deal with medicare or blue cross/blue shield? >> with blue cross/blue shield, every couple of years we sit down and negotiate a contractual agreement. every year medicare tells me how much they're going to pay me for an admission.

so it's a managementing relationship with the private insurers. medicare dictates what they will pay. >> dr. garrett said last night that insurance companies, in a sense, and he didn't use this term, i will, are overcharged because medicare undercharges. as a former patient in this hospital and somebody who has good insurance, i presume that i was overcharged. >> well, i would answer that this way. medicare pays less in costs. medicaid pays less in cost. that subsidy, if you will, becomes a cost to the hospital that is passed on to private insurers. to be more direct in my answer, absolutely. private insurance companies and their subscribers subsidize the underpayments that government insurers pay attention. >> and they're fully aware of that. >> they're fully aware of that.

that's right. >> one person could be in a bed over here and let's say it's $100 a day is your cost. but the medicare person pays maybe $75 and the person getting the exact same way over here may be paying $125? >> that's correct. >> jao*en, go ahead. caller: i wanted you guys to remark on the employees premiums at the hospital. i work at a hospital and we've seen our premiums go up in the last two years. my deductible now is $2,000 before i even kick out anything, and i'm working at the hospital. they have a two-tier program where the nurses are able to get a $1,000 deductible, 90/10 and i feel like i work every day with patients and i myself

cannot get coverage that is affordable and decent. you and i know what an 80/20 plan is. if you really had cancer and you had large medical bills, 20% would be unaffordable. our hospital is actually having employees who have cancer that have had to have spaghetti dinners and car washes to help them pay for their medical care and i just wanted you to comment. >> let's get an answer. >> i think obviously the insurance offerings from hospitals, as other individuals, they vary. we've been very fortunate at this hospital that we're able to provide 100% coverage for hospitalization for any employee who uses services here. we do have deductible. i think it's just a few hundred dollars and that varies among hospitals as it varies among all employers.

>> as a businessman, are you -- do you offer your employees competing insurance plans? do you ever a contract with one self insured? how does that work? >> we give them a number of choices and we have an open season every february and we'll probably be offering them yet another option next we're. >> at the same time as a corporation, you're paying premiums. >> absolutely. it's an expense. >> next call comes from upland, california on the uninsured line. go ahead. caller: how are you doing? i appreciate you taking my call. just to give you an idea of my health care, i've been uninsured for probably about 12 years and i haven't seen a doctor in that time and, you know, i really haven't been sick but i did have two questions. basically, how much of the

funding that your hospital gets goes to like nutrition or diet like teaching information and i don't know if you guys have heard of this word. thank you. >> dr. garrett, do you want to start? >> i've never heard of that last thing. we have a dietary nutrition service. i don't know how the funding is split up for that, but i know all of our cardiac patients receive a nutritional consult. i'm not sure about everybody else. we don't specifically have funding for that. >> well, let's make it a little broader and talk about preventive care. how important is that? how much emphasis is put on that? >> i think first of all, we're

a hospital. if you wind up here, maybe something in the past hadn't worked. i think preventive medicine is extremely important. i don't think it's a valid argument that it's going to save the day because there's still -- probably are going to get old. they're going to get cancer. they're going to get heart disease, they're going to get hospitals. but i think that preventive key is key for people, younger groups to establish good habits and i think, you know, three or four decades from now, we'll reap rewards from that. >> next call, hebron, indiana on the insured line. lori, go ahead. caller: yes. i'm calling to ask if you read the "new york post" article that was printed last week. in there -- i'm sorry. dr. immanuel, the health policy

adviser back in 2008 and the journal of medical school association. he believes that cummunitarianisn. an obvious example is not guaranteeing health services to people with dementia and also dr. blumenthal has long add row indicated spending controls, though he can see if they're going to be associated with longer waits and reduce the vulnerability but he called it debatal whether timely care the americans get are worst the cost. he says basic amenities luxuries such as hospital rooms in the u.s. offer more privacy. physician offers are typically more located and having parking

nearby. this goes against what the one doctor was saying about wanting to have the advanced care, the latest technologies and stuff. it sounds like what they want to do is, you know, hold everything steady to keep costs down and not treat patients as patients but as, you know, pick and choose. you know, everybody gets the same low quality health care roar than people getting the high quality health care. >> what's your been about all of that? >> my opinion is i do believe we need health care reform. could i think it could be done much easier? really there's like 15 actual million people who need it. and to totally overhaul the whole thing for just $15 million i think is upwise and it's going to cost a fortune. i do believe that this could be done through private sectors, through private health insurers.

at the pea taerts, we go to the meetings with the representative. none of this are taking we're on a private health care and you'll be on a private health care. from what i've been reading, it sounds like once you're off the public health care, then you almost have to take it for governments, unless they're going to change the thing again. >> anything you want to respond to, dr. garrett? >> the a.m.a. doesn't spaoem for so many of american physicians, including myself. and i think i understood a lot about what the caller was talking about but i do think there has to be some practicality in what we spend. and i think it could start with just, you know, physicians and families and all of us being aware of what things cost and at least having a discussion about it with the hospital or

with the family before doing it. you know, traditionally doctors have not had that role. we just do what's best. but i think it does behave us all to understood what the costs are and make practical decisions. >> what's your relationship as chairman of the board and president? professional? >> he's the boss. dr. garrett is chairman of the boss, if i may say so. i think he's done an exceptional job in casting a vision and even a passion throughout the organization for clinical excellence and i hope that you experienced when you were here, peter, a real

passion for the entire patient experience. as you know, and i think most folks who are watching know, when people come to a hospital, it's usually because they're concerned that something is very wrong. and so they're very a*ing shution and in many cases scared. so we really work the not only providing good clinical care but being sensitive to the anxiety and helping to relieve that. that spirit, that direction comes directly from the word and from dr. garrett as chairman. >> i'm here a lot. over the past decade i've gotten in his hair a lot. >> are you employed by the hospital? are you a private practice? >> i'm private practice. >> and do you when you say you have an office here, do you rent the office from the

hospital? >> i rent everything. everything that i use here that's not mine i pay to for. >> is that a revenue stream for the hospital? >> it is to a certain degree. on campus we have several medical offices at our -- leads to private physicians. >> do any of the doctors own their offices? >> in one of the buildings the offices are owned. it was built back in the 1970's, i think. >> do you look at patients as customers? >> partially in the sense that we want them to come back should they have future needs. and this gets to not only providing the technically correct care and the clinical care but prying to satisfy other needs and treat them as human beings the way that any one of us would like to be

treated. >> do you find that a lot of poem daoent understand that a hospital is a business and needs to understand business or they have a disagreement with that pill soef? -- philosophy? >> i don't think a lot of people have fought about that. i think people tend to not think about hospitals until they need one and then when they need one, it's very urgent. and the financial aspect of that is taken care of after the fact. >> next call for jim coal and john garrett of the virginia hospital center comes from union city, new jersey. please go ahead. caller: yes. i think some words are important to understand. peter, when he talk about costs, you have to really -- i think what you're really trying to say is what is your price or what are your choices? not what is your costs. and i would say to that, our

costs for business has increased tremendously o*ef the years due to regulation, medicare reirments for a cidation, continuing education i that is required for our licensed professionals to maintain their license. so our costs are outpacing the ratio that it used to be to our reimbursement. the other thing is not enough doctors. you know, i think that's the code message for the medical schools and the teaching hospitals wanting to get more money from the government and also lastly, i would say that as a medical professional and provider, i have to agree that medicare part c, the medicare

advantage program should be eliminated. i think it's a wind fall for the insurance companies and it's not necessary. i think medicare does a good job of regulating providers. and that's it. >> what's your profession? caller: i have a small private practice. >> you're a doctor? >> i'm not a doctor. >> ok. what do you do? caller: i provide artificial limbs and braces in orthopedic shoes. >> so medical supply company. >> well, prosthetic and orthotic provider. >> thank you. >> thanks. >> kha*u. >> what did you hear that you would like to -- >> the part of it being maybe a facade because there mate not -- want to be doctors, i would

disagree with that. i know in the field of surgery, you know, there's expected to be a shortage of surgeons and in the next 10 years. in my own field, cardiac surgery, we're currently not filling the training slots that at one time had waiting lists to get into. and part of the reason for that is pip kally you're in your mid 30's when you fin i be your training to be a cardiac surgeon and that's a long time. and the type of person that wants to do that typically also wants to be independent and not on overly leg rated -- regulations. that person might pick something else to do. >> you finished your cardiac training in your mid 30's? >> i was 35 when i got my first

job. >> can you tell us the full cost of your education, your medical training? >> well, what i can remember is i went to emry in atlanta and my tuition was about $5,000 a year then. then i went to the university of alabama in birmingham for medical school and it seemed like it was about 10 per year. >> how many years was that? >> four years. then i started training in surgery and in those days we made about $14,000 a year and slept in the hospital every other night. but what they used to say, it's better than nothing. the guys would have said you didn't have to pay us anything. but when i finished, it took me -- it was like a mortgage.

it took me a decade to pay that off and i was lucky to pay it off. no regrets. >> we learned your wife is a pediatrician. you're a cardiac surgeon. what's the difference in your malpractice insurance rates? >> it's huge. it's -- my rates are greater than my wife's. i would say probably 50 times more than she pays. >> is there a doctor anymore that has not been sued? >> i think there are doctors. personally in my entire career, i was sued one time and it was dropped. ok? but that still doesn't change

the fear that's engrained in all of us. we just do things a little more over the top to decrease the possibility that someone might say, well, why didn't you do that? you could have. >> our next call comes from tracy in michigan. i believe it's luniper. good morning. >> good morning. i don't have any questions, just a comment. just this last june, i was 46 at the time and i had a heart attack and ended up in the hospital, complications of the femorel artery split open and i lost the fluid in my abdomenen. i'm still weak. i don't have a lot of speak but i'm doing the best i can. i can't work. i now owe the hospital $218,000.

i have no insurance. i haven't had insurance in the last five years. >> are you employed? >> not anymore. i lost my job when i had my heart attack. i had no medical leave. i was working for a temp services. you know, what are you going to do? so now i'm uninsurable because i have a presk*ising condition. i'm extremely bummed out that the single pair was taken off the table and i will be really angry if the public option is not included. if you leave health care in the hands of the private sector and for private entities, nothing is going to change and you will be less out of the loop, and so will my family. i'm tired of corporate america running everything. that's all i have to say. you have a nice day. >> mr. coal? >> it's certainly a difficult

situation that she's facing, and i think everyone wants to see a system where people don't lose insurance because of private history, of complications. we just have to find a responsible way to pay for it. >> that woman, $218,000, would she be allowed to come back to this hospital if she were -- >> of course she would. and at $218,000, i imagine the hospital where she is will work with her to see what, if anything, she can pay toward that. and eventually that cost would be written off or she or an insurance company will not pay it but the hospital will absorb it. and that cost will be passed on to other insurers. >> next call, louisville, kentucky. cynthia, insured line.

please go ahead. cynthia? last chance. caller: hello. >> is this cynthia in louisville? caller: yes. >> please go ahead. caller: please don't cut me off. we only get on once or twice a year. i wanted to tell the gentleman who appreciates the doctor being so candid about treating that patient regardless whether he could pay or not. if he had over a million dollar bill, i expect he would have had to take bankruptcy to be able to afford the care for his wife. and we know that that is the leading cause of bankruptcies in this country is medical liability. the other thing i wanted to say, i've got two or three questions.

for those on the advantage plan, humana is the local insurance company here in louisville. i read in the paper last quarter, they had a 44% profit and i think their major focus has been the advantage plans. my rep, john lamos, is willing to take the choices we have if this passes. i've heard other legislators say that was a myth. the other thing, isn't there a government program that is reimbursing somewhat your inuninsured care? and are physicians monitoring themselves as well as they should? we've had many doctors here in kentucky charged with selling illegal drugs, false payments to medicare, also several sexual assaults and i would

like to comment on that, please. >> thank you. we have three points to talk about. first of all, medicare part c. does that come into your professional life at all, jim coal? >> it really has not been a major factor here. i can't speak to that. >> what about a government program to reimburse the hospital for uninsured people? >> i'm not aware of such a program. >> and finally, medical monitoring, m.d. monitoring. how are doctors monitored? >> well, you know, in the hospital we have a hospital called a critical risk management committee and any sort of intoward event that happens related to a physician within the hospital goes to that committee. and it's discussed by question of the physicians' peers and appropriate action is taken.

so on the broader point, doctors are people. just like most people are good, not everybody is. and, you know, i'm the first one to get in line against the dishonest physicians, the physicians that are overscribing fraud but most doctors, just like most people, are good. >> we learned last week from tom skully, the former head for medicare and medicaid, that only about 30%, 40% doctors are represented by the a.m.a. and you said you're not. why are you not a member of the a.m.a. >> i don't remember her specific comment but that sort of person within the leadership, again, not to speak for me.

i am independent. i'm not -- i want to maintain the ability to practice independent medicine and not be overly regulated. and i think the a.m.a. is -- actually years ago sort of crossed the line. >> jim coal, a month or two back, president obama had some hospital executives in and they broadcast that they were going to save $155 billion. what was your reaction to that? >> well, as i said, i think it's achievable, frankly. but it's got to be done in a responsible way where those hospitals that had done a good job of controlling costs and providing high caught resident penalized and that we do deal with a geographic variation and cost. the dartmouth atlas i think has

dramatically documented that there are significant variation but we need to be focused on reducing the costs in the high cost areas and promoting incentives and trying to learn from the areas that have low costs and good quality. >> next call for the two guests. lois, medical professor. please go ahead. caller: good morning. i have a 73-year-old, still practicing physician in the central valley of california and i have two points. one is, i know this is a personal question but do you folks -- you folks aren't personal now. you're on national tv. i would like the doctor there to tell me how much money he makes out of just doing his medical profession and how much his wife makes. she's a pediatrician. he's a cardiac surgeon. number two, this hospital that

you're talking about right new -- now is an elite town. i'm in a small town and my hospital recently build a $7 million building, a whole new building and yet they're all crying about heir losing money. the government isn't paying money. where is the money coming from? last night i watched this new electronic skappel. how do you buy that if you're wasting money? there's a lot of that in hospital competition and expenditures that would go to help poor people if you just couldn't do that. i'm nervous and i'm not probably saying this directly. >> doctor, i appreciate the call. could i ask you a question? how much money do you make? >> i was a practicing gynecologist. most of my business were in the

agricultural industry. the most i ever made, and i'm a board certified gynecologist. i used to make about $250,000 a year. that was max. if i would have practiced in new york city or san francisco, i could have tripled that. i know that. but i didn't. that's the answer to your question, sir. >> thank you very much for being so candid. dr. garrett? >> i'll pass on the income question. but i will comment about the silence. we don't lose money. we made 1.7% margin last year which gave us enough money to -- we were able to save some and we were able to buy new equipment. the typical equipment budget could be as high as $30 million. so we didn't lose money.

we're a business. we can't lose money. as i've said, in order for -- if we lose money, we'll either go out of business so we have to do things to prevent that. we can offer less or lay off individuals. regarding caring for people poor, we care for poor people. last year over $30 million in uncompensated care. if you come to this hospital and you don't have insurance, we'll admit you. i'll hop right on you. i'll see you three times a day. i'll see you in the middle of the nie. it doesn't matter. so -- >> is virginia hospital center an elite hospital? >> well, i think we're elite in terms of our medical staff and our nursing staff and the way that we've been able to equip the hospital over the years. but to put that in perspective,

as dr. garrett said, we had about a 1.7% bottom line on roughly $288 million. >> you have to add the deappreciation expense. and from that, we have to reinvest and -- equipment, et cetera, et cetera. i think you would find most any organization not bragging about a 1.7% bottom line. we essentially break even. and many hospitals in the country are below break even in their financial operations. as you pointed out, we're fortunate. we're in the washington metro area, relatively fluent area. many people have good reimbursement. yet, we're delivering, as dr.

garrett said, over 30 million in uncompensated care. >> where does the 30 million fit into the business plan? is that part of the overhead that you include in the -- >> it is an expense. it's an expense just like supplies are an expense, care that's not compensated is an experience as well. >> we have a few minutes left with our two guests, jim coal and john garrett of the virginia hospital center. wichita, kansas on the uninsured line. go ahead. caller: good morning, all. to follow this scenario as it plays out, i would like to ask a question of the folks there. i will preface it with if i called to get the windshield repaired of my car, they asked me if i'm insured or not because they have different

prices for people who are insured and people who are not. and what would be the circumstances if there was a more -- moratorium for hospitals and doctors in a year. the costs of medicine throughout the country and the cost of supplies for the hospitals throughout the country. >> thank you. jim cole? >> let me make sure i understand the question. the question is what would happen if there was a moratorium on all insurance payments to hospitals around the country? the literal answer is that most hospitals would close their doors at the end of that year. it's very unusual for any

hospital to have at maximum roughly a year's operating expenses in reserves. >> dr. garrett, you said last night that the people who asked the price or people who can afford it but don't have insurance. is there a price negotiator here at the hospital? if somebody came i need to have my appendix out. how much are you going to charge me? i'll pay cash. >> my point was that it's not -- i said the people who ask about how much it is are people not that can afford it but they're people who have money. ok? not that they can afford it, but they have money because who can afford to write a check for $50,000 for a hospitalization? but if you have some means, then you're going to be responsible for that bill and

so that is a scary thought. and so that's why people ask the questions. we negotiate with insurance companies for payments but for patients who don't have insurance, in our private office, those are the patients that we will lower our fees. i mean, face it. insurance companies don't pay me what i charge. and so why should someone who doesn't have insurance have to pay what i charge? we at least give those patients a break and let them be charged then what an insurance company would pay you. >> jim coal? >> perhaps the best way to answer is to give a personal example. several years ago my father was hospitalized at duke university hospital.

fine institution for quite a while. he was on medicare, medicare paid most of that. but his only income was social security at that time. there was a reserve and we made an agreement with the hospital to pay a small amount per month over time because he did have some income. we could assist with that. so the principle is, i think, in common practice where folks can't pay, they don't pay. but where people have the ability to pay toward those overages that most hospitals will make an arrangement for payments over time. >> how did you become a hospital administrator? >> i think it probably all started when my father was hospitalized when i was a teenager. i never really had any interest in medicine but i saw what the

doctors and the nurses were able to do, not only for him physically but for his anxiety and his well-being and i thought it would be neat if i could find a way to be a part of that. . and through a rather circuitous route, i finally came back to that many years later. host: time for two more calls. and medical professionals from north carolina. caller: good morning to both gentlemen. i heard the doctor last night on television and loved what he said so much. so i listened again this morning. i am glad to see live again. i am a registered nurse and a retired. retired. want to say thank you for all the wond >> i am a retired registered nurse and i want to thank you for all the nice and you said about registered nurses last night. i was a registered nurse before and after medicaid,cdrg,

coating andppos so i saw what happened with health care as each one of these programs can into effect. when drgs did trials across the united states, i had a friend who was the administrator at aç. zohe said to me that if drgs ce into effect, you will never ever do primary nursing care the way we're doing it now. nothing could be truer. i eventually left possible care, went back to school, and got a degree in public health education and did community needs assessments and wrote programs. i am now retired. i have medicare and a top of the law and insurance.

i recently moved to the raleigh area. host: could you get to your question? caller: i want to tell the a minister that before i moved here -- the administrator that before moved here, the doctors stopped negotiating with medicare. i have to pay up front for all of my care because the doctors here do not accept medicare and more. this is a growing problem. this needs to be addressed. i hope that men like you will step forward and address that problem. host: 90. do you have to accept medicare patients? guest: don't, we choose to. the bottom line is most of the patients that we operate on for heart surgery or older and on

medicare. we keep saying it in different ways but it is not all about the money. we like doing what we know how to do and help people and heart surgery makes people better. it is really true. host: do you have to accept medicare patients? hospital guest: past two but the caller is exactly right. it is a growing problemh that internists and primary care physicians are more and more reluctant to accept medicare. i think we have to ask ourselves why. host: do you have the problem here? guest: yes, there are a number of positions that do that accept medicare in their offices. the reason is that it simply it worth their while.

as we look at reform, we cannot lose sight -- the initiative for this whole debate over reform was extending coverage to everyone. that means even more people seeking more care. that means we have to make sure that we have an adequate supply of physicians but also nurses. the manpower issue will be critical going forward. host: last call, new castle, delaware, melissa. caller: thank you for taking my call. my mother is a gastroenterology nurse. my husband suffers from epilepsy. for the last five years, we have not had insurance.

recently, my husband and my five year-old daughter got approved for medicaid. i currently am uninsured. hp'd my husband to have medicaid. from living and loving my mother for the last 20 years who has been a dedicated professional, where is the moral issue in this? recently, my husband, in terms of getting medicaid, it was an uphill battle. we were denied three times before we actually got it. it is just my husband and my daughter who have the insurance. where is the morality in this issue? i have heard the administrator and a doctor talk about this being for-profit and losing money. if my husband was to lose his life, even in maryland, they had

a case of a little boy who died for me to bake. -- died from a toothache. someone address this morality issue. guest: the whole discussion about health care reform is about finding a way to provide coverage for everyone. the caller referred to attempting to qualify for medicaid, for example. in this hostile, which employs several people whose sole job is to work with patients who are admitted here and attempt to work through the bureaucracy of medicaid to get them qualified for that. anyone who comes to this hospital and any hospital in the united states will receive care regardless of their ability to pay. guest: it is the same for

physicians. we have no say of how to get insurance or how not to get insurance. i believe everyone needs to be insured. if you wind up here and you need something, physicians will take care of you. q is chairman of the board of the virginia hospital center and jim cold is the president and ceo. thank you for your hospitality and for spending an hour taking calls from our viewers. >> tonight, three doctors from virginia hospital center of arlington, va., tell personal stories about treating patients and offer their cures -- their views on health care legislation before congress. í0z>> the charges anywhere from $1,800-$2,000. the payment is usually a medicare reimbursement for a mastectomy between six and a $50.700 $50. >> also, an internist talks

about the issues surrounding patient care. >> patients have a tendency, when they have a symptom, to go to the internet and try to figure out what is wrong with them. without the medical background and grounding and the experience we have, they always get it wrong and usually think they have some horrible disease. if there is anything i would say, patients should not try to make their diagnoses on the internet. >> to - two night and watch all three doctors from virginia hospital center in arlington, va. shareñrñi their personal sts about treating patients and their views on health care legislation. that begins at 8:00 p.m., eastern, here on c-span. >> all this week, "washington journal" live from virginia hospital center in arlington, virginia. we'll show you the conversation this morning with the hospital ceo, the chairman of the board

and the head of cardiology after the doctors' panel. tomorrow, the chief financial officer and chief information officer talk about hospital finances, live at 9:00 a.m. and wednesday, the chief of emergency medicine, the i see you director, and the chief nursing officer our live at 9:00 eastern, right here on c-span. >> go inside the supreme court to see the public places and those rarely seen spaces, hear directly from the justices as they provide their insight about the court and the building. the supreme court, home to america's highest court, the first sunday in october, here on c-span. >> president barack obama is back in washington today and white house press secretary robert gibbs has a briefing scheduled for 1:30 eastern time. we'll take you there for live coverage when it starts -- starts of about 25 miles. meanwhile, a conversation about

the continuing recovery efforts in louisiana after hurricane katrina. host: we're joined this morning from baton rouge, thank you for being with us. this is four years after hurricane katrina, the date is march on saturday, what can you tell us about what remains to be done in recovery efforts in louisiana? guest: like you for allowing me to be on to talk about our ongoing recovery. we put out about $8 billion in grants to home owners throughout the coast of louisiana. what we are finding is that some of those homeowners have gaps. we are working to fill those gaps. we think there are 20,000 homeowners between what we could

give them and what their insurance could getçz9 them, ty still have rebuilding gaps. we have a lot of affordable housing units that were destroyed, about 82,000 rental units. many of those were affordable. we are working very hard to bring that back. we are making progress. if you go to new orleans and look at how we are rebuilding public housing, we are doing it in a way that is mixed in come principles that sean donovan used in new york. if you look at places like the lower ninth award that many people read about, we have gotten about $230 million worth of grants to about 2500 homeowners. some of those folks have chosen not to come back. some that are still there are having difficulty rebuilding. we are in the process of getting money from non-profits that will help those people rebuild.

80% of the new orleans area is back. many folks chose not to come back. many are living in the state of louisiana. some are living outside the state. we have a lot of progress in many national journals have recognized new orleans as one of the best places to sit out the recession we spent $7 million a day on a recovery in louisiana. we are create a lot of energy and a lot of economic -- opportunity. host: new orleans is reported to be 3/4 fall. do you envision it returning to population levels before the hurricane? guest: i really don't. wepzñ have had many conversatios about this. i've worked in recovery in many different ways. i was part of the evacuation to help folks evacuate after katrina. i worked with the center. i have seen it at a lot of different levels.

what we have talked about is a smaller footprint. we have worked very hard to try and bring back as many folks who wanted to come back. if you look at what is happening and the flood plain that letter coming out that the federal emergency management agency and army corps of engineers is working together on, you will see a smaller footprint and more decent -- more density. i think that many folks and we did our grant program, it gave people the opportunity to decide whether they wanted to come back or not. many choke -- many people of chosen to live elsewhere. we accept that but we are trying to create a stronger, safer, smarter louisiana, as we rebuild using 21st century planning principles, building codes.

yes, we will have a much better new orleans at the end of the day but obviously we have done everything we possibly can to bring back as many folks as are interested. host: we will take calls. we have paul bring water up until 10:00 this morning. you talked about the rebuilding of homes and the population coming back. what about defense for the future hurricanes, the levee system. what is coming along on that front? guest: the corps of engineers is making some progress. their goal is to have category three hurricane protection for

norland by 2011. during hurricane gustav, the governor sent me down to new orleans and one of the concerns of the governor was whether or not the levies would hold or not and they did. people have gained confidence. the army court spent about $3 billion and have another $8 billion to spend. people are hoping that we can get back to a level of confidence. we saw that during gustav and the levees held. but chemical against the level of a katrina? -- but can they hold against the level of a katrina. you need to evacuate in a hurricane three hurricane. many of us never believed the levies would breach in new orleans after katrina. we have 57 levee breaches. hopefully the army corps of

engineers is strengthening the levees and bringing them back up to a level where people can feel confident. there is progress but there is much work to do. host: new jersey, on our democrats line. caller: i wanted to ask the gentleman -- you have a lot of people donating money like rappers and famous people donating money besides you donating money. where did all the money go? guest: that money went to nonprofits like the unity of new orleans. we had a real homeless problem in new orleans. many nonprofits worked very hard to provide housing for people, emergency housing. brad pitt as is make it right foundation. they are building homes. that money was used to get people back into their homes.

over 134,000 homes were destroyed. people lost everything. it lost furniture and we had to really re-house these people. we had to buy new furniture in some cases. some of these donations went to that and help people get on their feet. many people were away from their jobs for four months. some people use the emergency assistance to survive. those dollars were well spent and were well accounted for. there has been very little fraud in the recovery. i think we have made great strides to account for those dollars. host: here is would've, wisconsin, independent col. caller: i went to new orleans in 2005 and fell in love with the place instantly. i had my heart set on moving their and katrina happened the

following autumn. i have been looking into it ever since and keeping up of recovery efforts. i don't work in a job that allows vacation time. the amount of money and time it would take to help rebuild, i might as well just move. do you have any tips for anybody looking to move to orleans -- to new orleans or people who had previous interest in the city and want to help the city get back to where it was if it can? guest: there are a number of organizations, you can go to the ngoinc web site. there was a number of younger

entrepreneurs the king into new orleans. there are great opportunities. we're spending $7 million per day on the recovery. much of the money is going to new orleans. there are great economic opportunities. we're getting the veterans administration which is getting ready to build a hospital. we are starting work on a new charity system, we would be covered by tulane university and lsu. there is a viable medical center planned for it there are really great opportunities. groups like gnoinc can help you get in touch. the st. bernard project is another group and you can go to their website. they are taking volunteers to help rebuild. gnoinc will allow you to see the opportunities and how you can live in new orleans and be a

resident. host: next up is lake charles, louisiana, republican column. make sure it did turn your television down and go ahead with your question. caller: our you doing? -- how are you doing. everybody talks about katrina but my mom passed about two years ago and she got money and my understanding was that once the victim dies that we did not owe that money back. we ended up suing the louisiana insurance co.. we paid lawyers fees which were about $100,000.

if we pay back the fees, we will not have the amount of money we would need to rebuild the home to make it marketable or livable. i was wondering what can be done about that. guest: there are several things we're working toward which is trying to make sure that people have the money they need to rebuild when you take the tree that and agree to, is the largest natural disaster in united states history. rita has not been forgotten about. i was the operations manager in southwest louisiana during that hurricane. that is my home area in louisiana. we have dollars that we can't get you. what i need you to do is to call our phone number and ask for irma she can get you in touch with our lawyers.

there are very complicated secession title issues. there were many elderly people who did not -- who could not survive the evacuation during or after the storm. it is a sad situation. we have a team of attorneys that work through those sorts of issues and we will be happy to sit down with you and figure out what we can do. host: we next go to the bronx, on our independent line. caller: i have a comment, more or less -- i don't think the natural disaster is in the back of everybody's mind. what pe rebuilding after the disaster. the lack of interest in trying to do the right thing for the people so if the people don't come back, what that is one of the basic reasons -- people have

that fear. host: any thoughts on his comments? guest: it is interesting. we have talked about this quite a bit. it has been discussed in the united states congress and the senate. i have testified about 12 times before congressional committees about how you show -- there is no question that when you spend $13 billion to louisiana and 18 billion -- $8 billion of that has been spent on housing. thousands of volunteers came from across the country to help folks. during the response itself, there were thousands of volunteers from the state of louisiana and a run the country that went to the city. during gustav, we evacuated

18,000 of the most impoverished people in the city. we provided trains and buses and planes to get people out and brought those people back. katrina changed so many things. there were -- there was a lot of negativity. many of us have worked very hard to shift the mood and focus on the positives and focus on the partnership we now have with the federal government and with the local governments to show that we do care and the government can work to be a positive force in the recovery. it wasn't always host: you are a first responder as a member of the national guard? guest: i was a city manager in lake charles and was asked to work in the emergency center for it when the levees breach, i was asked to manage an area near causeway boulevard.

i was into reserves and finished my second deployment overseas in the middle east. i have been an immerses the manager and louisiana before. most folks recognize that this would be a large event ended as much help as they could get. we've spent the first 36 hours in evacuating thousands of people. we were working with many first responders from around the country. there were brave coast guard and national guard helicopter pilots that rescue people off rooftops. this has been a difficult time and many of us have had an opportunity to come back under the new administration and really work to focus to change things and to make our response much better. we have a gentleman who is the deputy fire chief from l.a. county who works in the state of louisiana. he is making great strides in improving emergency response in

the state of louisiana and making sure we are ready. during gustav and ike, we had a much better system that was more organized. we are working to make a seamless recovery we have a good state, federal, and local cooperation. i think we are making good progress and speeding up the movement of the recovery dollars. host: let's hear a of view from louisiana. caller: mr. rainwater, if there is another storm i hope we don't have the same response as before. the main headquarters for the red cross is north of i-12. they never came into orleans parish. i was here for eight days after the storm. fema didn't show up till

friday. we had a tractor trailers that came down with i started if it was not for the united states marine dropping mre's, water, landing on a high-school practice field to bring supplies -- host: we are running out of time. what is your biggest concern about future possible situations in new orleans? caller: we are getting ready to elect brad pitt mayor because he has done more than anybody. because the people are not coming back, the businesses will not spend any money to rebuild. i am so frustrated because i love this city. i was born and raised here. it is the greatest place in the world. that is what we live here.

host: bank you for calling in. -- thank you for calling in. guest: there are about 350,000 people in new orleans and it was about 100,000 more before the hurricane. it is one of the best places you can ride out the recession. there are great opportunities. i understand that the problem with recovery is that you always have two different stories. there are people that have a lot of optimism. there are many young people who are pouring into new orleans to work as part of the recovery. host: to date, how much federal money has gone to the recovery and how much is state? guest: about $121 billion total from the start of the storm and that involves emergency repairs, evacuation's and other things.

if you look at the federal government, congress allocated $13.4 billion to the state, $8 billion of that has been spent on getting homeowners' back in their homes. we're spending another $1.2 billion as part of rebuilding affordable housing, indexed income communities. another $700 million is in doubt to the local governments to help them rebuild their infrastructure. the hard infrastructure damaged by the storm, fema has obligated about $7.2 billion. we think we will get another $2 billion. if you think about getting another $2 billion, you are talking about great opportunities for contractors to be part of the building and repair and recovery of new orleans. host: miami, good morning to unmarried. caller: first of all, thank you

for your great coverage of the health-care issue. the reason i am calling is i was considering an offer in new orleans. i am a professional and have a young child. i have heard about the problems in new orleans like the crime and the school system. i am concerned about that. i would like to hear mr. rainwater's sales pitch as to why young professionals should move theire. guest: when you talk about schools, there's a renaissance occurring in the schools in new orleans. there is a gentleman who reworked schools in chicago and philadelphia who was known across the nation as a guy who gets things done. it is amazing to go into schools, the new orleans

recovery school district, you can look at their website, they are making a huge difference in the lives of children. i have had the opportunity to go to the schools that have been rebuilt. we did a ribbon counting on langston hughes high school. when you see the children in the new facility, it is amazing. there are a number of charter schools that are being opened at set -- and have some of the brightest people from around the country teaching in those schools. when you made the teachers and principals, you cannot help but feel optimistic about what is happening. there's a crime problem in orleans. it is being addressed at state and local partnership levels. the state superintendent, a couple of nights ago, was talking about working with fbi and the dea and the secret service. they also work with the local

police department. we're working for the crime issue much of that is localized in neighborhoods. the fact is, many people went to new orleans and are very safe. despite what you might hear, there is a lot of opportunity to air and a lot of optimism there. your question about the schools -- i would ask you could go to the recovery school district website, check it out and make some phone calls. there are gentlemen and ladies who would like to talk to you about relocating there. you can make a phone call into other organizations that market the area. they can tell you about the positives. host: we have linked to those websites on our website, c- span.org. one more caller. caller: the rate of the coast

declined doing to the dredging of the dike and messing with the ecosystem in new orleans, it indicates the actual gulf coast will be up to the edge of the city within the next 90 years. what are they doing to adjust that? the land that exist now prevents a lot of flood waters to get up to the city. if that is gone, at the rate of two football fields per hour, what is the future in terms of a hurricane three hurricane hitting the city? what are you planning to do to rectify that? guest: that is a good question there are three levels of protection.

our protection restoration program is run by a guy who worked in the senate. he is very aggressive about making sure we have the first line of defense and we are spending money on coastal protection and restoration. the second piece of that is the levee system. the army corps of engineers is working on that. the third piece of that which is extremely important is what we can do internally by getting good, strong tremors programs, elevating homes and hardening homes. we are funding the largest allocation program in the history of the country right now. it goes beyond that. the senator has talked about water management and has gone to the netherlands to look at their water management program. we need to figure out smarter ways to live with water. there are ways to do it, as we have seen in other parts of the world. we need to look as some of those

principles and figure out things that we can adopt here that works. we can survive storms. during ike and gustav, in cameron parish, there was a house that was elevated after hurricane retouchedr hurricaneita, and that hospital survived the storm surge. we live in one of the greatest countries in the world and americans can figure of how to survive storms and how to survive floods in smart effective ways of rebuilding and protecting our communities. host: our guest is the executive director of the louisiana recovery program. thank you for being with us. >> president barack obama is back in washington, d.c. today. his vacation on martha's vineyard is over.

we're expecting to head off to camp david later in the weekend he is in the white house today and we're a couple of minutes away from the white house briefing with the press secretary robert gibbs. questions will be anticipated about the remarks by former vice president dick cheney. we will then taken to boston, massachusetts live for an update on the special elections to fill the vacancy left by senator edward kennedy. the governor of massachusetts will hold a press conference and we will have that live, scheduled for 3:00, here on c- span. let's go live to the white house briefing room. we are a moment or two away from press secretary robert gibbs. [no audio]

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[no audio] >> we are still waiting for this briefing to get under way with press secretary for the white house, robert gibbs. it should start soon. 3:00 this afternoon, we will be live in boston for the massachusetts governor discussing the special election situation with the passing of senator kennedy. we see mr. gibbs taking the cup -- taking the podium now.

>> good afternoon, everyone. welcome back. let me get organized. just one quick scheduling announcement -- on tuesday, september 15, the president will address the national afl-cio convention in pittsburgh. with that -- hold on -- divert the cameras over here. yes? tuesday, september 15, a big month for pittsburgh. >> is the president still asking israelis to ask all settlement building?

>> the presidents of views on this -- the president possible use on this have been clear and there has been no change from us. -- the president's views on this have been clear and there has been no change from us. there has been productive meetings over the past few weeks. >> the two sides may be able to come together during the general assembly meetings in new york. what would be the reason for optimism that the two sides could come together? do you have information about movement for a reason for optimism? >> i believe we have seen progress we continue to encourage -- i will not get into every discussion that we have

had with either side. we are hopeful that we can continue to make progress and if that happens in new york, we would be quite happy. >> has the presence in the mcchrystal report yet? >> the report is working its way up the chain of command like it normally does. i believe it has been delivered to the pentagon. >> world does have to go? >> there is a regional commander at central command he is the combat and commander and it will go to general petraeus. it will go to the pentagon and from the pentagon, it will come here and each step along the way, commanders and policy makers will have their comments to the strategic assessment the general mcchrystal has made.

there is broad agreement that for many years, our efforts in afghanistan has been under- resource. politically, militarily, economically. the president asked for a review of our policy. the president authorized additional security forces into afghanistan to lead up to the elections and appointed a new commander that is coming back with an assessment that i know many are eager to see. >> is the president willing to consider more troops for afghanistan? >> let's read the report before we get into that. >> the report might come down this fall. >> this report is an assessment of where we are and what needs to change.

any specific resource situation will be made in the coming weeks. i am not a part of this report. do you have a follow-up question? >> i do, we talked with the israeli president indicating that the meeting will take place on the sidelines of the u.n. meeting for he also suggested there is likely to be a suspension of israeli settlement activity to facilitate the meeting. is that your understanding? >> i would not contradict your interview with interviewperes, but we're hopeful that progress is being made. we hope that progress will continue in the future. >> on another matter -- a survey was conducted and found that only 4% of jewish-israelis consider president barack obama to be pro-israeli. does that trouble you in any way? >> what to you say about this

op-ed that the president needs to refresh the health reform discussion? >> the president has outlined a series of proposals and principles that he thinks should be included in health care. we will continue to see if we can make progress as it relates to that. >> on the specific plan, bob dole is saying he should not be a commentator, he is president of the united states. maybe he should take a more active role. >> he has talked with many members of the finance committee and members of congress in the house and the senate. i think the i think to -- i think to characterize the role the president is playing as inactive is inaccurate. if he had smart and with a golf ball, he would be more active in

health care. >> what is the calculation since he came back from vacation, he is going to camp david, when will he get back into this debate? >> the president did some meetings today that included discussions on health care. i assume he will continue to make calls. throughout the week in judging and assessing where we are. because the president might be doing something else does not mean that he is not focus on health care. >> a question about health care -- have you seen the fund raising letter from senator chuck grassley where he goes after being opposed to the obama administration's plans for health care reform?

it goes after president barack obama. it would seem to belie any indication the senator grassley is a partner with the administration. are you still firmly committed to working with republicans? >> the president is fairly -- firmly committed to working with democrats, republicans, independents, anybody who wants to see progress on health care reform. i will say this -- i have not seen the contents of that letter -- the radio address over the weekend by senator enzi, repeating the generic republican talking points that republicans are using and are bragging about being opposed to health care are tremendously unfortunate. in some ways they are illuminating.

it appears that senator enzi does not believe there is a pathway to get bipartisan support and the president thinks that's wrong. senator enzi has decided it is time to walk away from the table. somebody has to ask senator enzi and others is if they are satisfied with the way the system is working now? are they satisfied the premiums are doubling every nine years? are they satisfied that out of pocket expenses are skyrocketing? are they satisfied that small businesses are dropping their coverage? or you satisfied that every day, 14 million americans wake up without health care coverage? many may believe that we cannot afford to do anything.

this president believes we can't afford not to. >> are you satisfied with the ability the white house has shown in getting that message out? the congressional recess has been going on and some of us have left washington. do you think you are doing a good job as to what health-care reform should be? >> one last met in here, we look and discussed that the president has made progress and turned around some of the specific yet untrue allegations about this bill. it does not help to have republicans who say they are for bipartisanship and they are at the table to find a solution repeating republican party talking points about what they know is not true in the bill. i don't think that's helpful.

it is unfortunate that it looks like republicans are stepping away from seeking a bipartisan solution. it is bad for this town but it is much worse for this country. >> do you have to make comments on the remarks made by former vice president shanee yesterday? -- cheney? he says the administration's actions are not making the country safer. >> this is the same song and dance since literally the first day of the administration. i don't have a lot to say. i think the vice president, if

you watch some of his interview, he clearly had his facts on a number of things wrong. >> such as? >> the notion that this white house will be making interrogation decisions, not the high-value detainee group that is stationed at the fbi and will different intelligence and law- enforcement agencies within our governments. this has allowed people like fran townsend to complement the creation of this group. should she is tasked with home and security in a previous administration. i think was -- i think senator mccain's comments were illuminating about whether the

impact that these enhanced interrogation techniques that the president looked at and has now outlawed, the effect they have had on our standing in the world on our foreign policy. he certainly does not agree with us on every issue as it relates to this. i understand that. i thought that given his experience, they are tremendously eliminated. i am not entirely sure that dick cheney's visions on interrogation have borne a lot of fruit in being positive or correct. >> what does the president continue with the tension? how does he think this can be

monitored? he is thousands of miles away. >> i think it is important to reiterate that the president, after a review of enhanced interrogation techniques, i came to the same conclusion as senator mccain said yesterday. >> what happens when you send them to bl;ack sites? >> there are no american-made black sites. there is an outline of the use of enhanced interrogation techniques. we follow the geneva convention and the army field manual. we will close guantanamo. we will repair the image of this country and make this country safer. >> will detainee's go to other places? >> they are not sent to other places to be tortured. that is the policy of this

country. >> to be interrogated. >> some may go to other countries that -- to face charges they have in those countries but they are not shipped in the dark of night to be tortured. >> it was march when the president announced his strategy in afghanistan. since then, things have gotten worse. july and august have been the "worst month in terms of u.s. fatalities. it takes a long time to implement a military strategy. after six months, not only are things not stabilize but they are worse. is this an early sign that his strategy is not working? >> we under-researched afghanistan for the better part of a decade. >> he is sending an additional troops and it is not getting better. >> the assessment that is coming back is part of what a new commander does when they go to a region, when they are newly assigned.

whether it is the economy, health care or anything, the president will not see the entire thing turnaround in a few months after years and years of neglect you cannot under- resource the most important part of our war on terror. you cannot under-recourse that for five or six years? whether it is civilian manpower or economic development funding. you cannot hope to snap your fingers and have that turnaround in a few months. what the president in a seated throughout the campaign and actualized as part of this administration was to change our direction in afghanistan and understand it was the central focus that in the hills of afghanistan between afghanistan and pakistan, there were those

applauding us -- plotting to do was talk time. we ignore that for a long time with the resources to deal with the size and scope of the problem that existed. >> as big as it was when he came into office, it has become significantly worse. >> it is a challenging place. we are forever indebted to the men and women who serve their and particularly those who sacrificed -- make the ultimate sacrifice. we will see the general assessment when it gets here. the president is focused on ensuring that we meet measurable benchmarks and that we disrupt, dismantle, and ultimately destroy al qaeda and their allies. it will take some doing. it will take more resources which the president has dedicated to this problem.

understand, this was under- researched, underfunded, and ignored for years. that will not change overnight. >> is it possible that we are losing control in afghanistan? >> based on reports from general mcchrystal, he says it is serious but it is a winable war. >> how long does it take to get the report here? >> that is a better question for the pentagon. this comes up through the chain of command. >> have you inquired to find out what it will be here? >> there is no fedex tracking number. >> when would this report of the president's desk? >> i assume it will be sent over by the pentagon and secretary gates.

the president has continued to do briefings with ambassador and former general eikenberry and others involved. but the president will want to do is to review the report and discuss and talk with all those who have expertise in them, to get their viewpoints and insure that each and every person is heard on this. that is what the president intends to do. >> how about responding to christopher dodd who says he wants the president to come back and really frame of the health- care debate. >> he will franke what is important about getting health care done and doing it in a way that improves the quality of care and doing it in a way that changes the amazing amount of resources that takes to provide

46 fewer million people that need health care with something that is more expensive than any other country in the world. it is sapping our economy and budgets. >> christopher dodd is somebody who is in charge, it is his committee. he is asking for presidential leadership. >>ngñ he went through over 200 amendments and the president will continue to work on those. >> will he get the finance committee bill? is this something he will do with a couple of speeches before he gets the finance committee bill? and when you expect that bill? >> that is a good question for the finance committee. .

>> it is a better question for the republicans to have made those type of commons. >> has max baucus let you know when he will have a bill for you, september 15? >> and believe his deadline is september 15. -- i believe is september 15. >> there seems to be no sense of urgency on the the general mcchrystal report. >> do not misunderstand. the report has to go through the chain of command.

it will be commented on by those in the theater. >> will be on my desk by wednesday? >> it may be. to assume that because we have not gotten a report from the pentagon that the president does not believe it is a serious problem is an unhealthy thing to insinuate. >> on health care, senator satch of the way for negotiations already, and enzi has shown his cards and is not interested in a bipartisan resolution. what you think of the prospects? are republicans negotiating? >> that is a question you should ask them, jonathan. some of the comments that have been made, it certainly seems to suggest to anyone who reads them that they seem to be less interested in the bipartisanship

that about a few weeks ago. >> could you say we think of the gloom last week about the forecast for next year's election? >> it would be like me predicting who will win zero world series in the year. i will let the extremely smart prognosticators who always predict with unfailing accuracy the brilliance by which americans will render their opinion in more than a year. >> robert, those the white house now believe or suspect -- does it now believe that scotland released the terrorist because of an oil spill in libya? >> i do not know the answer to what caused scottish or british

officials to make the decision. as you know, mark, this administration weighed in repeatedly with those officials. this administration said that this person should serve his sentence in its entirety in the location he was at that time which was scotland. we continue to believe that. we believed this was the wrong decision. the motivation for the british is a question for the british. >> they know the last time president obama spoke with gordon brown? >> no, i would sit has probably been more than a month. we can check. they have not spoken since the release. >> you say that it is a question for the british government, but it will the u.s. have any

official investigation? >> i do not know. i do not know scottish law. i just know what the administration did in weighing in at and what the administration has continued to say about the actions. beyond that, i have nothing for you. >> on the japanese elections, japan wants closer relations with china and russia. will the u.s.-japanese alliance change as a result? >> we believe we have always had a strong relationship and it will continue regardless of

which japanese government is in power. obviously there are great number of regional issues we have discussed. many discussed particularly the actions of the north koreans that might lead the japanese to seek better regional ties from their allies. we would not begrudge the. >> the new leader says he wants to move japan away from the u.s. >> i do not know what dependency he refers to. >> do you expect any change as early as the g-20 in pittsburgh? >> none that i'm aware of. >> the ap is reporting that the governor blagojevich's new book

says that he asked to seek rahm emanuel -- to see him, and to ask for his seat back? could you tell us if that is the case? >> i have barely cover this. i have not spoken to rahm about that, nor have i seen the book by the indicted former governor of illinois. [laughter] >> the know anything about the transition? >> no, i do not remember discussion about that. >> concerning the policy of deferring on troop levels, is that a policy that this president explicitly has come or not? >> the president once the report

reviewed by those in the chain of command and it will want to review with the chain of command what they see in here in this report. one of the hallmarks of what this president has always believed in when it comes to making these decisions is that all those involved should have visited the table, the the president will listen to their opinion. >> if the commander asks for it, the stuff you would not get -- is that right? >> it was sitting on a general said the score he had written request for more troops for more than one year before we got here. so, i am not sure that is a standard by which to measure. i think the president is anxious to continue discussions

about afghanistan to save what general mcchrystal -- to see with the general was supportive of putting in place. to see what he has to say about going forward in the decisions will be made when that comes. >> as a natural disaster, the fires around los angeles are reaching staggering proportions. have you gotten any update on whether the president will get involved on the federal level? >> i will check on that. we all the regular updates on these types of news events, and these types of disasters. i assume as part of his daily briefing this morning he was briefed on the situation in local, state, and federal

response. >> the former senator bradley over the weekend suggested that tort reform might help with republican support for health- care reform. >> i would refer you to what the president said concerning the ama. >> it is hard to understand how far he was willing to go with that speech. >> voila. again, i think there is at least a healthy amount of evidence that many states which of had caps like this have not seen decreases in interest costs. the president is willing to consider any number of approaches, but there have to be people on the other side of the table to respond to those gestures. many of us are concerned that

people in those chairs seem to be living were rapidly than the american people want them to. >> are there bright spots on the legislative calendars but the white house is looking for, and how was the climate bill going? >> i have not heard in a day yet on where energy legislation is in the senate. -- i have not heard an update on that. a very important date coming up in mid-september marking in many ways the date most americans in their minds begin to see the real effects of the deteriorating financial crisis with the collapse of lincollehmn brothers -- a major push from this administration and from

members on both sides of the aisle on capitol hill will be efforts to reform the regulatory mechanisms by which our financial systems must operate. the will be a very important part of the legislative agenda moving forward in the fall in strong hopes that by the end of the year we have new rules of the road. so that something like this does not happen under the same circumstances again. april? >> a couple of things. hurricane katrina -- has president obama talked to anyone in new orleans as they approach their anniversary time? >> i do not know if he made specific calls to new orleans last week. >> it back to general mcchrystal, during the campaign for oval office the report said the u.s. troops were higher --

what reports are the getting on trips drink, their attitudes, etc., right now as we talk about putting more troops there? >> there is no doubt that we have a military that has been called to do a lot of things in a short period of time. that it has strained our military, strained relationships with soldiers and their families. the president talked about this in phoenix when he spoke there. about insuring that we protect those who protect us. secretary gates has outlined a speeding up of the expansion of the armed forces to meet the commitments we have around the world. obviously, one of the things this president talked about a

lot before the campaign, during, and afterwards is withdrawal of our troops from iraq as a way of lessening the burden. >> last question, senator kennedy's letter to the pope where he says he was committed to doing everything he can to achieve, access for health-care for everyone. what is the president is saying about that? [inaudible] >> competition is one aspect of what one must have in the marketplace to ensure those who do not have access to affordable insurance can get it. you cannot have access without the choice in competition in a market dominated by only one

company. i can assure you the president shares the late's goal to ensure that every american in this country has access to affordable health care coverage. david? >> two quick questions. is the white house preparing to push for the creation of a financial products safety commission that this fall? >> i was referring to a larger financial regulatory reform. part of that is a consumer, something that will take of the tasks in be the advocate of consumers. that will be a strong push. >> secondly, going back to the afghanistan, how would you define "winaable?" >> the president and his advisers have talked about

disrupting, dismantling, and destroying al qaeda and its allies. we have to ensure that while there are those currently planning to do our country harm, that they will not provide a safe haven for them. the government in afghanistan will be self-sufficient, and that there would be a security force in the country able to do with the challenges. -- able to deal with the challenges. going back to april's question, our commitment cannot be forever. >> it is not just militarily? >> no, if you do not have a country that has the government al institutions to provide for its citizens, that ultimately creates lawless, and govern areas that spawned the type of extremist activity we see. >> how kinney said the

commitment is not forever? -- how can you say that? maybe it will take close to forever. >> i do not think it will take close to four. i do not know what year that would be. >> on wednesday the administration will host a clean energy forum. what did you choose saginaw? what does the administration hoped to accomplish? how the sticklers been chosen? it is interesting that it is in addition only if your turn to give people aware? -- it is invitation only when you're trying to get people aware.

>> our live coverage continues this afternoon. in 45 minutes we will take you live to boston where we expect to hear from deval patrick who will make an announcement about a special election, or relative to the special election to fill the seat left vacant with the passing of senator kennedy. we expect that at 3:00 p.m. on the subject, congressional quarterly is reporting that two of his closest friends in the senate said it would support ted kennedy's widow serving there. they said sunday that victoria kennedy could serve at least temporarily. "sure, i think that vicki ought

to be considered as she is a brilliant lawyer. and a solid lawyer" she has declined interest in the seat and in recent months according to the paper. senator christopher dodd said that if she did it use for it and he thinks you would agree. to fill the spot he thinks is something the people of massachusetts would welcome. he says he thinks the could certainly use her in the senate. the story goes on to remind us that under current law deval patrick must call a special election by january to elect a successor. perhaps we'll find out more in about 45 minutes. that will be live coverage here on c-span. >> tonight, three doctors from the virginia hospital center in arlington, va. tell personal stories and offer their views. you will hear from the first

doctor concerning a mastectomy operation. >> the charges from $1,800 up to two dollars. a medicare reimbursement is usually between $650.700 $50. also, the second doctor talks about issues surrounding patient care. >> patients have a tendency to go to the internet to figure out what is wrong with them. without the medical background and grounding in experience we have, they always get it wrong. they usually think they have some horrible disease. patients should not try to make their diagnoses on the internet. >> joined us tonight and watch all three. share their personal stories about treating patients and their views on health care legislation.

>> this week "washington journal quality is live from the virginia hospital center across the potomac river. we examine the american health care legislation. this morning we talk to the chief upper credit surgery and we will show that tonight at 8:00 p.m. eastern. -- is the chief cardiologist. wednesday the chief of emergency medicine, though icu director, and the chief nursing director will also be live here on c- span. >> in more than a dozen works, this national book award winner has analyzed the american public education system. on sunday he will take your questions live on "book tv."

>> today the national election result in japan will be considered among issues. ian kelly speaks with reporters for about 35 minutes. >> good afternoon. i have a brief statement to make up the tab. the u.s. is deeply concerned over the attacks by the burman army against several ethnic groups. we continue to monitor developments closely. the fighting has forced thousands to flee their homes for safety in thailand and in china.

it has reduced stability and the prospects for national reconciliation. we urge the authorities to seize the military campaign and develop a genuine dialogue with the ethnic minority groups as well as with the democratic opposition. with that i will take your questions. >> what is your policy review on burma? >> we awaiting on a number of developments, particularly the trial of one man which is taken place. we have most of the information we need to move on it. i would expect some time in the next couple of weeks as to get through the summer holidays and labor day break we will have a final review and approval.

>> are you leaning toward more sanctions? >> i will not say. i don't want to pre-judge the process. >> the latest report seems to indicate the fighting has subsided. thousands are returning. >> yes. >> i'm wondering since this was raised last week by your statement of concern arrives as things appear to be calming down? >> i was not aware that refugees are returning. that is good news. our call to the burmese authorities to continue to develop a national reconciliation -- that call

stands. but if they are returning that is welcome news. >> has the date and venue for the mitchell meetings for the israeli delegation -- have they been determined? >> no, i would imagine either late today or tomorrow. >> where is mitchell now? there are no meetings today? >> no there tomorrow, but later this week. the topic? >> there were three south korean fishermen -- for you thinking of this in light of some other gestures in terms of meeting with bill richardson?

they said there were going to open the border. they sent a delegation for the finger. is this some kind of sign? -- they sent a delegation for the funeral. is there some kind of cease? >> of course we are encouraged by developments, particularly the release of our two fellow citizens. we are encouraged by more dialogue between the north and the south. we have always supported that dialogue to increase the amount of mutual understanding and reduce tensions. however, even though this

creates a better atmosphere than that which we saw few months ago which was north korea being belligerent in rhetoric, shooting off missiles, which was very damaging to regional stability and the possibility of dialogue on the korean peninsulatheour position remains the same. -- on the korean peninsula, our position remains the same. we encourage north korea to rejoin us. the offer we have on the table is the six-party talks.

>> you know with north korea's sometimes they send signals. you do not see this as them sending signals they are ready to talk? >> it is more helpful than the kind of signals they were sending before. the belligerent and extremist rhetoric, of course we're not seeing that. i will not say it necessarily will lead to resumption of talks. it is up to the north koreans to decide that. >> one more concerning comments made by vice-president dick cheney to fox news. he said he thought was a big mistake for president clinton to take the trip to north korea to free the journalists. he said it sends a bad signal. he says it rewards bad behavior. do you have your response? >> i disagree with that

characterization of history. it was a humanitarian mission designed to allow these journalists to be reunited with their families. >> one more concerning former vice-president dick cheney. he says he thinks the military options should not have been taken off the table. he says the idea that iran is not concerned that there could be some military option does not give it incentive to negotiate or follow-through with anything else. >> with iran we have a clear way forward and that is for iran to respond. they should sit down in the context in discuss the very real

concerns of the international community about the nature of their nuclear program. you have heard the president and others say this kind of offer will not be on the table forever. we're hoping in the next month we can move forward. that is the proposal right now. >> on a different subject -- >> anyone else on the same? >> with regard to north korea, are you get in a position to announce when and where the ambassador will be traveling? >> we expect in the next couple of days to announce that. >> can you explain why even though he himself expressed an

interest about talking to north koreans earlier this year, why now is not the time? >> well, it is because we see the best solution is a reasonable one. we do not want to do anything to disconnect our partners in the region. they have a tremendous stake in de-nuclearizing the korean peninsula. that is why we are now ready to sit down and talk in a substantive way on the security issues until they agree to this multilateral context. you also on north korea? iran. in the other on north korea? -- any other on north korea?

>> the you have any comment that north korea and china should signed a peace treaty? >> i have not seen such a report and have no comment. >> what do you think of the japanese election and what it will mean for the six-party talks, if anything? >> i take it that you saw our statement over the weekend, the we congratulated japan. our alliance with japan is key to no. of important regional and even global issues. they play a key role in helping stabilize afghanistan and pakistan. they're not nato members, but help with isap in refueling efforts.

as japan goes forward with forming a new government one of the key issues we look forward to working on is this critical issue, the de-de-nuclearization of the korean peninsula. >> busey the election having any impact? -- be see that having any impact? >> we will have to wait. we look forward to addressing this important security issue. also, the whole range of issues which are important for cooperation, but until the government is formed a refrain from speculating on which

direction it may go. >> a follow up on the critical role they play. it looks like it will and in january under the pledges of this new government. they want to reevaluate the arrangement with the u.s. how concerned is the u.s. about these critical changes? >> a stable, prosperous afghanistan is in the interest of the entire international community, including japan, but of course it is up to each country to determine how they can best contribute to that effort. we look forward to working with the new government when it is formed. we look forward to a discussion on the role japan will play. we will wait.

>> a different topic. >> both on north korea? go ahead. [inaudible] >> i am not aware that they have. i think that we have a number of stipulations that would commend that we would need to have within the international community in terms of how the aid is delivered. the policy has not changed. on japan? >> i think president obama will visit japan in november so we do not have enough time to prepare.

>> regarding any presidential trip i would have to refer you to the white house. regarding corp., there is a government in place. -- regarding cooperation with japan. we will continue to work closely with the government. >> any progress on where he might stay now? is new jersey completely off the table? this gordon brown, the situation complicate the matter? are you trying to convince him not to come at all? >> i'm not clear on this edition of gordon brown. >> whether there was a back and forth concerning the release of ghadafi.

>> with the statements that came out on friday a think it is safe to say will not be staying in new jersey. there are ongoing discussions between the libyan mission and the city of new york's regarding appropriate accommodations. i'm not aware of any final decisions. >> the british did attempt to make his release part of the deal related to oil and gas. this is your closest ally in their bargaining away his release, someone who has been convicted of killing 180 americans. what does that say about the strength of the relationship between the u.s. and the uk? >> we have a very strong relationship with the u.k. we have seen the allegations. we hope they're taken very

seriously. >> it sounds like [inaudible] , not allegation. he is not billing the beans on what happened. >> there is a vigorous political debate right now in the u.k. these are serious allegations, but i can only tell you what our role has been no prior to his release we made it very clear to both the government of scotland -- i am sorry, but to the authorities in scotland and the government of the u.k. the we thought he should finish his sentence in scotland -- that we thought he should finish his sentence. we're deeply disappointed.

but regarding the political debate going on, would have to refer you to the u.k. >> you keep referring to them as allocations when i think it is more of a confession. -- your for to the mess allegations. -- you keep referring to them as allegations. >> let's let the process run out. >> you say you're deeply disappointed by the decision. are you disappointed by the british move to make his release part of their bargaining on economic deals? >> if that were true, we would have concerns. we had no direct role in this process. we cannot characterize what kind of discussion went on either

between scotland or the u.k.. >> are you seeking clarification from the british? >> it is up to them to work these things through. we have complete faith in the british system to air these allegations completely and it transpiring. it is obviously going on in a clear and open way. they are allegations until it is determined. >> the documents do not look like allegations. >> i have not seen the document. >> if the revolutions did not come out of britain was involved, what will be the consequences? -- if the revelations do not come out that britain was involved. >> new topic?

>> the report that came out late last week said 300 centrifuges are now in operation in iran. is this the result of technical problems? >> the short answer is -- i just do not have the information on the reasons. i can tell you that this report, although i have not read it all the way through, and i do not have all the details, but it clearly shows iran's continued lack of cooperation with the international community.

they continue to refuse to suspend all proliferation and a sensitive nuclear activity. they continue to install centrifuges rich in uranium and construct the heavy water research reactor. it has refused to address in a sustained and complete way the real concerns of the international community about the intent of their nuclear programs. this report is yet another in a series that have indicated this. on wednesday there will be a meeting of the political directors of the p5 plus one

group in germany. this will be an important discussion item. >> what is the danger of his red getting involved? >> i will not comment on that. of course we're engaging israel diplomatically. we do that every day. >> this report came out three days ago. it is only six pages long. >> i am just saying that i have not seen the report. >> but there's nothing more to say than that? what you just said was a repeat of where you said on friday. >> yes. nothing more that i can give you. >> there's a meeting of special envoy is for afghanistan in paris mid week.

will mr. holbrooke go? what is the subject? >> yes. just a moment. as you know, the international representatives for afghanistan and pakistan meet on a regular basis to discuss issues related to the two countries. the next in the series is in paris on september 2 and will cover a wide range of issues. >> this is being depicted as an emergency meeting. >> no. >> paul burke will go? >> -- holbrooke will go?

>> yes. >> would you comment on this piece concerning the u.s. administration micro-managing the affairs in kabul? i will read a little bit. it says -- back from vacationing. it says the generals are being micro-managed by washington and are not given enough room or resources to do their work. meddling, implicit criticism. >> i respectfully disagree with that criticism. there is a great deal of communication between washington and kabul. i have participated in a number of conference calls between

washington and the embassy general mcchrystal and. -- and with general mcchrystal. we are in a time when we are trying to be patient and let this afghan-lead process play out. i would reject any accusation of meddling. we have been scrupulous to allow of this election to the afghan- led and developed. we have pointed out thasome of e concerns we have. you have seen accusations of

fraud. we urge afghan authorities and other members of the international community have also urged afghan institutions to take these allegations seriously. we'll need to be patient. >> over the last few days a number of allegations of fraud have doubled. what does that say? president obama hailed the elections as major victories for afghanistan. it turns out there more complaints of fraud. it was not a free and fair election. what does that say about credibility? cook's first of all, that there is a process in place to evaluate and analyze these

allegations of fraud that is a good sign. -- these allegations of fraud. that is a good sign. these institutions will look at them carefully. there is a complicated and a transparent process. we need to be patient before we pronounced one way or the other whether these elections are legitimate. what we want, the international community wants, and what the afghan people want our results that accurately reflect the will of the people. >> you think that the serious allegations of fraud reflect the will of the people? >> we have not seen the whole process played out yet.

>> he was criticizing my career- management of the generals work in kabul. >> i would reject that. >> has scott returned and presented his recommendations on sudan to the president or secretary? >> i think he has returned to the u.s., not aware of whether he is in the office, or night. he expects to make his presentation soon. -- whether he is in the office, or not. he expects to make his presentation to the president and secretary. he has played an ongoing role in the review process. like the burma process we

expect this one to be completed in coming weeks. >> tomorrow there will be a negotiation. some polish politicians expressed their disappointment. they are disappointed about the u.s. level of presentation at this anniversary. does it indicate problems -- does it indicate problems in the relationship? >> the short answer is no. there are deep and extensive ties between the u.s. and poland.

we are bound only by ethnic and cultural ties, but also by our membership in nato. we appreciate the tremendous sacrifice that the people of poland made in world war ii. i think president obama today formally announced the presidential delegation going to that city to attend the 70th anniversary observance ceremony on september 1. bill will be led by general jim jones, the national security adviser to the president. there'll be some other members of the delegation including at least one congressman, the senior director for the european

national security council. and of course the u.s. ambassador to poland. >> but the poles expect the secretary of state or vice president to be there. >> this is a senior delegation led by the national security adviser. i do not think it indicates any kind in the lessening of the relationship with poland. >> there are some reports that the administration considered scrapping missile defense for poland and the czech republic and is looking for alternative ideas so as not to upset russians. can you say anything? >> there is an ongoing review of the missile defense. this will be based on a couple of main factors. one is the efficacy of the

system and at the other is cost consideration. -- and the other is cost consideration. we expect the review to be completed in the next month or so, but the decisions will be based solely on the stated need of that this site in central europe to counter the emerging threat from iran. >> but it looks as if there are possibly other areas of europe, for instance the balkans or turkey, that you're looking at that could deal with the short- range missile threat from iran. >> no decision has been made. this system will be set up in coordination with plans for nato for theater missile

defense, but no final decisions have been made. >> going back to libya. tomorrow the libyans are celebrating the 40th anniversary of ghadafi's rise to power. does the u.s. government plan to send anyone from washington or the embassy to those ceremonies? >> in not aware of any plans for anybody to come from washington, and i'm also not aware of any other plans for someone from our embassy to send. >> concern namesri lanka of course they're sentenced a reporter to 20 years in jail. that is an emblematic symbol of persecution. >> thank you.

this name? >> that is right. >> yes, i know that the president mentioned him in particular as being a journalist who was either in jail for being actively harass. i am not aware of the court decision. -- or being actively harassed. but mr. to confirm and we will get your response. >> [inaudible] >> not today or tomorrow, but i've understand that he is here. he will have meetings at the oas tomorrow. i would refer you to them as to who he plans to meet with. no decisions have been made about who from the u.s. side

will meet with him. >> what about the signing of the declaration? >> we do not have a decision. i'm not going to guess on that one. one more. >> there is a poll that shows only 60% of israelis support and think president obama is pro- israel. does that concern you at all? >> i think our support for israel is unwavering. i have not seen the results of the poll, but i think the citizens of israel know who stands with them. >> the thing that secretary clinton thinks more balanced to the policy would be more appropriate? >> do you think that? >> you are asking me a very tough last question i have to

say. i will defer comment. thank you. >> i wanted. no one thing. there in the course of this briefing you have talked about four policy reviews the ec will be completed within the next several weeks. -- that use it will be completed. >> iran. >> you said that iran has until the end of the month to decide. that is about one in 10 minutes. >> we are standing by here at c- span in washington to take you live shortly to boston where we expect remarks from the governor of the commonwealth deval patrick talking about a special election to fill the seat left vacant by senator kennedy.

in the meantime, some phone calls from this morning's show. dick cheney calls the cia torture probe outrageous. >> it is a terrible decision. president obama made the comment weeks ago that his administration would not look backwards to try to persecute or prosecute cia personnel. it is based on the inspector general's report that was sent five years ago and was completely reviewed in years past. the made decisions about whether there was any prosecutable offense there. they found only one. in involved personnel from -- that was conducted. it was not cia personnel. it has. with the way would expect by professionals. now we have a political

appointee coming back. supposedly there will be another complete review and possible prosecution of cia personnel. we could talk of the entire program about the negative consequences. it's a terrible precedent. it involves cia personnel that are in a difficult program approved by all three bodies and then when a new assertion arrives a becomes political and define themselves possibly drag ged up in front of the grandeur and. it is terrible. dragged@@p host: the right that merkel last week appointed john durham as special counselor to reconsider

pursuing criminal charges against cia employees who interrogated some of al qaeda's hardest core members. the justice department previously declined to prosecute under president george bush. let's get your comments on that and by the investigation. good morning, on the republican line. caller: good morning, i think this investigation proves the democrats are more for the enemy band for the protection of the u.s. this is just absolutely ridiculous. i just cannot imagine anyone wanting to work for the cia anymore. i think it will be eventually dismantle. who would want to carry out anything? the bottom line is to go after george bush. you can turn on msnbc and all

you ever get is they are wanting george bush, his skin. i think it is sick. . . caller: this is about the

soliciting. -- this is about the silliest thing. it is in dick cheney's best interest for people to be afraid in this country. if you are afraid, you don't investigate and you don't look. the woman earlier talked about wanting our enemies to with inverted the only true enemies of this country are the enemies of the constitution. we know that laws were broken. we know that we tortured we know that the man that gave up information gave it up the -- before they were tortured. we know that in the past, the cia are not the people who do interrogations'. we know all of this. and one that works for the fbi or the intelligence community will tell you this. i don't understand why we keep going back to this man and we keep asking questions.

i love cspan and appreciate it. i always paid my cable bill. you have had ronald keesler on twice in the last few months who wrote a book on intelligence. host: he wrote a book on the secret service. caller: q. both times you have had him on, he said things that were false and no one ever challenges him. the first time, when i called, i mentioned that people have been prosecuted for waterboarding and he brushed me off. host: you were able to get through but you felt he did not answer your question. caller: he lied. the second time he was on recently, a woman called when he

was talking about the secret service protection of president barack obama. and what about the man who told a joke and was arrested t? what about the people were taken out of town hall meetings because of t-shirts they were wearing? and he sort of giggle. he said those things never happened. host: thank you for the comment period on to orlando, florida. caller: 94 cspan. i cannot believe that dick cheney has not already been invited. -- indicted. we know all -- we know bush and cheney subverted our democracy. do we have to restore our moral code in this society.

it the group dynamic is that we all want to live in denial. this has to end. it has to go all the way back to what happened on 9/11. there are many unanswered questions. we have to look into that and mr. cheney has a lot to answer for. host: this is a story about the comments that dick cheney made. the 2004 inspector general's report considered that some cia interrogations' went beyond the bush administration's rules permitting the use of techniques like waterboarding or simulated drowning. terrorists disclosed more information after being subjected to these map it spurted -- these methods. sampras's coach, sheila, on our

democrats line. -- san francisco, sheila on our democrats line. caller: i am amazed that he came out publicly speak about this now but we did not hear anything while he was in service. there is a lot of information that he does not want to have come out of things that a man bush were doing. thank you. host: good morning to brian on our independent line. caller: i command eric holder as being independent-minded attorney general when barack obama said he dug -- did not want things like this to go forward. we need to restore credibility around the world and show that we will not commit war crimes and those who do will be investigated and prosecution would be the next step. it is obvious that dick cheney

has a lot of information that he doesn't want to get out publicly. for him to talk about the obama administration is not keeping the country safe, the scare tactic arguments are not working anymore. as long as he thumbs his nose at the judicial system, if this trickles up to dick cheney, he should be held accountable. the whitewater investigator essentially put bill clinton's sex life out there. this definitely needs to be investigated and a prosecutions are warranted, let the chips fall where they may. chick dick cheney is not above law. -- dick cheney is not above the law. host: there was another story

this morning, the rise of a new era in japan. 50-year dominance and as voters oust the existing regime. the japanese voters overwhelmingly over ejected -- voted out the party that ruled the last half century. the historic change in government could offer in a new era for japanese politics. we have about 80 minutes more or so on this topic of former vice president shanee and his comments about the cia and the investigations to be held by the justice department. we go to new york, joe, on our republican line.

caller: i was about five blocks from ground zero. if you were not here, you have no clue what happened. i think they have a right, not to torture people, but to protect us anyway possible. all of these weird us from california have no close up the destruction and the lives that were destroyed over here. they don't have a clue -- what they saw on tv was 1/1 hundred of it. it was a threat of torture. they did not actually torture. they were not here and they did not go through anything. host: next call is from our democrats line. caller: dick cheney did not protect anybody. neither did george bush. the man is clearly a criminal. he clearly needs to be indicted.

he has been a coward all his life. he made all his money off of weapons systems from this government. he is a no good of vice- president and i am sick of him coming down on barack obama. host: the comments by former vice president dick cheney prompted more comments. >> i have read the 2004 inspector general report, which is a stunning report. i have read it on edit it. i was horrified. i understand the attorney general's reaction. however, the timing of this is not very good. the intelligence committee has under way now a total look at the interrogation and detention techniques used for all of the high-value detainee's.

we are well along in that study. i am trying to push along more quickly at this time. we will not be deterred from completing this study. candidly, i wish that the attorney general had waited. every day, something trickles out into the public arena. very often, it has mistakes. very often, it is half the story. i think we need to get the whole story together and tell it in an inappropriate way. host: california senator dianne feinstein. hercules, california, on our independent line next. caller: i rolled out of bed i just happened to have the tv on and saw you guys were talking about this. i saw dick cheney making these comments again. i have to say that i cannot believe that they are allowing

him to spin this over and over again. it is so clear that they violated so many laws and derail the constitution and hijacked the country. they continue to spin this thing. how could anybody believe anything they say. it should go for the top down, not from the bottom up. host: thank you for joining us. kathleen rights that dick cheney said it would cause a chilling effect. tell the so be in the cia that they abide by the constitution, not to dick cheney. this is a story on the front page of the new york times." lack of translators is still hampering the war effort. congress wants about the weakness. the national security agency

remains weak of translators after the 9/11 attacks. the u.s. intelligence personnel capable of speaking regional language such as middle eastern languages remains nonexistent. the intelligence committee wrote a warning in its 2010 budget report. the gap has become critical in the war effort, especially in afghanistan and pakistan. this is the theater where al qaeda and tell them -- and the taliban text message. greensville, texas, republican line. caller: i wanted to comment that

i feel like we get into trouble with the court of public opinion. we know that dick cheney -- >> we will take you live to boston mass. where governor deval patrick is stepping up to the pros -- podium to make an announcement on the special election to fill the late senator ted kennedy's senate seat. >> under our law, is up to the people of massachusetts to fill it in a special election. today, in accordance with my responsibility under massachusetts law, i am designating tuesday, january 19, 2010, as the day of the special election. massachusetts voters will have their opportunity to fill this senate vacancy. later today, secretary of state william galvin will issue a

calendar showing the dates and deadlines for the events leading up to the special election including the primary date. that will be on his web site before the end of today. i encourage the voters of our commonwealth to participate in choosing our next united states senator and i join with them in looking forward to a robust and substantive campaign. in the meantime, without the modest change that senator kennedy himself proposed, mass. will not be fully represented in the united states sent it. -- senate. he went from health care reform, to jobs bills, to climate change and education, the congress is debating some of the most sick historic and significant legislation in decades, bound to affect all of us for decades. let me be clear -- i wholly support the special election and the democratic process to fill the remaining two-years of his term.

i will continue to work with the legislature on legislation authorizing an interim appointment to the united states senate for the five months until that special election happens. this is the only way to ensure that massachusetts is fully represented on told voters of the state elect our next senator in january. i understand that this option was proposed years ago. that proposal, at that time, was voted down very i was not here then and i do not know the reasons why. on the merits, the proposal seems reasonable and wise. i hope that members of the legislature, regardless of their party affiliation, will see that, too, and consider up most, the interest of our citizens in being represented in washington continuously over the next five months. i am happy to take your questions. [inaudible]

>> i was trying to look at where the impact of the holidays that intervene between the primary and the general election would be minimized. it seemed to me that that was likely to have the earlier primary. >> [inaudible] >> did you say this morning? i have spoken with the senate president and the speaker numerous times over the last several days about this. the setting of the date is within their power. they have set it for as soon as they can. >> [inaudible]

>> i think they have an open mind and are working their way through it. they talk with their members and listen to their members. i don't think it is a certainty that it will happen. i think that they are trying to find a path from here to there to honor the very reasonable life of senator kennedy. >> there is no way that this person would not be able to run. >> the lawyers have advised us that it is probably unconstitutional to legislate that. it is my intention, if given this power, to get a personal assurance from the appointee not to run in a general election out of fairness to the candidates.

do i have names yet? it is too soon to tell. it depends on how quickly the legislature acts and that the act favorably and in the interest of having two voices and a full complement representing massachusetts, i try to make a decision as soon as possible. it depends on how quickly the legislature moves. >> a hearing starts the process. are they moving quickly enough? >> i think they are moving as fast as they can. it is important to move as fast as they can. comthis is also premature but 'd think what we want is someone who understands the issues facing the commonwealth and

understands the importance of having those interests served by being a strong voice in the united states senate. we would want somebody who is up to speed or who can quickly get up to speed on health care issues and job skills and education initiatives and climate change which are the key initiatives before the congress, right now. >> [inaudible] >> i was not here. i don't have to accept the premise of the question. my job right now is to think about the best interest of the commonwealth. i think that having a full complement, two voices in the united states senate, is the best -- is in the best interest of the commonwealth. we have a stake in climate

change and education initiatives and i think that our interests advise in favor of having a voice, two voices representing us in the united states senate at all times. i am concerned about it and i know that harry reid is concerned about it, as well. he and i have talked about that. they are in recess until after labor day, if i am not mistaken. i am talking about the united states senate. obviously, the longer they are in recess and taking up regular business in washington, without our having two voices, the greater my concern is for it is that what you're getting at? >> why can't they come back this

week? >> i think he should ask the legislative leaders about that. my understanding in talking with the senate president and the speaker is that they are moving this as quickly as they can. they have to and they owe to their membership to consult with their members and they have been trying to do that. >> [inaudible] >> i have heard from senator kerry who is on board with this proposal and shares these concerns. >> did the president's big about this? >> no, no. >> [inaudible] >> i am a democrat. i believe in democratic values. i believe in the values that senator kennedy reflected and

worked so hard for, caring about being the voice of the voice less, trying to give people a way up and wait for word and that government is not responsible for solving every problem but the government has a role to play in helping people to help themselves. personally, i think it is enormously important that it be a democrat. as governor and a citizen, i will respect the will of the people. i think we will have a robust race. we have a lot of political talent in the commonwealth. i think a lot of that talent will come out and compete for this opportunity. >> how strong and interest will the temporary replacement have? >> i have spoken to mrs. kennedy and two staff members about this. they feel strongly about it because it was centre kennedy's wish and i think they will get

involved as much as they can and as much as is helpful. >> [inaudible] >> you're talking about the individual women as to the change in law? i'm sorry. i have not spoken with mrs. kennedy or the family about an individual for the position. i thought you were talking about the change in law. mrs. kennedy is not interested in the position. >> would you consider running for the senate? >> no, i have a job. i have my hands full with this. i will not seek the position, thank you very much. i am running for reelection for governor, just to be clear. >> [inaudible] >> that is all the talk about. >> have been contact by anybody that is interested?

>> yes. did you have a question? i'm sorry. >> [inaudible] >> no, he did not. he is very concerned about the timeliness of our action and a vote as soon as possible. >> have you been contacted by people seeking p interim seat and a permanent seat? >> i get people contacted from people seeking all kinds of things. all of the above and then some. all kinds of scenarios for it anybody else? >> [inaudible] >> yes. everything else went out of my

mind. i think i have a great team. my wife will be there. i'm looking forward to a speedy and complete recovery. >> does the fate of the kennedy stepped have any bearing as to who will take his place? >> i am not sure i understand your question. do you mean would my decision the influence on what happens to the staff in place today? >> the staff in washington, does that influence your decision? >> whether to seek to change all lock? nope. what's influencing me is that senator kennedy asked and made the case very thoughtfully as he

would. that massachusetts mes two voices in the united states senate at any time but particularly now with the gravity of the issues before the congress. >> does governor dukakis have any interest? >> i have read that speculation and i think it is too soon to talk about any particular individual. i have enormous respect for governor dukakis. i do not want to imply anything other than it is too soon to get into individuals. >> are you reconsidering going to the doctor tomorrow? >> yes, but i have worked my way through all that. i am due there at 6:00 in the morning. then there is the preparation and they do the deed and i hope it goes smoothly and i know they do, too.

there'll be time in the recovery room in the afternoon tomorrow and, if everything goes as planned, i will be admitted into a room later in the day and i will spend a couple of days there learning how to put my shoe on and get out of bed and walk upstairs. >> [inaudible] >> certainly a day, maybe 12. >2. >> did senator kennedy's letter includes you? >> i don't need this headache. by that i mean the purely political business of saying yes to someone and no to a lot of other people. like i said, the senator's interest and my interest are the interest of the people of the commonwealth and the

commonwealth needs two voices in the senate. this seems to be a nice and rather elegant compromise. it leaves in place and respects the current law that provides for a special election. some people will get an opportunity to cast a boat. there will have that opportunity in five months' time in january. it assures the continuity of our representation for that period of time before then and it is a critical period of time. >> [inaudible] >> i have talked with the legislative leadership about the pace of their action. they have assured me that they are moving as quickly as they can, consistent with success. that means that they have to take the time to talk to their members and build support and organized for the hearing and

get the witnesses there and they set the date, as you heard, for next week. given the fact that it is summertime and some folks are a way, i think they are doing well. >> [inaudible] >> i think it is a matter of fairness for the candidates in the special election. the question has been, can you legislate that the appointee could not run. the consensus of legal opinion is that you cannot. it is probably unconstitutional to say that, if given this power, i will get that insurance -- an assurance personally. thank you. >> tonight, three doctors from

virginia hospital center in arlington, va. tell personal stories about treating patients and offer their views on health care legislation before congress. you'll hear from one doctor specializes in mastectomy operations. >> the charges anywhere from $1,800-$2,000. the payment from medicare for a mastectomy is usually between $600 and $750. >> also an internist talks about issues surrounding patient care. >> patients have a tendency, when they have a symptom, to go to the internet and figure out what is wrong with them. without the medical background and grounding in the experience we have, they always get it wrong. the usually think they have some horrible disease if there's anything i would say, is that that patients should not make their diagnoses on the internet. >> join us tonight and watch all

three doctors share their personal stories about treating patients and their views on health care legislation. that begins at 8:00 p.m., eastern, on c-span. >> all this week, "washington journal" is live from the va hospital center. we will show this morning's conversation with the hospital ceo plus the chairman of the board who is also the chief of cardiac surgery tonight at 8:45, just after the 8:00 p.m. doctors,. tomorrow morning, the chief financial officer and chief information officer talk about hospital finances at 9:00 a.m. and wednesday the chief of emergency medicine, the icn director, and the cheap nursing officer will be live at 9:00 in a.m., eastern on c-span.

>> this week, we kick off a week of discussion about health care, talking with doctors and staff at the virginia hospital center located outside washington, d.c. 8 we begin with dr. john garrett who is chairman of the board of directors and chief of cardiac surgery. host: dr. john garrett, chairman of the board of directors at the virginia hospital center, can you remember the first moment you might want to read -- you might have wanted to be a doctor? guest: i think so. my stepfather was a surgeon.

i want to copy him and it got more serious and high school when i injured my head and i had to be in the hospital for about seven weeks with a pin in my knee and traction. i have a lot of time to observe people working in the hospital in my mind, i really decided then that i was going to do it. host: where did you grow up? guest: montgomery, alabama host: where to go to college? guest: 20 emory university in -- i went to emory university in alabama and went to university of alabama in birmingham. host: when did the part part of this into your life? -- the heart guest: there is a strong cardiac program led by a man who was one

of the world's greatest cardiac surgeons. cardia surgery is highly visible to medical students. that is where i got to see a heart surgery for the first time and then i did an internship for surgery training and one of the things i rotated through was cardiac surgery dr. kirkland was my mentor. it was a brutal six weeks of very little sleep and hard work but when you finished it, you felt like you had been through marine boot camp and were very proud. when i finish that, dr. kirkland put his arm around my shoulder and said," you should consider doing this." from that moment on, even though my stepfather was a general surgeon and we have always talked about doing that, after that, i was cardiac all the way.

host: when was the first time you did an actual heart operation were you opened the chest and what was it and where was it? you were the boss. guest: it takes a long time to be a surgeon and it takes longer to be a heart surgeon for i. you do parts of it with a mentor or someone who is training you. from the time that i was at alabama, as an intern i did parts of our operations. -- heart operations. there are thousands of different steps in any operations and in cardiac surgery, you do one part and over time, you would have done a whole operation but never the whole operation yourself. it was only when i went to houston, texas, to train in

cardiac surgery with another famous man named dr. cooley, after about half the year, i was left alone to do a cardiac operation. by that time, i was an experienced surgeon. i knew how to operate but it was an unforgettable thrill to be in charge of that patient. host: have you ever done a heart transplant? guest: yes. host: what is that like. ? \ guest: people think is more glamorous than it really is. the beauty of a heart transplant is seeing a desperately ill patient looks sick and looks like he is dying and you put the cart in him and

the actual technical part of the transplant is not a big deal. there are a big stitches and big suture lines. literally, instantly, by the next morning, the patient has a different look. that is the most thrilling thing about that. it takes note, call for the patient to look magnitudes better. host: are you ever frightened in the middle of an operation? guest: no, i don't think frightened is the right term. sometimes after an operation, i will fight what could have happened or why didn't something happene and that is after the fact. you might get scared of what the consequences could have been.

sometimes, during desperate sorts of operations where it really is life or death, you are so focused in what you are doing, you don't think about the consequences. host: what is the longest you have been on your feet in an operating room? guest: probably over 24 hours. host: doing what? guest: we were doing a patient that had torn their eighth order, the big order the comes out of the heart. -- their eighth order of, the big -- aorta. the patient bled and we could not stop the bleeding. if there had been one of despair, not together, we would have stopped but we were there together. it was in our program here and the nurses still talk about

because the ships changed but we didn't. -- the ships changed and we -- the shifts changed and we sat on stools waiting for this patient. we did not give up. the pace and eventually stopped bleeding and walked out of a hospital -- the patient eventually stop the bleeding and walked out of the hospital. host: the most difficult patient situation you have ever had the chicken think of? guest: ok, i have it. host: go. guest: this is a great story -- it was years ago but i was operating on a priest. i had just begun taking the pain out of his leg in the operating room. i was by myself.

one of the general surgeons came in the room and asked for my help. they had a young lady that had an appendectomy but she had a cardiac arrest. her heart stopped and they were not sure what was wrong with rich was about 28 years old. i broke scrubland went over and look and i thought she was a young girl and i thought she had a blood clot in her young -- long. i ran through all the possibilities of what i could do, a little because of who the patient was, i made the decision to move the patient out of the operating room, which is not a standard thing to do, and over into the operating room. i opened her chest, opened at

the artery where i thought the blood clot was to save her life and the blood clot was not there prepared -- was not there. . there was no blood clot. i had this patient that i moved out and his patient that i made a wrong call on. i felt around her heart and she had some blockage i could feel in her coronaries. blindly, which is sub-standard, i did three bypasses into these blocked arteries. she came off the heart/lung machine with a little difficulty. the next day, later that day, i woke the priest up iand told we had good news and bad news. the good news was that you saved another lady's life and the bad news is that we did not do your

operation today. the end of the story is the girl lived, a beautiful girl. she became friends with a priest. he felt very much involved with her situation. we ended up catheting her. cathing is when you stick a catheter into the heart arteries and scored the dye ion and see what blockage there was. we did that after the bypass. i did not know what was wrong, i could just feel some hardened areas on her heart indicating blockages. as it turned out, the graphs that i did were just the ones she needed.

she got just what she needed but it was not the standard weight you get that. host: patients come to you, what can you almost always predict they will do when you start to talk about their condition? guest: more than you think, at least in cardiac surgery, patients have a high degree of trust for you. many patients do not want to know a lot of detail. i think it is pretty different in cardiac surgery and other specialties. although, more and more patients will have been on the internet reading and learning things. so many patients just want you to do what you do and are grateful for it and do not need to know a lot of details.

they are interested when they can go back to work. they are interested in a likelihood of them dying. a lot of the other details, i think, they are not too interested in. it puts the burden on us. there are certain things you need to know. we try to tell patients those banks, even if they are not too interested. host: let's say you're doing a bypass surgery, how many people are in there with you and what do they do? guest: well, before i answer that, the team in heart surgery is critical. i have been blessed with a team that has been together for 20 years and there has been very little turnover. we learn each other. it is like family.

there is an anesthesiologist, who is a doctor that cushions the patient to sleep and manages the drugs during the case. he has a helper. at the operating table, i have an assistant and i operate with a nurse and i have three of these people. i am more comfortable doing a case with one of my rn first assistance than i would with one of my partners because i have their total attention for it they know exactly what my routines are. they are nurses. they are extremely skilled nurses. next to me, the person that passes my instruments is called a scrub. in cardiac surgery, we usually have one other person at the table called a second assistant who is there to hold the heart

back and retract the heart so i concede where i need to operate. in the room itself is a person called a circulatory. the circulator is another nurse who gets you the things you need. if you need another stitch or another instrument that is not there, that person gets that. that is pretty much a standard open heart team. it is bigger than a typical team in a typical operating room. host: you say you have done this for 20 years at the virginia hospital center. did you come here in 1989? guest: i did. host: from where? guest: i finished my cardiac training in houston in 2006. excuse me, 1986.

you can't just go somewhere and start doing heart operations. it takes a hospital that will give you the equipment and a team you need. it takes a lot of resources. one of my dear friends and i started a program in auburn, alabama, at east alabama medical center. we were there for about two years and we brought nurses from birmingham and i brought a step from houston and we started this program there. during that time there, the hospital here began plans to have open heart surgery here. they went on a national effort to recruit surgeons. we were included in that. we came up and looked at the facility and the city.

i have always wanted to live in washington. in 1986, there was no opportunity to come here. this gave us an opportunity. we left on good terms and alabama and moved appear in 1989 and started the program. host: why did you want to live in washington? guest: it was washington. there is a lot going on here. i am all into food but not so much into culture but my wife is. we like to live in -- we want to happy and alabama. we wanted to raise our family in this area. host: where did you meet your wife? guest: i was a chief resident of surgery and one of the medical students was on my service and her best friend was my wife, mary.

we had a blind date. in those days, i drove a beat-up car, it was a volkswagen with holes in the car and all the girls i went out with complained about the car and mary got in the car and never even noticed. that was the first thing i liked about her. host: does she do guest: today she is a pediatrician. she is in the office next door with a group of pediatricians on campus. host: you will work together? guest: we do. host: there's a big difference between being a heart surgeon and a pediatrician. guest: air is a big difference, yes. host: the first thing is the difference and what you make?

guest: it would astound you to learn what pediatrician makes. if you consider the amount of training that they have to go through and the expense they incur to get where they need to go. host: you have been chairman of the board at this community hospital. is it non-profit and if so, why? guest: we are a not-for-profit hospital. let me take a minute and describe what that means. not-for-profit hospital does not mean that we don't make money. we have to make money. it means that we don't have shareholders. we are not responsible to anybody but our community.

we are a 501e3 organization, tax exempt. what we do here is we try to either break even or had a small margin of profit. last year, we had a 1.6% margin. we invest that profit back into the equipment. we try to have the latest and greatest that medical science has to offer. two years ago, we purchased a $7 million cyberknife, which is a special piece of radiation equipment. that is what we do with our money. we do not get out to shareholders. it is not to say that we don't need to make income.

we employ many people. this is not charity. host: gross revenues for one year? guest: about $280 million print host: how many people work here? guest: a couple host: of thousand how many of those are doctors? guest: we have about 300 on our active medical staff. only a handful of those doctors are employed by the hospital. most of the medical staff here is independent. host: there is noise in the background. do you know what that is? guest: it is some sort of alarm but i don't know what it is because i do not work down here. this is in the emergency room and this is the fast track.

part of the er. you hear these disaster stories about having to wait three hours before you get seen in er, this is the part of our er where we try to avoid that. is the fast track where we get to in and get you out without having to wait so long. i don't know what that alarm is. host: we will stop. it is not annoying to us, it is annoying to the audience. there is, it stopped. we can keep going. why did you take on the job of chairman of the board? how much time in your day do you spend doing that job? guest: i worked my way up

through leadership here in a hospital. i then got on the hospital board. i felt like i made some reasonable contributions. i did not feel that that have any special ability. the previous chairman a man by the name of pat haeley, when he was going off, he encouraged me to run for the chairmanship. i did not think that i have much to offer. i did and i was elected. i have grown into the job over the years. i work here.

my office is here. i am here a lot. i do spend time every day with chairman sorts of things. the one thing i have done is to provide a vision for excellence. in clinical care, in the programs we have developed here, an example would be the nor surgery program. my cardiac surgery program. the nationally accredited senate for breast health. -- center for breast health. these are programs that we have had the vision to bring forward. in the hospital we have built, we offer all private rooms to patients, regardless of their need or ability to pay.

host: why? guest: because we can. is the best thing for the patient. years ago, you could stay in a hospital for five days with pneumonia. it was not that sharing a room with someone. nowadays, if you are in moscow, you get sick -- you are sick. you get discharged. i think it is unacceptable to share a room, in this age, with another sick person. it is better for the patient to have a private room. that is the main reason we do that. that is the main thing that we have pushed is to try to do what is best for the patient. host: you have 320 rooms? guest: i think we have 350. host: we came here to ask you to do this because many of us use

this hospital because we live in this area and many of our employees are here and government workers come here and members of congress. as you sit and listen to the debate over health care, what are the first things you would like to tell somebody that they don't know what they're talking about? guest: oh, well i guess everybody knows it is complicated. ok, for starters, about half of what we do here is medicare and medicaid. about half of our admissions in this hospital, medicare and medicaid, we lose money on all medicare and medicaid patients. medicare and medicaid covers, at best, about 80% of the cost, not the charges, but the cost.

and so, i guess the thing i want to tell people is that so far what we have seen is the way the government controls costs, they just pay you less. we take that. we accept that but we would have to change what we do if not for the private insurance carriers whom we aggressively negotiate with to get rates that are 140% of medicare. because we are able to do that, we are able to make a 1.5% margin so that we can buy expensive equipment. host: our company has full insurance. what you are saying is that we

are paying to make up the difference between medicare and with costs. guest: yes, you do, your insurance does. if we did not get that extra money from your company, if all begot was what medicare paid, then do the math, we lose 20%. we are a business park. we cannot lose money we either go out of business or we offer last so that we can break even. offering less and health care remains that we do not give you the latest and greatest which is not as good. .

>> if i do and medicare operation, i accept what medicare pays me. >> what is that? >> it is about $2,000. host: what do you do for $2,000? guest: there are paid at globally. if i operate on you, i get one payment. for that month or until i get you well, that is what i get paid. i can see you 10 times a day. if you have complications, come in the middle of the night, whatever it is, i get that one payment.

for the hospital, it is similar. they get drg payment which is based on the diagnosis. for a bypass surgery, i think it is about $18,000 that the hospital would get from medicare to pay for whatever happens to that patient. host: the total cost is $20,000 that medicare will pay? guest: yes. host: what does it really cost? guest: it costs more than that. i am not sure how much more than that. host: if medicare is going to pay $20,000, who assumes what the insurance company is going to pay?

guest: we negotiate with the insurance company. that is part of the rub, is that we feel like that is a little bit of an unfair forward. medicare sets the rate and everybody wants to go there but we lose money with the floor rate that medicare sets. host: howdahs medicare set the rate? guest: i don't know. host: is that frustrating for you? guest: it is really different now than it used to be. host: what did it used to be? guest: there used to be more money -- alon host: we are in a hospital. [announcement, over the

intercom] guest: there used to be more money in the system. host:why? guest:look, medical care get better and better every year, new technology. it is expensive but it is better and better. things used to be cheaper. we are of the mind that there is nothing too expensive, we want the latest and greatest, and we are willing to pay for it. and we have. that occurs at the same time in parallel when we are getting paid less, the hospital is getting paid less. host: every year? guest: absolutely. that is part of what medicare has the ability to do, to lower

the amount that they pay you. we have nothing to say about that. physician fees, every year they threaten 10% decrease in our reimbursement. for the past several years, right at the very end, they don't do it and we have a sigh of relief. host: if i am in your position -- how much are you motivated by money? guest: i am not. host: that is a little more startling than the last announcement. guest: most doctors but truly did not go into medicine to make a big income. at least the physicians in my generation were attracted to

madison by what you can do for people and the idea that you could be independent, work for yourself, be your own person. host: we were interrupted for the code below. what does that mean? guest: it means when somebody has a cardiac arrest, and 18 within the hospital ascends upon that patient to resuscitate him. host: would you do that? guest:no. we have medical staff, residents here from universities. they sort of lead the team. this is a daily occurrence in the hospital. it brings up a point of, this is what we do in the hospital.

our default is to help, to save people. in doing that, we don't think about the money. we don't. it is the last thing on a physician's mind, is what money we are spending to bring somebody back. i think that illustrates a very important point. it is not part of what a doctor does. host: we have been hearing -- we talked about where some of the younger people coming in the business had a different attitude about money and their time then say people your age. guest: it is clearly different. i think the reasons are justified but i think young physicians see a different

horizon than the guys and girls in my era. i think they are much more protective of their private time. i think they are much more eager to be employed, to have the responsibility to run their practice. the opportunity to hang out your own shingle is very difficult. it is too expensive. you can't afford it. so young people do not want to take that risk. there is more of a shift mentality. in my group, we never get away from thait, even on our nights . it is part of your life. i think the newer generation of physicians, you work your shift,

there is long hours, but at the end of things, you are off and you have your life. host: what do you want to say in this debate that you think is not being heard? what else? guest: let me make a little point about tort reform. host: explain what that is. guest: in everything that we do as physicians and in the hospital, we have the possibility being sued by patients or family or whenever -- whatever. it is not something like is in the front of your mind but it is something ingrained into you.

it has unintended consequences. i will give you a pertinent example that honestly just happened this week. i had an 86-year-old chronically ill man. he is my patient. he came into the emergency room and he had a ruptured aneurysm. he was still alive. he had had recent of domino surgery so he had an ad demand that had been opened before. he was dying. i had absolutely no problem saying this patient is too sick to have emergency surgery. he is not going to survive. we have new technology, new expensive technology called stent graphs.

there are placed out in the aneurysm and avoids a big operation. we have that capability. because we have that capability, i sent this patient who normally i would have said just stop down to radiology. they called me and they said we can do this. we can save him, but if we save him, he will lose his kidneys. we are short of that. -- we are sure of that. if i did not have the family that i could talk to at that point, i would have said the go ahead. that would have committed that man to undergo dialysis and he probably would have died within a month. i would have been afraid to not proceed on the fear of what if

the family really wanted to go ahead and said you could have saved him, which we could have, and we did not. fortunately i had a family that understood everything and elected to stop. if the family had not been available, we would have done what we do, which is to take the next step, which a lot of times is easier than just saying stop. that drives up the cost of health care. host: we are right in the middle of the fast-track room of the a emergency room. it is in this place where you had a lot of defensive medicine based on the reform that you are talking about and wanting to cover yourself. can you explain that? guest: a lot of people who come in emergency rooms do not want to be there. they did not plan to be there.

it is not like you have a relationship with me, you pick me as your doctor, i operate on you. the embassy room, you come in and you do not want to be there. you don't know anybody. if it is a bad situation, there is a lot of things going on. things can drop through the cracks without tight protocols. sometimes, more things are done , kind of like a shotgun approach. it is easier to do everything so you don't leave every -- so you don't leave anything out then to pick and choose. that drives up costs. host: $7 million machine, a cyber knife. is this the first one in northern virginia? guest: yes. host: how do you pay for that and how much of that is

controlling the cost? you have to put patients in front of it or you will never get your money back. what does it do? guest: it delivers a focused beam of radiation to a target regardless of motion and all that is going around with lungs going up and down, any type of body movement. it is a precise way of delivering radiation. yes, we don't utilize the machine to pay for the machine but we do pay for the machine by utilizing it. if that makes sense. host: did you have to buy this machine on time or did you pay cash for it? guest: we usually pay cash. host: is that where your profit

comes into the picture? guest: exactly. host: what had gone through the board's decision to bring it in here? what would have been the reason? guest: we do a needs assessment. we look at the technology and compared it to other technology. at the time, we are recruiting a couple of world-class radiation oncologist who are here. they believed in the technology. we really thought as a board this would put us in the forefront of patient care in that area of radiation oncology. that was the prime reason that we decided to do it. we did have a business plan that predicted how many years it would take to pay for itself. we try not to do things that are

going to lose money. we lose enough money doing our routine, taking care of patients. host: how much money comes from patient and how much money comes from donations to a community hospital? guest: we don't get a lot of -- we have a foundation board that is pretty new. we were out of the fund-raising business for about a decade. we are back in it now. we raised about $1.5 million last year. we are hopeful that that is going to grow. in these economic times, we have seen a downturn in what people are able to do to support the hospital. host: how often is your hospital full? guest:it is full a lot.

i do not know the exact percentage. we have to reroute several times a year. that is when the hospital is full at the seams and we cannot get a patient in said they have to go to another hospital. host: what motivates somebody to have a not-for-profit hospital and which is better for the patient, better for the country? guest: what motivates somebody to have a for-profit hospital is the profit. i think not for profit is the best for the country because i think it is cheaper. if not for profit hospitals can adopt some of the fiscal restraints that for-profit

hospitals have, it would be a valuable thing to do. keep that savings, as opposed to giving it out to shareholders. this hospital did a joint venture for two years in the late 1990's. during that time, it was a valuable experience for us. we learned some fiscal restraint that we still benefit from because we saved money in areas that normally we wouldn't have. in a for-profit system, that money savings goes to shareholders. in our system, it goes back into the hospital. host: patients have spent less and less time in hospitals. you come in and have a operation and are only in there for two days. what changed that? guest: a lot of what happened is

that insurance companies, at least with surgery, they changed paying things on drg basis. you have a diagnosis like pneumonia. instead of paying you piecemeal, they pay you a lump-sum fort pneumonia. when that happened, there was pressure on the position to get the patient out of the hospital sooner. the sooner the patient got out of the hospital, the less money that would be spent. if the patient stayed in the hospital an extra two days, any part of the profit that might be present would be dissipated. host: is that good or bad? guest: i think it is good. host: so we really did not need to spend all of that time in the

hospital. guest: a lot of times you do not know what you can get away with unless you are pushed to do so. we used to keep patients in the hospital for eight days for cardiac surgeries. now we get patients out in three or four days. quite honestly, a lot of that was pushed from limited reimbursement. if you wanted to have a successful cardiac surgery program, you cannot spend all the money. you have to have enough money left over to buy the equipment that you need. host: from your perspective, as you listen to this debate on health care, what is the worst thing that you hear? on a day-to-day basis, you hear

people in these town hall meetings, members of congress, or wherever. guest: the thing that scares me the most is the thought of having the government -- having a massive medicare or medicaid and having all of the inefficiencies that that brings and ending up with a system that is poor, a hospital system that is poor, and having no ability to offer the best to our patients. that is what scares me the most. host: why would that happen in that kind of system? guest: right now, we lose 20% on medicare admissions. if we lost 20% on everybody that came in, we would have to do something different.

the first thing that i would do is limit our capital budget. every year, we buy $30 million worth of equipment. that would stop. it would have to stop. we would have to lay off people because we would have to get down, we would have to make up that 20%. the easiest way to make it up is to not buy new stuff. that is what we do in our personal life. new technology is expensive. the people that are driving new technology expect a return on their investment. if nobody is buying it, it will just be a matter of time before nobody is making it, nobody is thinking about it. that is a disaster. host: knowing what you know

about hospitals and doctors and operations, what would you tell a patient coming in that door? they are afraid, they are coming in, what should they do to give themselves a more peace of mind if possibl? >guest: you know, i think everybody needs insurance. if you don't have insurance, you need to get insurance. host: what if you can't afford it? guest: i am not a politician. there is something to be said about insurance reform, making it more competitive so that even that people who do not have a lot of money can have some insurance. what you don't want to happen --

everybody can get care. the problem is, somebody who does not make a lot of money and does not have insurance, they are responsible to pay for the bill that they got for that care. that is the problem, paying for it. the only person that asked me about how much something cost is someone who has money but no insurance. they want to know what is going to cost because they have to write a check for a. somehow, we all need to feel some of the pain of other than writing a check for the insurance company, we need to feel that cost issue. i do think there needs to be insurance reform. i think everybody needs insurance. but i would start with trying to

make there be more competition between the insurance carriers so there is affordable insurance. host: who is your biggest competition in the hospital business? guest: do you mean what other hospital? host: yes, it do you feel competition? guest: absolutely. inova is our biggest competitor. they are in the area we serve our patients. they would be our biggest competitor. host: so when you go home at night, you hook up with your wife, a pediatrician. what is the difference between your two lives? when you talk about your day in madison, what is the difference between your two perspectives? guest: i am speaking for myself.

i tend to feel more of a burden. i worry more. my wife has a lot of well patients. when she does have a sick child, she is totally worried at night. that is not very typical. i think most pediatricians see well babies, routin sort of stuff. as opposed to my practice, i frequently have patients who are pretty sec. -- who are pretty sick. it is a burden. i don't run away from it. it is just a part of our lives. sometimes, patients do not survive. that is a terrible struggle. over the years, it gets harder

because you have a sense that your ability should be so much greater than what it was say 20 years ago. host: if you were to pass on to somebody else this job that you have had in addition to being a heart surgeon, we only have two minutes, what would you tell the next chairman to worry about? guest: i would tell the next chairman that regardless of -- i would tell the next chairman to worry about the system getting down down and having it affect patient care -- dumbed down and do not do anything that affected patient care, that made it mediocre. keep an edge of pressure on the

condition, on the board, to never cut corners, to never let this thing that we have built where we give our patients the absolute best, do not let that change. that is my biggest fear. because at the end of the day, you have to pay them. host: if you are not a cardiac doctor, a heart surgeon, what would you be doing? guest: i would be a chef. i would own a restaurant and there would work in my restaurant. that is my second love. host: your favorite food? guest: italian. host: you finally smiled after this interview. we are out of time. thank you very much. [captioning performed by

national captioning institute] [captions copyright national cable satellite corp. 2009] >> for a copy of this program, call the number on your screen. for free transcripts or to give us your comments, the visit us online. "q&a" programs are also available as podcasts. >> you have been watching interviews with officials at the va hospital center located just outside of washington, d.c. tonight, we will hear from the doctors that works there. our program starts at 8:00 p.m.

eastern, followed by more from the va hospital center with president and ceo james cole and the chairman and chief of cardiac surgery. they talk about how the legislation making its way through congress would affect their day-to-day operations. as the debate over health care continues, c-span's healthcare hub is a key resource. followed the latest. watch the latest events including town hall meetings, and share your thoughts on the issue with your own video. there is more. tonight, texas republican john culberson show is how members of congress use technology to stay in touch with their constituents. maryland congressman chris van hollen held a town hall meeting

last friday in his district to discuss health care legislation. this event was held at a senior citizens community center in silver spring, md., just outside of washington, d.c. >> may i have your attention? please be seated so we can start. please turn off your cell phones. i will wait. we are very fortunate that we were able to have congressman van hollen come out here today.

i would like to introduce who is here. my vice-chairman is phil marks. [applause] on my left is senator teitelbaum. [applause] hank goldberg from the aarp. [applause] greenburgh, excuse me. our distinguished guests, chris van hollen. [applause] and then, of course, our distinguished guest advice van hollen. okay. i would also like to recognize the officials that could vice principal here today, senator mike lynnette. please stand up. delegate roger maynow, delegate

ben kramer. this is going to be a tough one. jay sakuski who is rear for senator milkuski and jay richards for senator cardin, and dolly kildee for council member nancy navarro. congressman van hollen was first elected to congress in 2002. he serves as assistant to the speaker of the house of representatives and is the chairman of the democratic congressional campaign committee. congressman van hollen serves on the house committee, on ways and means and also on the committee on oversight and government

reform. congressman van hollen has always enjoyed the opportunities to come and visit leisure world and its residents, and i think we should give him a warm welco welcome, and that's all i'm going to say because i want him to speak. thank you. >> thank you, marian. >> thank you very much, marian. it is wonderful to be back here at leisure world. i've had the privilege of being here on many occasions in the past and have always found the leisure world community to be actively engaged in the public debate and closely following events and always taking your responsibilities of citizens of this great democracy seriously and with the turnout today you didn't disappoint me in that regard. it's great to see everybody here engaged in clearly what is one of the most important national debates that we've had in a long time which is on the question of health care and health insurance

reform, very pleased to have the members of the dell gag from district 19 year, mike lynnette, roger mannow and, of course, ben kramer. thank you all for joining us as well as the representatives from other elected officials to marion altman. thank you for organize this and bringing us together. if we could give miss altman a big round of applause. also very pleased to be here with hank greenberg who as you heard is a representative from aarp which, of course, is the nation's largest group organization representing senior citizens and also very pleased to be here with my very dear friend and former colleague in the maryland state senator glen titlebaum. glen, thank you for your service to your state and also to our country. i'd also at the outset here like to say a word of remembrance about senator kennedy. senator ted kennedy i think we

all know was a giant in american politics. i think he will go down in history as one of the great u.s. senators. if you look at his legislative record and from the comments that you hear on a bipartisan basis i think people would agree with that assessment. you may not have always agreed with the positions that he took, but senator kennedy was absolutely passionate about pursuing the issues he cared about, a fair deal for working people, making sure everybody got a fair shake in life, for civil rights, for education, public education in this country and a whole range of other important issues. he was passionate. he was a fighter till the very end. he was also somebody who we well know was able to reach across the aisle, to reach out and work with other people to get things done and that's why he has a long record of accomplishments. just earlier this year we passed in the united states congress and president obama signed

service to america act, the serve america act to encourage and make sure more young people have the opportunity to help participate in this great democracy by working in fields of public service, and, of course, one of the things senator kennedy said was that health care was the fight of his life, and in fact he was successful. he was the leader in the effort to expand health care in the late 1990s to america's children through the children's health insurance program, the chips legislation. he teamed up with senator orrin hatch and others, and they were able to get that done working with senator clinton in the white house at the time. and that was a great victory. and earlier this year under the leadership of barack obama the congress passed an, tension of that children's health insurance bill. it was the second bill that president obama signed this year because the full promise of that

legislation had not been realized. there were still millions of children in america who were not getting access to coverage under the children's health bill that senator kennedy had been a leader on, and so that was the second bill that was signed by our new president. but, of course, in the area of health care there's still a lot of unfinished work, and senator kennedy was working on this issue, of course, up to his final days, and that brings us to the question of health care reform, our health care system in this country and where do we go from here, and i think that we should recognize at the outset that we have many strengths in our current system. there are many good aspects to our current system. one of them is the engine of innovation. there's lots of incentive in our system to develop new treatments, new cures, new techniques, new drugs to deal with different diseases, and in the process of fixing what's

broken we don't want to harm what is good. of course, the doctor's principle is first do not harm and we need to make sure that as we fix what is wrong with the system we preserve what is best with the system, but you have to acknowledge and i think we all recognize that we can have a better health care system. we can strengthen our health care system. it does have many weaknesses. in our country we spend now 18% of our gross domestic product. i'm not talking now about the federal budget. i'm talking about all our spending, our spending as americans, part of our gross national product, what we spend every year. we spend 18% of our dollars on health care in this country. it is by far the largest expenditure on a percentage basis of any western industrialized country in the world, and so we should be asking ourselves what we're getting for those dollars, and

the fact of the matter is despite being by far and away the largest spendser in ter eee of health care dollars we have an estimated 45 million americans who have no health insurance whatsoever and many more who are underinsured who can scrape together some dollars and buy a health insurance policy often only to discover when they need it most that what they need it for is not covered, so you've got about 45 million americans with no coverage at one point or another during the year. some of them on a regular basis and then again many more who do not have adequate coverage, and the institute of medicine which is a non-partisan organization has estimated that about 85,000 americans die prematurely each year because of lack of coverage, because they didn't get the treatments when they needed them in an -- and in time to reverse the course and catch their illness because for those

americans their first line of medicine is the emergency room, and many of them wait, of course, until whatever their health condition is has worsened to the point where sometimes it's irreversible by the time they finally go to get that care, and that's a staggering number and that is rationing. there's not rationing in this health care bill. that is rationing. now in 1965 as a nation we decided to address one of the big problems with our health care system at that time which was the lack of coverage for seniors. we had millions of seniors in the united states who could not get the health care they needed, and what we did as a nation was enact medicare, and many of you were following that debate at the time. i was relatively young at the time, but i have done my homework and read the history, and it is really remarkable to

read the history of those times and look at some of the language that was used against medicare at that time and see how similar it is to some of the language being used against some of the health reform proposals that are being debated today. medicare was attacked viciously as socialized medicine, as a communist plot. people said it was, quote, german medicine. i encourage all of you to just re-read some of that history of the fight over medicare, and i say that because tid medicare is recognized by most people i think as a successful program, a very successful program in our country. and, again, you've got a little bit of repeat in history in terms of the language being used in the debates. now we need to strengthen medicare. we need to make sure we put it

on a sustainable footing and a sustainable basis going forward because i think all of you know that medical inflation in this country, both in terms of public dollars spent on health care meaning medicare and medicaid and in the private insurance market medical inflation is rising at a very rapid rate, much faster than the rate of inflation in the other parts of the economy. between the year 2000 and the year 2008, insurance premiums jumped by twice. they doubled. during that same period of time insurance company profits also soared. in fact, if you look at the top ten insurance companies during that period, their profits exceeded 400% over that same period of time as premiums were going up. that's not a coincidence, of course. premiums were going up, and profits were going up, but also the underlying health care costs

are going up, and so we need to make sure that we tackle that issue through more efficient delivery of medicine, and there are lots of ideas out there for addressing those issues within our overall health care system, and we need to address those issues as well. in addition to having to grapple with the cost factor there are obviously other major flaws in our current overall system for insurance in this country. i'm not referring now to medicare but in the other insurance market. people are denied, of course, based on pre-existing conditions. we have a system right now that is based entirely on your employer for the most part providing health care because it's very difficult as an individual to go into the insurance market and buy affordable health care which is why most people in this country by far, apart from medicare, and

there are about 45 million americans on medicare right now, about 38 million seniors and about 7 million individuals who are disabled who@@@@@ @ through their employer which means if they lose their job, it means they lose their health care. people, today, are expected as they start out in their careers to switch jobs four or five times, which means every time they switch jobs, they have to make sure their next employer has adequate coverage. if they get sick on one job and then lose that job, they are not going to get it on the next job because they have a pre-existing condition and be denied. because they will have a pre-existing condition and be denied. there's also a fairly regular use of what we call recisions

which is you've been paying your premiums month after month, year after year. finally you need it, and when you need it most, the insurance company goes back and finds some fine print in the contract to try and deny you the care when you need it most. it happens on a regular basis because the fact of the matter is some insurance companies, i mean, that's -- by denying payment, obviously that increases their bottom line and helps their shareholders and stockholders and these are some of the other major problems in our current system that we are determined to try and fix, and that's what the legislation does, and that's why i believe that while americans may disagree on some of the specifics on the best way forward the overwhelming majority of the american people understand and believe that we need to improve and strengthen our system. now there's been a whole lot of misinformation, a whole lot of misinformation out there about

what's in the plan. i should say that there are obviously as in any big debate there are going to be areas of legitimate disagreement, and we should have that debate but we should have it based on facts so this is an opportunity to talk about what the facts are and have a conversation and get your input as to what you think we need to be doing as a country so that when members of congress go back into session we can talk to our colleagues about the best way forward. before i talk about specifics of the bill let me give you an update on where it stands in the process. president obama has not himself submitted a piece of written legislation to the united states congress. instead, he took the position i think rightly so that he was going to outline a series of principles that he supported and work with the congress to develop specific legislative proposals, so there is no specific bill out there that the

president has submitted. in the house of representatives, and it's a great privilege to represent all of you in the house of representatives, in the house of representatives we have three committees that have what we call jurisdiction over this health care bill. three committees where their area of responsibility touches on some part of this debate and have worked to fashion legislative proposals. the ways and means committee which i serve on, the education and labor committee that deals with a lot of the employer-based coverage issues and the energy and commerce committee. as of today, all three of those house committees have reported bills meaning they have voted in their committees on bills so you now have three bills before the house of representatives, and it will be our job when we come back bases on the input that we get from you and my colleagues

get from their constituents to take those three bills and try and bring them together, merge them and make any changes or modifications or additions that we think are appropriate going forward. that bill would then go before the full house of representatives for a vote. now in the senate there are two committees, not three. in the senate there are two committees that have jurisdiction. one of them is the committee that had been chaired by senator kennedy. it's known as the health committee, health, education, labor and i think pension committee and that committee has also voted out a bill. senator dodd took up the reins? senator kennedy's absence and that committee, too, has voted out a piece of legislation. the other senate committee that has jurisdiction is the senate finance committee chaired by senator backous and the senior republican, the ranking republican member on that committee senator grassley from

iowa. and as you probably know they have put together what they call the gang of six, a subset of that committee, three republicans and three democrats and they have been trying to work out an agreement so that that committee can also report out legislation. when the senate finance committee, and we hope they will have a bill, when they have a bill, the two senate bills out of the help committee and finance committee they will also have to be reconciled and they will come together on the floor of the senate in some form. after that, if all goes according to plan, you will then have a house bill and a senate bill and then they would go to conference where you work out the differences between the two. again, if that all goes smoothly and, you know r, not sure that will go smoothly, but if that all happens, that all happens that combined bill then goes back to the house and back to

the senate for one final vote because each body in the legislature has to vote on -- on every detail of the final agreement, and then if it passes the house and the senate, of course, it goes to the president for signature or for a streeto, and that is the process, and that's where it stands today. now i'm going to talk about the house bills because as i said we have bills that have been coming out of three committees, and let me briefly say what they do not do. they do not create death commissions that encourage people to terminate their lives. they do not do that, okay. they just do not do that. that is nonsense. that is nonsense. what they do -- what they do is say that doctors can be compensa compensated for advice and counsel they give to their patients about different treatment options that they have. some something that many doctors

are already doing and some doctors don't. why don't some doctors do that? because while they get paid for giving you a particular operation they don't get paid for the time they take with you and your family to talk about the different treatment options, but there's absolutely nothing in this bill that provides any encouragement or any incentive to any doctor to substitute his or her decision for your decision. your decision will prevail no matter what, but i think all of us recognize that in order to make informed decisions we need information. i know from our family personal experience is always good to know what the treatment options are and how you can best proceed, but you, the patient, consumer, the individual, of course, will always in consultation with your doctor be able to make whatever decision you think is best for you and your health care. number two, this bill does not provide coverage to people who

are in this country illegally. it does not provide coverage to, again, illegal immigrants in this country. in fact, can you go to the bill, and there's a specific provision that says that coverage is not made available. now we have a serious issue and debate in this country with immigration, and we have to address those issues as a nation, but that debate will take place separately, and there's nothing in this bill that says people here who are here illegally get coverage. number three. this doesn't cut any medicare benefits. it does not cut medicare benefits. in fact, as i'll mention in a minute it expands some medicare benefits, especially with respect to prescription drugs. so those are three areas that have gotten a lot of attention and where there's been a lot of misinformation that at outset i

want to get the facts straight, and what does the bill do? it fills in the gaps in our current health insurance system which as you well know as we've talked about is already fairly fragmented. we have medicare for now 45 million americans. we do have the children's health insurance program for kids in millions of american families. we have the medicaid program for the indigent, but that still leaves, as i said, over 45 million americans during the course of a year who have no health coverage, so we want to work with the current system and fill the gaps which means as the present has said that if like your current coverage, your employer coverage, first of all, i said medicare it's not -- it's not touched except for it's enhanced. i'm going to talk about that in a minute, but for people who are

not covered by medicare what it will do is encourage them to keep their employer-cover coverage if they like it and want, it and the employers are going to be encouraged to keep that coverage, but for people who don't have coverage either because their employers don't provide it and increasing numbers of employers in the united states are not providing coverage because the costs are going through the roof and they have to compete with other companies and businesses from around the world that are not providing health coverage and are not assuming those costs, and, therefore, as time goes on fewer and fewer american businesses are providing coverage. it's still by far -- the majority of big businesses provide it and fewer are and certainly many are not and so for people who do not get coverage through their employer and are self-employed and can't afford coverage, what this bill does is create another option for them. it establishes what we call a

health care exchange. now i don't know how many of you were federal employees or on federal -- the federal employees health benefit plan. i don't know if you could raise your hands if you're on the federal health, okay. members of congress are on the federal health employees health benefit plan. just like you every year during open season we get out our booklet and what do you do? there are a whole lost plans out there, and you can compare among and pick and choose which plan you think is best f yourself and your family. we want to provide that option to millions of americans who don't have coverage, and they will be able to select from among those plans, and from among the plans they will al also -- there will also be a public option. most of the plans will be -- all the plans but one will be private insurance plans that have to meet certain criteria to

protect the consumer, yes, just like under the federal health employees benefit plan where the office of personnel and others monitor those insurance companies ry carefully to make sure they don't put something in fine print that undermines your care. these will be very transparent, and the insurance companies that are offering plans under this exchange will be held accountable for what they are offering, but there will be a series of plans, some basic coverage and then for people who want to pay more you can buy another plan, just like under the federal employees health benefit plan and you'll have a public option. the public option is not required. this is another great myth out there, that somehow people are going to be forced into a public option. it is an option. people can choose. there are a lot of people who are opposed, especially the

insurance industry, because it creates more competition. there are many places in this country where you may have only one or two insurance carriers. when you only have one or two insurance carriers, they get to dictate price to the providers, okay? and providers also sometimes like that because they are the only guys in town. now this will provide more choice. if people don't like it, if people don't like the cost or they don't like the care, they can say no. it's also very important to understand that this public option has been circumdescribed, been limited in a way to make sure that there's an even playing field between it and the private insurance companies. what do i mean by that? it has to support itself on its own premiums.

the initial startup costs that would be advanced by the federal treasury have to be repaid. it has to operate just like any other entity. it will be a non-profit because the federal government is not in the business of making a profit so it will be a non-profit. it will be like medicare. it will be an option like medicare for those people who choose it. they want to choose the private plan, they choose the private plan. they want to choose the public option, they choose it. more competition, more choice. that's what it is. now the congressional budget office non-partisan congressional budget office that comes up with projections and estimates in all sorts of areas have looked at the interaction of all of these elements in the house plan, and they have looked forward to the year 2019 and according to their projection in the year 2019 you'll have more americans than today o