[captioning performed by national captioning institute] [captions copyright national cable satellite corp. 2009] . . >> as the debate over health care continues, our health care hub is a key resource. go online, although latest

tweets, what's the latest advance including town hall meetings, and share your own videos, including any videos from town halls that you have gone too. >> of our coverage of the health care to be continues with three doctors from the virginia hospital center in arlington, va. talking about legislation being considered by congress and how the health care system works for them. this is 45 minutes. >> why did you get into medicine? >> i worked in a family where my father colorectal father -- where my father was a colorectal surgeon. i could speak to him and get the inner workings of taking care of people. it was very exciting from the beginning to be able to

participate. it was a very easy process going to school, and since i grew up and pu -- in puerto rico, it was a very natural thing. i was exposed from the beginning and it was exactly what was in my mind i was called to do from the beginning. nothing dramatic, but it was what it for myself and for what i wanted to do in life. >> dr., how about you?

>> it is an honor to work with patients to preserve that. there have been tremendous expenses in my field in terms of breast cancer. that allows us to give patients more options and get them back on their feet sooner. >> dr. michael amedeo, how about you? >> my first contact with madison was 9 years old. my neighbor was a neurologist. he took me through neurology rounds, and i was fascinated, which now are very rudimentary and barbaric, but i was fascinated to see what he was doing. it sparked an interest that held on through high school, college, flirting briefly with

your research, but it was not for me. i was more of a people person. i went to medical school, and had a great transition in career ever since. >> explain what you do? >> as an internist? as a general internist, i am the point man for my patients. they are my responsibility. i am responsible for all aspects of their health, coordinating their care. i am the first person they see when they have a problem. that gives me a great window into their lives, and it is an incredible honor to be so intimate with these patients and to share their problems, their choice, their kids -- i have several families where i am

taking care of the third generation of the family. that is an incredible honor to be able to do that. >> explain what you do. >> i am a colorectal surgeon. the basic difference is that we are not usually the person that sees patients initially. i am a general surgeon but also specialized in colorectal surgery. we deal with the basque gamut of diseases that involve the colon and rectum, from cancer to the nine diseases. i am a surgeon, so i am in the zero are -- the o.r. 50% and the time. the way we see it, that is what we bring to the table. çówe do smaller incisions and things that are lessñi painful,ó

certainly try to cure and resolve issues withñr."çó surgl procedures. ñrxdin my particular case, it ho do with a lotçó of cancer and bowel disease,ñr and similar problems like embroiledñr diseases -- immortal -- hemorrhoidal diseases. i was in my practice with my "tçóñril section for the hospital four years ago. >> when did you decide to become a breast specialists? i was pretty much after i finished my internal surgeons seek -- general sergisurgeon residency. so many things were not available for breast cancer patients then.

minimally invasive techniques, there has been an explosion in breast emerging -- imaging, and numerous surgical techniques that are all on the horizon. that is why i wanted to participate in that. as a breast surgeon, all i do as breast surgery. cancer, and also a non-cancerous problems for women. >> we as patients say a lot of things about doctors. i want you to tell us what you would like to say to patients -- not about, you are going to be all right, but what the patients do that irritate you? anything? overall, on a regular basis? >> i do not know that it may be slightly irritating, but from my point of view is also sad. patients have a tendency when they have to send them to go to the internet and try to figure

out what is wrong with them. without a medical background and grounding in experience that we have, they are alwaysñr gettingt wrong. they usually think that they had some horrible disease. patients should not be trying to make their diagnoses on the internet. ñiwhat i tell myñi patients is,t i tell you what is wrong with you, learn all that you can because you may be able to find things in teach me things. but you're not going to be able to make the diagnosis yourself without medical background. the anxiety that comes up when a patient, someone yesterday came ensure that they had multiple sclerosis when all they have done is pitched a nerve. -- pinched nerve. one person was sure that she had in this. that is very anxiety provoking and it is a shame that they go

through that. >> it is really a give-and-take relationship between the physician and patient. mutual respect is important, respect for both -- forñiçó tim, on time,ñrñ&r not overbooking, e patient showing up on time. it also works in terms of the internet. ñii haveçiçó seen patients comn with three or fourñi pagesçó of breast cancer questions, which isñrç?rñi fineñi with me. they will have every question from that standpoint it is helpful. çóit goes back to it working boh ways. ñixdqñiçóas long as the patiente positiomr as anñi-9 -- have a l respect for each other, -- the patient and the doctor at the mutual respect for eachçó other, it will work out. >> the key thing for me is that this is some people coming into the office, notamjerh chip in

their shoulder, but that this is goingñi to be a battle. what we have toçeti] over is tt õ.h5ñ is a team. i am on your side. it is a difficult process, and when the diagnosis is not nice, it is not a good diagnosis. that isñr something weñi cannote his doctors. if we are able toçóxd maintain m very critical>'óçó relationship between the patient and the doctor, where no one else can get in,ñi not the insurance companies or the hospitals, no one, then things will come out no matter how serious the condition is. that is what brought us into madison, to take care of people and every person. that is what turns us on most times. if we are able to not have an adversarial contact and work on the same side, it can be very

simple and very complicated. if that hurdle is passed and people mother we're trying to do the best, and yes, we make mistakes and do not know all the çóanswers, andñi yes, we are fallible andçóó human, then it always turns out toñnd be a positive experience for the patient and certainly for us. i love what i did. r+e what youñiñi do, if you have theñiiñi chance toi uu(r that for me is the most important process to get across to the p dollars we're sitting in part of the emergency room but they virginia hospital center -- at virginia hospital center. a lot people at c-span come here. we know the hospital. dr. wilson, one of my doctors, and you are very helpful in making this happen. from your standpoint, however like to know what your day is like. how many patients do you say? how many days a week do you

work? and are you on call 24 hours a day? >> as far as on call, i am on call two of the four weekdays, and my partner is on the other two at night. on weekends, we have a group said that we can cover, a group of eight internist. every eight the weekend -- every eighth weekend, i am covering eight doctors and their patients. i come in and do initial paperwork, have patience from 9:00 to 5:00, they come to a hospital and said hospital patients, the paper work, and if you as my wife, she will tell you midnight. but i can put in up to 12 hours in a day. >> when they visit your office, how much do -- chemist time deal allocate? >> it is a follow-up on an

established patient, if it -- it's 15 minutes. an annual physical is 30 minutes. a new patient is 30 minutes to an hour, depending on their age. a young person may not have much history, but an 85-year-old person, we may need that full hour and maybe even more. >> as an intern is damage you do know surgery. >> i do nose surgery. -- as an internist, you do no surgery. >> i do no surgery. dollars my eye patients can be 15 minutes, new patients for 30 minutes, and a new diagnosis is 60 minutes because there is so much to cover. i am on calls all the time, every single day, so if you and i have a relationship and you have a problem, you can reach me

at any time. when i go away, i obviously have coverage, but otherwise i am constantly on call and available. that has not really been a problem because i know my patients. luckily i do not have a lot of cross coverage. that is pretty much my day. >> is a 1.5 days in the operating room? describe what you are usually doing in the operating room. >> i do a variety of breast- related procedures. anywhere from as simple as a breast biopsy, to try my diagnosis -- to try to make a diagnosis, to do a lumpectomy or a mastectomy for breast cancer. the pace it can have a set -- i tried to coordinate with plastic surgery so that the patient can have a mastectomy and reconstruction surgery at the

same time. >> are you one time most of the time? >> barring some situation that has occurred or unplanned, but we certainly try to, as was mentioned before, respect the time of the patient. my day, i see patients to 0.5 days a week -- 2.5 days a week. i am in the or two days a week. -- i am indeed o.r -- i am in the o.r. two days a week. it can be very easy and quick, and nine ailments, where people

go on the same day. and then a lot more complicated operations or procedures, for inflammatory bowel disease where we have to intake -- take the entire large bowel out and reconstructed using the small intestine said at the present tense continued have normal functions without the: -- so that the patient can continue to have normal functions without the colon. we have o two full we have.r. -- we have two full days of the o. r. time. it seems to my wife, but that is not usually the case. the days can go up to 12 hours or longer. i have a partner, and we are a

self-contained unit. the week that we are in units, it does the whole week. we know our patients, since we are usually operating as well, we know each other's patient as well. it can be very easy are very difficult. there is a lot going on, emergency-wise, and surgery can be a very busy week. >> health care is in the news every day, almost every hour now. the your patience talk about what is going on? >> all the time. in the past three weeks, i have had patients ask to have their imaging studies moved up. we have that timetable for patients needing a mammogram or an mri. i had patients who needed studies in january asked have been done in december because they are worried that they are going -- there will be changes

precluding them from having that done. there is a lot of insight at. breast cancer patients have anxiety, i do -- anyway, baseline, but will they be able to have to care that they need to maintain their health now that they have gone through the health care and the surgery and everything else? it is really an acute, palpable feeling in the office. ñ8hey want to talk about it all the time. and i cannot blame them. >> dr.ñiñi amedevñi? >> it comes up a lot. we often get into a more professional level of conversation with some of my patients. certainly in the last month, i am getting a lot more questions about swine flu. the anxiety of the pandemic and how it will impact and when will they have the shots? çóçówho will get it? that has been theñi foremost, bt there is a lot of curiosity and

health care reform is so nebulous and up in the air and there's so much rhetoric about it, it is hard for people to get a handle on it. and like stephanie says, it causes a huge amount of anxiety. i don't think we have a clue what will come out, if anything. >> i started with you. i asked you what you thought about the health care debate. you told me that you have to start with the defining whether or not this is a moral right of americans, to have health care. t get people besides me talking to you about this? -- do you get people besides me talking to you about this? >> before, not so much. now it is almost daily. it affects us as professionals and patients eventually. from my standpoint, when i started thinking about this, the

key question in my mind, to sit back and say he is receiving adequate health care are right for every american citizen, or is it something that you purchase like a car? even though it sounds not that important, well, it is. if everybody who lives in this ñiñrñrcountry has a right to heh care, you have to define health care, a complicated equation as it is, but that is one of the critical questions, start to address -- starting to address it, which we have not. the rhetoric starts to the maximum level where they start calling each other names, and it is not very nice. and the question is, is this the right? i am not a lawyer but it is something that obviously in my mind is a very important

question. do we have a right as american citizens to receive adequate health care? or is this something that you purchase, and the more money you have, the better health care you get? that is a very tough question to answer. i am sure that theñi people on e hill are dealing with that. ñiñiçó+áñiñiñi have all but tals the mopd importantñi question,t will color the wholelebate. >>ñr if you could pick up one thing to say to capitolçó hill about this debate, what would you say to them as the debate goes on? >> i would say, do not destroy it what works well. we are aware that certain things have to be changed and modified, but we have without doubt -- i can tell you without doubt, we have the best health care situation in note world.

it has its flaws and some things have to be changed or modified, but don't destroy what works very well for añiñi good number- the vast majority of the american population. be gentle and take your time and think it through but do not destroy something that works extremely well. 5a>> dr. amedeoñr chris demarñ? >> primary-care is dying away in the united states because of the aware can -- because of the way that theçóñiw3 american medicalm sho"tçó shrift. that has shown up in the choices that medical students make, as far as their special training. if there is one message, it is that if we do not change that trend, the system is doomed. if you look at every other developed country, they had bet

all -- better health statistics and spend less money providing it, but there -- but they are primary care-oriented. we are more oriented toward procedures and some specialty care. ñithat difference is a major cae of some of our problems today. until primary care gets some serious attention, and something is done to make it attractive, they're not going to do it. >> why did you pick primary care? dollars intellectually, i wanted to be some specialists. i liked working with my hands, and i originally wanted to be a surgeon. but i owed a couple of years to the national health service, so

i had two years with a storefront clinic in baltimore. i worked there with the nurse practitioner, and essentially they taught me the outpatient primary care that i did not get in my specialty oriented training. >> what was your medical school? >> georgetown. both medical school and residency. by the end of that two years, number one, i have learned outpatient primary care, and number two, i had a wife and child. g.i. fellows back then were making about $12,000 a year and i cannot see supporting a family on $12,000 a year. i love what i had been doing in primary care. so i basically shifted gearsñi, came back to arlington, where i grewñrñi up, and started a prace here. >> dr. akbari, whatñiñrçó?7 abos

debate? >> i echo what they have said about this. this is an incredibly complex issue. we have not defined health care. nobody knows what they're getting when they pay f)khrá. if youçó go to the store and bua box of cereal, you know what you çó for it. but when you are gettingñi a bi, with all the charges and payment isñi less than the charges, noby çóudmrrvandsñr the pricing and t you get for what you pay. the most important thing here is toñr define does everyone have a right to health care, and then who is going to pay for it. if we all think that that is a right, we all have to contribute, and it will not come from dr. costs, or cuts the

hospital -- cuts to hospitals. and as a multi-sectorial thing. it will involve the taxpayer. that is a tough not for politicians to stand up and say, and for patients to honestly say, ok, i will be willing to contribute more of the less money i am making in these difficult economic times to health care. >> when you are doing an operation or seeing a patient, you have any idea how much this will cost them? >> i do not. i know what might charges are. i know that i am not paid what might charges are. i have a contract with the insuranceñi company, as do most doctors. i do not know what that would translate in terms of copayment, in terms of the 80/20, 90/10, and that patients do not know either. >> if you're doing a radical

mastectomy, what does it cost? >> the cost in the charge are different. >> what is the difference? >> the charges anywhere from $1,800 to $2,000. é@the payment is usuallyñióñi- medicare reimbursementçó for a mastectomyñi is usually betweeni $650.700 $50. >> the money comes directly to you. >> that helps to pay for my salary, my[ñ overhead, i have e employees working in my office, i will have two associates, another one starting next week. ñithat covers rent, malpractice insurance, supplies for the office, and one of the misnomers for physician reimbursement is that that money goes to my house into my bank. w3that is not what happens. çóñrbig businesses have overheao cover, and said its decisions. that helps to defray all those

costs -- and so do decisionbh[s. that helps toñi defray all those costs. >> if i am seeing patients and i'm more participating providers, i have agreed to except what the insurance company contract payment is. ñ(gñif the patient is seeing ani am not çñii][ññrçóñr participa, i have the ability to build for the difference between what the insurance company will pay and what my charges are, but typically we do not do that. >> ehudo you know what is goingo cost the patient? ? you have to distinguish what the hospital charges, which we have no -- i do not have any idea what the charges areñr. we have no control, nor doçó we

know what happens on the hospital side. çóñrare conscious about what wee any o.r., and our limited resources. we will use what weñr needñi in trying to be as frugal, in terms ñiñixdñçxgññiñiñrñi."thq5ñ=)ññe use w%!!jz be variants -- expensive. from: that the main -- for the colonetomy, we can charge $2,000. and we get paid $300 to $900 from medicare. thatçó covers the 96-day period after surgery. if you have to intervene, you

are basically getting paid $900 for that procedure, all of the post of care for the next 90 days. private insurance is takençó an idea for medicare and uí5hpì(l answer is companies that use is one-and-a-half medicare. -- i do not know an insurance company that pays us one-and-a- half medicare. we're very much under paid for the procedures that we do any insurance companies -- and the insurance companies are using medicare and -- as their base line. we get paid out -- some get paid more, you can find out what the

rates are for their visits, which is minuscule. when you call a plumber and a charge you 10 times what we can charge, it was useless orbit $100 and that is cash. there is no insurance. the dollar'>> what do i end up , whether it is medicare or insurance or out of my pocket? >> it will depend on the length of the visit, like they said. mike charges have really relationship to what i get paid. we may charge anywhere from $50 to $250, depending on the extent of the visit, but what i paid, it usually very close to medicare fees for all of the payers, maybe 33% of that.

a simple office visit, i might get paid $40, maybe $50 if we do some laboratory tests. some insurance companies said they will not even pay you for drawing the blood. you take that out of your expenses. it is significantly less than the charges. >> i am hearing that somebody somewhere anteroom decides that the medicare organizations, what you're going to get paid. tell me if that is true or not christian or dollars that is completely true. >> who does that? >> medicare rates are established. >> an organization called medpac, a board that was formed made up of multiple people from medicine and from the federal government. they basically said something called the rbrbs rates. they about the way how much it

costs to be a doctor, run an office, a pace that, to pay malpractice, and the basis of that, they said the reimbursement rate. -- they set the reimbursement rate. that is a deeply fall system -- flawed system. that formula currently being used is going to cause a 20% reduction in all physician reimbursement. if that happens, this system is going to crash and burn. >> it will collapse because doctors that are able to take new medicare patients will not be able to. it will not be cost-effective in you will not be able to pay your rent and your employees. from our standpoint, it would get to the point where we cannot make ends meet. the amount of work that it takes

to run an office and reimbursement, if you have wanted% medicare, you would not. -- if you have what had% medicare, you would not. -- if you have 100% medicare, you would not. you are not going to be able to maintain the business and most of us cannot call and ask for either rebate or a bailout. that is not when happen. some have tried. we will not be able to maintain -- and the unfortunate thing is not closing your business. my parents, myself, when we get to that age, we will not have doctors to take care of us because they cannot afford it. >> another thing about medpac, it really comes out of congress and is administered by the government accountability office. it leads me ask whether what we

have right now is government-run medical treatment in this country, socialized medicine. some people get upset about that name. what you think about the medpac thing? >> in a sense you are right. everyone follows the medicare rates. it seems, however, at -- that as we move forward, there is an interest in changing that even more to make it a much more controlling system, was choice, single payer, and that will eliminate a lot of things that we as doctors feel are necessary and important for patients. when patients come to my office, pay have an expectation as terms of care. along with beckham technology. we will not be able offer that kind of technology, all of those

new things cost money. if we change the playing field so that the highs and lows are eliminated, a lot of that will go way. i think there will be tremendous disappointment in the level of care that patients receive. >> his health care in this country a moral right? [laughter] ñiñi>> i do not know if it is a moral right. i believe that people are entitled to a basic level of [#%arw i think the morality is, is it right have somebody else pay for someone's meucal care? in otherçóñi words, currently te going on, okay? ñiñiif you are a medicare patie, if you are in the hospital, you're care is being subsidized by patients who aren't -- who

are on an commercial insurance. and that's not right. all the cost of your care are being subsidized by commercial insurance companies. as a hospital, it is critical, since medicare, and you have no negotiating power, it is left to the commercial insurance companies to essentially make up the difference. medicare is not going to cover the charges and your expenses and so you have to make it up from the commercial companies. the immorality is in that that equilibrium between the amount paid and the amount received. >> a moral right? >> i think so. anybody that lives in this country, americans, should have a right to health care. the question gets murky when you say who is going to pay for

this. in a simplistic way, we are all going to pay for this. this is not something, certainly not working by cutting what hospitals get paid, what insurance and doctors get paid, that will not solve the problem. having said that, as mike was saying, it is a complicated equation. the basic question is do we have of basic right to receive health care? my straight answer is yes. how are we going to pay for it and how are we going to allocate care and are we going to restrict or limit what patients can receive because of the issues of funds and money? the example throughout the world is that most likely we cannot offer 100% all the time. we cannot have a liver transplant for every person because there is no country in the world where that as possible. and every system of health care,

no matter where you look, they are awful lot. there is not one system that is perfect. in terms of answering the question, do we have that right asñi citizens in this country, n my mindñi in opinion, the answer is yes. >> dr. akbari? >> i would lead the moral right out. but how do we define health care? at what level does that mean? a liver transplant for everybody or a basic level of preventive care, immunization, screening tests, and then beyond that, we allocate based on age and morbidities' whether something is appropriate. that will be the hard part, to define what you get. health care, what does that mean? you get a basic level, and once we define what everyone will get, it will be easy to see how much that will cost and

distribute that across the paying parties. >> what year did you graduate from medical school? >> 1979. >> georgetown, right resort >> yes. as it turned out, yes. my practice still is as close to the markets will be kind of model -- marcus wilelby kind of model. i think that that is changing and i think that medicine is becoming more of a profession -- there is less commitment to the long-term relationship, the extra hours, the kind of thing

that the old guys did. the younger folks, and i don't necessarily fought them, but the ads would have a life, be home for dinner every night, but want to see their children grow up. -- they want to see their children grow up. so there is a loss. if i was when the work 40 hours a week, than 20 hours a week, i would be less available to my patient. someone else would be seeing them in getting to know them. i think that that is changing, but i have been able to maintain the image that i wanted by keeping the practice small and heading tight control. it does not mean that i have not used the highest technology. i might huge proponent of information systems and have been here at this hospital and around the country for many years. you can be high tech and still be warm and friendly. >> what about in your case? did it turned out the way that you planned it? >> for the most part.

i graduated in 1985, columbia, and then trained in boston. and in colorectal in the university of minnesota. my father was still around as my mentor, after medical school and residency. it is different when you have your dad. it was a great honor and i was probably the best part. it has been worth that. in terms of surgical care, there has been an explosion that i never envisioned. all the minimally invasive processes that are still there. you could tell i am older than stephanie, but when she started as an intern, we work at the beginning of laparoscopic surgery.

i had to learn how to take at gallbladder attitude. -- to take a gall bladder out of a tube. i am not sorry that i chose what i chose. if i had to do it tomorrow, i would do it again. it has been great. i love what i did. all that fancy stuff that we do is very exciting, but the most important thing, what gives me the most intense pleasure is to be able to take care but people, to have relationships, to be friends, even though we're surgeons and do a lot of basic stuff. in case you come to work with a smile knowing that you touched people's lives. >> did you know each other before? where? >> we trained in boston together. >> as this turned out for you? =/%ñrt(tell us what you do here.

>> i and the medical director of the center, the only multi- disciplinary breast cancer treatment center in northern virginia. we have amassed breasts imager is, people who specialize in breast cancer, radiation oncologist, nurse navigators, all in one location to really provide comprehensive care for the breast cancer patient. this hospital has been at the forefront of enabling that to happen because nobody else in the area had really stepped up to the plate to have that kind of system and played. >> your use of guarantee of pennsylvania? >> in 1991 -- you are university of pennsylvania? dollars in 1991. i love being a surgeon and what i did. when i talk to dr. wiltz, i appreciate being able to work with people and feel honored to be able to becomeçó an intimate

part of their family, even if it is a short period of time. but as we look forward, there are significant challenges. dr. amedeo said that the crop of doctors coming out have a different expectation level in terms of what they are going to be paid in their work hours. i think patient expectations continue to rise. at some point, something has got to get. i think that there are huge challenges ahead, but the patient and doctors. ñi>> weñi are out of time. thank you for your time. you can go back into which you enjoy the most. [captioning performed by national captioning institute] [captions copyright national cable satellite corp. 2009] >> as the debate over health care continues, our health care hub is a key resource. goal line, follow the latest week's, what's the latest events including town hall meetings, and share your thoughts with

your own citizens video, including video from any town hall you have gone too. and there is more. in a few moments, the president and chairman of the virginia hospital center with their perspective on health care system. in an hour, the senate republican congress holds a health care town hall meeting in kenner, louisiana. ñiacq) that,çó massachusetts go. the ballñr patrick --=áuñi devi patrick announces that all lake edward kennedy's senate seat will be -- that the late edward kennedy's senate seat will be filled with a special election. >> tomorrow morning on "washington journal," we will

look at this legislation with michael wilson from americans for democratic action. the vice-president of news corp. discusses his recent opinion piece on the obama administration. and our series on health care continues from the va hospital center, with robin norman, the chief financial officer, and its chief information officer. "washington journal" is live on c-span every day at 7:00 a.m. eastern. >> this morning on "washington journal," we began a three-day series of programs from the va hospital center. our guests were the center's president and chairman. this is about an hour. host: 10 miles from the u.s. capitol in arlington, virginia is the va hospital center. it is a 350-bed not-for-profit

medical center. we are live there all week to get a perspective on health care debate. we are live in the emergency room with the president and chief executive officer, as well as the chief doctor of cardiac surgery thank you for being here. as president and ceo, mr. kohl, what are your responsibilities? guest: it is analogous to being the general manager of the hotel, but in a much more complex environment. we are responsible for making sure all of these support services are available for physician and staff. also, i work closely with the medical staff on our quality initiatives, improving quality, also in the financial management of the organization. host: what are the revenues of the hospital in a year?

guest: last year in + $280 million. host:, many employees? callerguest: about 800 medical f that is totally in -- independent. host: do you have doctors on staff? guest: we do. we employ about 35 physicians, but the overwhelming majority of physicians are independent practitioners who choose to bring their patients a year. host: can any accredited doctor in the u.s. practice here? guest: that would be the first step, but then each physician applies for a privilege here. we employ several people full- time whonvets the individual,

is peer reviewed by constituents, and a further review by a committee of medical staff, and then finally by the board of directors to grant final improvement -- approval. host: why are some doctors on staff, why are some not? guest: we are seeing the independent practice of medicine for some physicians is becoming less attractive to to economic pressures, lifestyle concerns, and we are seeing primary-care physicians and some specialists entering into an employment relationship. host: where do your revenues come from? guest: fundamentally from our insurers. about 46% of our revenue comes from medicare and medicaid, government programs, and the

balance comes from private insurers. host: this is a relatively affluent area, probably pretty well-insured, also with the government as an employer in the area. what is the percentage of uninsured that comes through your doors? guest: probably above 4%. in addition, 5% of patients are medicaid. medicaid pays a us only about 65% of what our actual cost of care is. host: could you explain, dr. garrett, he was a guest last night in this discussion. one of the comments that you made was the va hospital loses 20% on all patients in medicare.

how do you determine the cost of the procedure? how is that determined? guest: perhaps i could address that. if you look at what goes in determining cost, first of all this death. -- first of all this staff. there is the expense of staff and. there is supply costs. and then there is the equipment that is here. that is usually calculated by applying a depreciation expense for the equipment. we are very fortunate here to be extremely well equipped with the latest in diagnostic and equipment, but all that costs money. host: is a free-market system? guest: i would say is a hybrid.

it is a free market, but a great deal is determined by the pacers. as i pointed out, the government today is one of our major payers, not only for this hospital, but it is typical for most. host: i want to reintroduce dr. john garrett, president of the board of doctors. dr. garrett, you talked last night in the interview about the importance of having the latest medical technology. why is that so important, if it increases the cost? guest: well, it is better for patient care. as i said last night in the interview, every year things improve. you have companies that make

devices, drugs that are better than what is currently available. there is lots in the pipeline. if you do not embrace those technologies, it does not take long before your are practicing medicine that is five years outdated. that is not good for patients. host: we want to get the callers involved. we have divided them differently than we usually do you can see them on the screen. if you are in short, 202-737- 0001. if you are not injured, 202-737- 002. and if you are in medical

practitioner, 202-628-0205. how closely are you following the health-care debate in washington, and what concerns you the most? guest: i will speak to that first, if i may. from the hospital perspective, one of the primary concerns is the plans being proposed is looking to achieve cuts in medicare of over $500 million in the next 10 years. from the hospital perspective, that number was derived from and dartmouth study, which showed significant variation in medicare costs for medicare beneficiaries across the country. for example, in most of the metropolitan areas in virginia,

the cost per beneficiary is about $800 a year. but in south florida is about $16,000 a year. -- $8,000 a year. so there is better cost for better efficiency, but the proposed controls on medicare expenses is across-the-board percentage cuts. so states like virginia, wisconsin, iowa, minnesota, that have good quality and relatively low cost, and then there are states like texas, florida, massachusetts, that had a relatively high cost. so is simple across-the-board reduction in reimbursement applies the same, and in fact, penalizes relatively low-cost states, and effectively awards high-cost states. i do not think it is a good way

to get rid of the excess. i would like to see an approach which provides incentives for cost reduction but does not penalize those that are already doing a better job. host: does the public option were you? guest: -- worry you? guest: it does. medicare is a public option, as we discussed. they pay hospitals less than the cost of care. i see no reason to believe another public option would not follow that same approach. host: dr. garrett, same question? guest: as board chairman, simply, i worry about the hospital having less funds available to allow us to continue to lead in the forefront of our patient care.

as a practicing doctor, unconcerned about losing the independence about being a doctor, having a relationship with a patient, off from what i think he or she needs -- offering what i think he or she needs, in an independent way. i think that may change, and that is key to what makes american medicine so wonderful. this ability to take care of our patients and send them to other physicians that you know will give them the care and will not the limited, as i believe we are threatened to be. host: as president and ceo, and do you have a relationship with the local congressman here, jim

moran, or with senators webb or warner? guest: we are all open to dialogue. we recently met with senators web and warner, and they are web and warner, and they are willing to consider our views. host: our first call up, new hampshire on the insured line. caller: i listen to your interview last night, and you were very informative. i learned a lot. my question is, two years agoñiy wife had preparation and her stomach. she became septic and beat -- and spend two months in the i see you, three months in a room after that. she had complications. the medical bill was all a

little over $1 million. if we did not have insurance, in your honest opinion, because i find you an honest guy, in your honest o"union which she had received the same care if we did not have insurance? and you can chime in after him if you would. >> dr. garrett. guest: i am glad that you ask that question. i can tell you wonder% that she would have received exactly the same care -- i can tell you 100% that she would have received exactly the same care. we do it all the time. $1 million is a lot of money, but as a practicing doctor, i do not check, i don't know what people have insurance or money or anything. all the other doctors are just like that. we do what we do. we come to work and take care of sick patients. so, yes, in this hospital, over

the last year we gave away $30 million. it is part of our mission. i hope that your wife is doing okay, but she would have gotten exactly the same care. . guest: i would agree. in fact, last year we provided $30 million in uncompensated care, as the doctor said. we also provide free diagnostic care to out-patients at the arlington free clinic and at the arlington pediatric center. the experience here is typical of america's nonprofit hospitals. that is why we are here. host: you also have a business to run. where did -- who did that $30 million go to? guest: part of it was patients

who could simply not pay their bills. parted it was a subsidy of medicare-medicaid. around $5 million to medical education expenses that are not fully reimbursed. we are a teaching hospital. we provide training for residents at georgetown, primarily. so there is a lot of expensive and is not directly reimbursed. host: 9 law, do you have to treat anyone who comes to the emergency room? guest: as a nonprofit hospital, guest: as a nonprofit hospital, that is part host: is that federal? guest: i am not really sure. it is simply what we do. guest: a physician has a choice.

guest: the physician does not need to enter into that relationship, but again, that is what physicians do. host: that brings it in the liability issue how many lawsuits are pending against a hospital at any one time? guest: i would say perhaps one or two. host: is that a big concern for you, liability issues? guest: it is a concern on two levels. one on the immediate effect of being sued, and what goes with that, but perhaps a larger concern is the cost of defensive medicine. trying to make sure the hospital and individual physicians are in the best possible position to defend themselves. we are fortunate in virginia to have a cap onalpractice

awards. but i read a study recently by price waterhouse coopers on the cost of defensive medicine. they are estimating it is as much as $200 billion per year. we are in the midst of a discussion about national health reform. obviously, everyone wants to see everyone injured, but that costs money. -- insured, but that costs money. i am disappointed that the legislation has not looked at the cost of coverage. when they are estimating that $200 billion per year is spent in duplicative testing, consol that may not be necessary, but

are necessary to define that primary-care was rendered. i think that is a sincere that needs to be addressed. host: waukegan, illinois. caller: i want to answer the first caller's question about if he would have gotten the same care. i have had two heart attacks. i am on medicare. i have good doctors. perhaps you will know my doctor. i am located in waukegan, illinois. i watched the questions last night. not wanted to ask him say -- wanted to ask him to repeat that private insurers needed some competition. thank you. guest: private insurance does need competition. my understanding is there are restrictions about competition

across state lines, and other restrictions. i think competition is good, and competition would ultimately bring the price down. guest: all i would agree. one topic in reform is insurance reform. one of the straight forward things that could be attacked is to come up with a corporate regulations so that insurance companies can compete across state lines. it has been argued that there are 17,000 insurance companies but there is a reality that in any given state there are state regulations. opening up insurance across state lines could be a big help.

host: would you rather deal with medicare or bluecross blueshield? [laughter] guest: with bluecross blueshield we get to negotiate contract every few years. with medicare, every few years they tell me how much they will pay me for an admission. so it is a negotiating militia chip with private insurers, medicare and dictates what they will pay. host: dr. garrett last night said that insurance companies, are in a sense, overcharged, because medicare under-charges. as a former patient in this hospital and someone who has good insurance, i presume i was overcharged? guest: as i said, medicare 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, absolutely. private insurance companies and their subscribers subsidize the underpayments net government interest pays today. and they are fully aware of that. host: so one person could be in a bed over here at $100 a day, your cost. but the person with medicare could be paying $75? guest: that is a fair way of putting it. host: next phone call from del rey, ohio. caller: i wanted you to remark on the employee insurance coverage at your hospital. i work and a small private hospital here in ohio. we have seen our premiums double in the last six years.

my deductible now it is now $2,000. and i am working at a hospital. they have a two-tier program where nurses can get a $1,000 deductible 9010, and i feel like i cannot get coverage that is affordable and decent, and i work with people all day. we all know what a 80/20 plan would mean. our hospital has had employees with cancer who have had to have spaghetti dinners and car washes to help them pay for their medical care. guest: i think insurance offerings of hospitals, employers, they vary from

location to location. we have been fortunate here to provide 100% coverage for hospitalization for any employee to use the services here. we do have deductibles. it is just a few hundred dollars. it varies among hospitals, as it does among all employers. host: as a businessman, are you offering your employers competing plans, do you have a contract with one insurer? guest: we give them a list of choices. we will probably offering another one next year. host: but at the same time, it is an expense. guest: absolutely. host: next phone call from upland, calif.. from the uninsured line.

guestcaller: i have been uninsu for about 12 years, i have not really been sick. i do have two questions. basically, how much of the funding that your hospital gets goes to nutrition, diet, teaching? guest: guest: -- we do not havec

funding for that. host: let us talk about preventive care. how much emphasis is put on that? guest: first of all, we are a hospital. if something in the past has not worked, i think preventive medicine is extremely important. i do not think it is a valid argument that is going to save the day because people are still going to get old and get cancer, heart disease, hospitals. but i think that preventive care is key for younger groups, to establish good habits. three, four decades from now, we

could reap the rewards. host: indiana, on the in sured line. caller: i wonder if you read the "new york post" article that was out last week? there was also an article where he talks about connie terrorism. coverage should be held for those who are non-disabled. not from those who are potential benzes and. an example is not guaranteeing health services to people with dementia. also, dr. blumenthal has long advocated government spending controls. he concedes there will be associated with a longer wait and reduce availability and new

devices, but he says it is about time americans get good care. he also says basic amenities like hospital rooms provide more hospitals. this kind of goes against what the doctor was saying about wanting to have the advanced care, the latest technologies. it sounds like what they want to do is hold everything steady to keep costs down and not treat patients as patients but as pick and choose, everyone gets the same will quality health care, instead of high health care. host: so what is your opinion about all that? caller: i believe we need health care reform, but i think it could be done easier. there are only about 15 million people who need this.

to overhaul the whole thing for just 15 million@@@@@@@@@ @ @ @ i think this could be done through private health insurance with some regulation. i have seen at tea parties with the representatives, they say they are under private health care and we will be. once you are off this, you almost have to take the government health care.. >host: anything you want to respond to? guest: the ama doesn't speak for many physicians, but i do think

there has to be some practicality in what we spend. i think you can start with physicians' and families and all of us being aware of what things cost. and at least having a discussion about it with the patient or with the family before doing it. you know, traditionally, doctors have not had that role. we just do what is best. i think it does behooves us all to understand what the costs are and make practical decisions. guest: i would concur with his remarks. host: this year relationship as chairman of the board and president? how professional? -- what is your relationship? guest: he is the boss. dr. garrett is chairman of the

board and has done an exceptional job in casting a vision and even a passion throughout the organization for political excellence, and the whole piece that you experienced, when you are here, a real passion for the entire patients experience. as you know, and i think most people that are watching know that when people come to a hospital, it is usually because they're concerned that something is a very wrong. so they're very anxious, and in many cases, scared. so we really work hard in that not only providing good clinical care, but being sensitive to that anxiety and of trying to help relieve that. that spirit in the direction comes directly from the board and from dr. garrett as chairman.

guest: i am here a lot. my office is right upstairs. over the past decade, obviously, i have gone into his hair a lot. host: are you employed by the hospital or private? guest: i am a private practice. host: when you say you have an office here, do you rent the office or own it? guest: i rent the office. everything that i use here that is not mine, i pay for it. host: is that a revenue stream for the hospital? guest: it is to a certain degree. on campus, we have several medical offices that are leased to private physicians. host: do any of the doctors' own their offices? guest: in one of the buildings, the offices are owned. that building was built in the 1970's, i think. host: do you get patients as customers? guest: partially, in the sense

that we want them to ce back should they have future needs. this gets to not only providing the technically correct care and the clinical care but trying to satisfy their needs and treat them as human beings, the way that anyone of us would like to be treated. host: do you find that a lot of people do not understand that a hospital is a business and needs to make money or they have a disagreement with that philosophy? guest: to be candid, i do not think a lot of people here to fore have thought about that. people tend to not think about hospitals until they need one, and then when they need one, it is very urgent. and the financial aspect of that is taking care of after the fact. host: next call for jim cole and dr. garrett comes from union city, new jersey, a medical

professional. caller: yes, i think some words are important to understand. when you talk about cost, i think what you are really trying to say is, what is your price or what are your charges, not what is your cost. i would say that -- to that, our costs of business have increased tremendously over the years due to regulation, medicare requirements or accreditations, continuing education 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 reimbursements. the other thing is, not enough doctors -- she know, i think that is a code message for the

medical schools and the teaching hospitals wanting to get more money from the government. lastly, i would say that, as a medical professional and provider, i have to agree that medicare advantage programs should be eliminated. and think it is a windfall for the insurance companies, and it is not necessary. i think medicare does a good job of regulating providers. that visit. host: what is your profession? caller: i have a small private practice. host: you are a doctor? caller: i am not a doctor. i provide artificial limbs and braces and orthopedic shoes. host: so a medical supply company? caller: we're a prosthetic and

orthotics provider. thank you. host: what would you like to respond to? guest: the part about it maybe being a facades that they're not enough doctors. i would not agree with that. at the that there are fewer physicians being trained. i think that the horizon of what it will be like to practice medicine has changed somewhat. i know in the field of surgery, there is expected to be a shortage of surgeons in the next 10 years. in my own field, cardiac surgery, we're currently not filling the training slots that had waiting lists to get into a one time. part of the reason for that is that you're typically i knew their mid-30s when you finish your training to be courteous surgeon, and that is a long

time. and of the type of person that wants to do that is also typically the type of person that wants to be independent and not so are barely regulated. so it stands to reason that that person might pick something else to do. >cguest: i was 35 when i got my first job. host: what was the full cost of your medical training? guest: what i can remember is i went to emory in atlanta, and my tuition was about $5,000 a year. then i went to the university of alabama in birmingham for medical school. it seemed like it was about $10,000 per year for four years. then i started training in surgery. in those days, we made about

$14,000 a year and slept in the hospital every other night. but what they used to say, that is better than nothing, the older guys would say they did not pay us anything. but when i finished, i note, you know, a lot of money. it took me, like a mortgage, probably dictate to pay that off. but i was lucky i could pay it off. no regrets. host: we learned last night that your wife is a pediatrician and you are a cardiac surgeon. what is the difference in your malpractice insurance rates? guest: it is huge. my rates are exponentially > my wife's. which in my rates are exponentially greater than my wife's. i would say probably 50 times more than she has.

host: is there a doctor anymore that has not been sued? guest: i think there are doctors. i mean, personally, in my entire career, i was sued one time, and it was dropped. ok. but this still does not change this the year that is ingrained in all of us. we just do things a little more over the top to decrease the possibility that someone might ask why we did your did not do that. host: our next caller is from michigan. it is on our uninsured line. please go ahead. hostcaller: this morning. i had a heart attack last june at age 46 and ended up in the hospital and had complications.

i lost 10 units of blood and almost died. i spent two weeks in the hospital. i am is starting to feel a little better. i am still weak. i do not have a lot of strength, but i am doing the best i can. i cannot work. for i now owe the hospital $218,000. i have no insurance and have not had insurance in the last five years. host: are you employed? caller: not anymore. i lost my job when i had my heart attack. i do not have any medical leave. now i cannot be insured because i have a pre-existing condition. i am extremely bummed out said it was taken off the tape -- table and i will be angry if the public option is not included. if you leave health care in the

hands of the private sector and ford as private entities, nothing will change and i will be left out of the loop and so will my family. i am just tired of it. i am tired of corporate america running everything. that is all i have to say. have a nice day. guest: it is certainly a difficult situation that she is facing. i think everybody wants to see a system where everyone can be in short, were there no -- people do not lose insurance because of prior history or complications. we just have to find a responsible way to pay for it. host: that woman, $218,000 -- would she be allowed to come back to this hospital going bad? >> of course she would. at that amount, i imagine the

hospital will work with fiducia she can pay anything toward that. -- will work with her to see if she can pay anything toward that. she or an insurance company will pay it. the cost will be passed on to other insurers. host: next call from kentucky on in the injured line. -- on the insured line. hello? please go ahead. caller: please do not cut me off. we only get on one surplus a year. i wanted to tell the gentleman -- i appreciate the doctor being so candid about treating the patient regardless whether he could pay or not. if this bill was over $1 million, i expect he would have had to take bankruptcy to be

able to afford to care for his wife. and we know that that is the leading cause of bankruptcy in this country, medical liability. the other thing i wanted to state, i have two or three questions. for those on the advantage plan, humana is the local insurance company here in louisville, and i read that they had a 44% profit last quarter, and i think there major focus has been the advantage plan. my representative is willing to take the choices that we have if this passes. i have heard several other legislatures, so that is another myth. the other thing -- isn't there a

government program that is reimbursing some what you're igdrr@ @ @ @ @ @ @ @ @ @ @ @ @ r we have had many doctors charged with selling drugs and fraud with medicare, and several sexual assaults. and i would like you to comment on that. >> we have three things to talk about. medicare part c. this is coming to your life? -- come into your life? host: what about a government program to reimburse the hospital for an insured people. host: i am not aware of such a program. host: finally, medical monitoring, how are doctors monitored? guest: well, in the hospital, there is a committee called a

clinical risk-management committee. and any sort of event that happens relates to a physician in the hospital, it goes to the committee. it is discussed by committee of the physicians peers and appropriate action is taken. on the broader point, doctors are people. just like most people are good, not everybody is. i am the first one to get in line against the dishonest physicians, of the physicians that are over prescribing fraud. but most doctors, like most people, are good. host: we learned last week from tom scully, former head of centers for medicare and medicaid, that only about 40% of

doctors are represented by the ama. use it if you're not. worry not a member of the ama? -- wiry not a member? guest: that sort of person within the leadership began at not to speak for me. i am independent. i am not -- i want to maintain the ability to practice in the pan and medicine and not be overly regulated. and i think the ama crossed the line years ago. host: president obama had some hospital executives in a month or two that, and of the board hasn't there were going to save $155 billion. what was your reaction to that? guest: well, as i said, i think it is achievable, frankly.

but it has got to be done in a responsible way where those hospitals that have done a good job of controlling costs and providing high-quality are not penalized. and we do deal with the geographic variation in cost. there is documentation that there is significant variation. but we need to be focused on reducing those costs in the high cost areas and promoting the incentives and trying to learn from those areas that had a low costs and good quality. host: next call is from california. a medical professional. guest: i have a segment -- i am is 73 passio-year-old working physician. i know this is a personal question, but you are on

national tv. i would like the doctor to tell me how much money he makes out of just doing his medical profession and how much his wife makes as a pediatrician. he is a cardiac surgeon. the difference in their incomes would be very interesting. number two, this hospital that you are talking about right now or you are in is a very elite hospital. i am in a small town, and hospital just recently built a $7 million cancer center, a whole new building, yet they are all crying about losing money and the government is not paying enough. where does the money come from? i watched a new cancer electronic scalpels last night that your hospital bought for $7 million. there is a lot of ways in hospital competition and hospital expenditures that would

go to help poor people. host: i appreciate your call. how much money do you make? guest: i was a gynecologist practicing in the center valley. most of my patients were in the agricultural and -- industry. i am a board certified gynecologist and spend about the same amount of training as you did, and i made about $250,000 a year and that was next. i could have tabled that in new york city or san francisco. host: thank you for being so candid. >> i will pass on the income question. but i will comment about that instrument. we do not lose money.

we made 1.7% and a larger last year -- margin last year which give us money to say if and also to buy new equipment. a typical equipment budget can be as high as $30 million. if we lose money, we will 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 poor people, we care for poor people. last year, over $30 million in uncompensated care. if you come to this hospital and do not have insurance, we've made you, is semantics care of you, i will brief you, and i will see three times a day and

in the middle of the night. does not matter. host: is va hospital center and elite hospital? >guest: i think we are at least in terms of our medical and nursing staff and the way we have been able to equip the hospital over the years. but to put that in perspective, last year we had about 1.7% bottom line on roughly $288 million. >host: so little over $30 million? guest: have to add the depreciation expense on building and equipment. so our bottom line was about $4.5 million. from that, we have to reinvest in equipment or more. i think you would find most

organization not bragging about a 1.7% bottom line. we are essentially break-even. many hospitals in the country are below break-even in their financial operations. we are fortunate. we're in the washington metro area, are relatively affluent area, where many people have good reimbursement. yet, we're delivering over $30 million in uncompensated care. host: where does that $30 million fit into the business plan? is that part of the overhead did you include? >> it is an expense just like supplies are an expense, care that is not compensated is an expense as well. host: we have a few minutes left with our two guests from the va hospital center. wichita, kan., on our uninsured line. caller: the morning. -- good morning.

i have been interested in how this scenario plays out. i will like to ask a question to people there. if i break the windshield of my car and called to get it repaired, and they ask me if i am ensure your nod. -- if i am ensure the warnock. because they have different prices. what would be the circumstances if there was a moratorium on all insurance paid to hospitals and doctors for a year, what would that do to the cost of health care throughout the country? and of the cost of supplies for the hospitals throughout the country. host: to vote.

-- thank you. guest: the question is, what would happen if there is a moratorium on all interest payments to hospitals around the country? the liberal answer is that most hospitals would close their doors. it is very unusual for in the hospital to have roughly a year's operating expenses in reserves. host: dr., use of the snide the people who ask the press -- she said the people can come. if people say they have cash, how much will charge me? guest: i said the people to ask about how much it is our people not that can afford it but our

people who have money. not that they can afford it, but they have money. because you can afford to write a check for $50,000 for hospitalization? but if you have some means, then you're going to be responsible for that bill, so that is a scary thought. we negotiate with insurance companies for payments, but for patients who do not have insurance, in our private office, those are the patients that we will lower our fees. face it, insurance companies do not pay me what i charge. so why should someone who does not have insurance have to pay what i charge? we at least give those patients

a break and let them be charged on what an insurance company would pay you. guest: perhaps the best way to answer is to give a personal example. several years ago, my father was hospitalized at duke university hospital. a fine institution. he was on medicare. medicare paid most of that, but his only income was social security at that time. there was not a reserve. we made an agreement with the hospital to pay a small amount per month over time. he did have some income. we could assist with that. so the principle is, i think, in common practice for people cannot pay, they do not pay, but where people have the ability to pay toward those averages that

most hospitals will make an arrangement for payments over time. host: why did you become a hospital a administrator? guest: it probably all started when my father was hospitalized when i was a teenager. i never really had any interest in madison, 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. i thought it would be neat if i could find a way to be 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. i want to say thank you for all the wonderful things that you said about registered nurses last night. that was great. i was a registered nurse before and after medicaid, drj, cody, hmo'sj, and ppo's. so i saw what happened with health care as each one of these programs came into effect. with a drg, when they did it trials across the united states, i had a friend who was the administrator at a local community hospital. he said to me, is drg's to come into a fight, you will never ever do primary nursing care the way that you are doingow. and nothing could be more true.

i eventually left hospital care, went back to school, and got a degree in public health education and did community needs assessment and programs. now i am retired. i have medicare and the top of the line insurance. i recently moved to the raleigh area last year -- host: i apologize. could you get to your question. caller: right before a move here, it the doctors at duke and other university stopped contracting with medicare. so i have to pay up front for all of my care because the doctors here do not accept medicare anymore. this is a growing problem that needs to be addressed. i hope that men like you will step forward and address that problem. host: thank you.

now you have to accept medicare patients? guest: we do not. but we choose to. i mean, bottom-line is most of the patients that we operate on for heart surgery are older and have 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 helping people. heart surgery really makes people better. that is really true. host: do you have to accept medicare patients? guest: the hospital does have to accept medicare patients. but she is exactly right. it is a growing problem that physicians, especially internist 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 with your 300 yourself physicians? guest: yes. their number physicians to do not accept medicare in their offices. and of the reason is that is simply does not pay them enough to make it worth their while. as we look at reform, again, we cannot lose sight of the initiative for this whole debate over reform which was extending coverage to everyone. so that means even more people seeking more care. that means we have to make sure we have an adequate supply of not only physicians but also nurses. so it is the manpower issue and will be critical going forward. host: last call for our guests from delaware. caller: thank you so much for

taking my call. it is in such a blessing. i would like to start by saying my mother is a gastroenterology nurse and has been for the last 20 years. my husband supper's from -- suffers from epilepsy. for the last five years, we have not have insurance. recently, my husband did and my 5-year-old daughter did it approve for medicaid. i currently am uninsured. but my daughter and 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 and the both the doctors take? recently, my husband, in terms of try to get medicaid, it was an uphill battle. we were denied three times before we actually got it. so my husband and my daughter

have medical insurance. where is the morality in this issue? i have heard the administrator and a doctor about this taliand looking at losing money. even in maryland, there was a case of a little boy who died of a tuesday. he could have had his life saved force of the dollar extraction. someone address this morality issue, please. guest: this whole discussion about health care reform is about finding a way to provide coverage for everyone. the caller is intended to qualify mark -- for medicaid. at this hospital, which employs several people whose sole job is to work with patients who are admitted here took him toork through the bureaucracy and medicaid to give them qualified

for that. anyone who comes to this hospital, and i will say in the hospital in the united states, will receive care regardless of their ability to pay. guest: and it is the same for physicians. we have no say of how you get insurance or how not to get insurance. i believe that everyone needs to be insured. but if you wind up here and need something, physicians will take care of you. host: thank you for your hospitality, and thank you for taking the calls from the viewers. >> "washington journal" is live from virginia to cover the health care perspective of the doctors.

tomorrow the guest will beçó the chief information officer. then we are joined by the heads of [unintelligible] and the chief of the nursing office. >> as the debate over health care continues, the health care hub is a key resource. watch the latest events including the town hall meetings and share your thoughts on the issues, including video from any town halls that you have gone too. and there is more at c-span.org /healthcare. >> in a few moments, the senate republican conference hosts a town hall meeting. deval patrick will announce that there will be an election in january for ted kennedy's seats.

the interior sec. salazar on a memorialñr forñi flight 93 on 9/11. >> a couple of live events to tell you about. the former abasaddor talks about the threat from the nuclear -- ambassa#'$ talks about the thread of iran's nuclear program. then how the japan election may effect japanese-u.s. relations. >> the senate republican conference hosted a town hall meeting in louisiana, this is one hour and a half. [applause]

thank you for being here. good afternoon and welcome to the health care reform forum. pelosi may think that you are an anti-american mob by i am delighted to see you here. i am also delighted to be joined by four other members of congress, a colleague from the senate and house members representing different parts of louisiana. let me introduce them. john grasso of wyoming was

appointed in 2007. he is known as wyoming's doctor. in 24 years as a surgeon he served as the president of the wyoming medical society and was named physician of the year. he also brought low cost health screening exams to people across the cowboy state, and represented natroma county in wyoming for many years. welcome him. [applause] [captioning performed by national captioning institute] [captions copyright national cable satellite corp. 2009]

>> we are delighted to have rod ney alexander, representing the fifth congressional district. rodney was the chair of the house welfare committee and he brought through the louisiana children's health insurance program. he believes there are areas to help the health-care system, he is against the current bill because this sets the tone in washington for the takeover of the health-care system. welcome rodney alexander.

." >> he represents the first congressional district and so many of you. and of course before being elected to congress, he served for 12 years in the louisiana legislature. steve is a member of the house commerce committee, over the largest part of health-care legislation. he has taken the position that individuals should be in charge of their health-care decisions, not bureaucrats. steve's police -- steve scalese. [applause] >> last but not least is congressman and doctor john flemming, representing the

fourth congressional district. he has spent his career as a family physician, and was named to the doctor of the year in 2007. we have introduced legislation requiring that all members of the house and all members of the seine at are put in any government option that may be passed, welcome dr. john flemming -- senate are put in any government auction that will be passed. welcome dr. john flemming. why don't we all get started in the right frame of mind, and the right frame of heart, by standing up for a prayer. and please remain standing after the prayer. we will have the pledge of

allegiance. we will be led by al carter of the living water baptist church. >> heads bowed and eyes closed. father, forgive us for our sins of ommission and give us the strength to release hatred and forgive one another. we kno you will not forgive us unless we for give others. we ask for your guidance as we cover these issues that will affect all america, and ask that you guide the leaders in the right direction. you will turn this whichever way that you will, and we pray that this will be healthy discourse and peaceful.

let me tell you that as you give the instruments of healing to man, the healing of man is through your hands. we pray that where there is sickness, that there will be healing, and whether is poverty, let there be prosperity. where there is ignorance, let there be knowledge, and where there is knowledge, let there be peace. we ask for special blessings for the president's and for sen. -- president and for sen. vitter and all of the congressman. we pray for the protection of the children and the elderly, and peace in jerusalem and finally, we ask for blessings upon the state of louisiana, and the united states of america. we ask that we will remain, one

nation, under god, individual, with liberty and justice for all. this is by the name everyñr knee shall bow, our lord and savior, jesus christ. >> thank you, reverend. >> and now we will be led in the pledge of allegiance to the flag, by the mayor. >> thank you for coming here, and thank you for all of the good things that you have done. i pledge allegiance to the flag of the united states of america. and to the republic for which it stands, one nation, under god, indivisible, with liberty and justice for all. [applause] >> thank you, and again, thank you for your help.

. your comments and your questions and/or concerns. if you have not already, please use some of the sample pieces of paper we're handing out to jot down your name and your comment or question, and please pass it

to staff, and then we will go through absolutely as many comments and questions as possible. i am going to announce a few people ahead, said that when your name is called, if you could move to the microphone here in the aisle, and you'll be ready for our conversation. we certainly want to follow-up conversation. with that, let's get started. and let's start with dr. john barrasso. >> thank you. i want to thank all of you for being here and joining me along with senator vitter, who is truly a great american. we went to afghanistan last easter, and it is a privilege for me to serve with him in the united states senate. [applause] and we have such respect for our military. it is all right for you, we would ask all of those here with us today who have ups -- who

have served our nation to stand out, and let us thank you. [applause] i had a chance of one of only to doctors to serve in the senate to talk about the issues that we are trying to face. these are vital if shoes, personal issues, that affect all of us. health care is such a personal thing, and no matter what they do, it will affect every person in this room, every person in america, and it is one sixth of our economy. it is something that we all must take very seriously. i'll tell you, ladies and gentleman, we do. i walked out here with this big briefcase because i wanted to show you some of the bills.

[laughter] people say, had you read the bill? this is house bill 3200. i held this up at town hall many -- at town hall meeting in wyoming, and someone in the front row said, burn it. [applause] and then they say, what about the senate bill? this is just part of it. the paper clip was only big enough. this is the help committee bill in the senate. oh, there is more. one minute. [laughter]

and then in wyoming, they said, start a bonfire! [applause] and tom coburn and i have been traveling the country with our senate doctor show, we were in omaha, neb., northern mississippi, northwest arkansas, and we have been getting crowds like this saying, this is not what we won. there is a member of the house of representatives from michigan, they asked if he was going to read the bill. he said, read the bill? it would take two days and two lawyers to explain it to him. if it takes two days and two lawyers to explain it to any of us, we should not be passing such a bill, and nobody should vote for that kind of a bill. [applause] i do not know how many of you

watch fox news on television. [cheering] i had the opportunity to be on theire this morning, and we were talking about these bills. i will tell you, we are at time when our nation is spending too much money, borrowing too much money, and there are too many government takeovers. and we have to stop it. [applause] now there are folks who actually believe, and nancy pelosi is one of them, she actually believes -- barras[booing] she believes that all of these people showing up to a town hall meeting as contrived and people are being paid to be here. people are here for the right

reason, because we're trying to protect our freedoms. [applause] i could go on and on, but david has a whole list of questions. it is better for us to hear from you than you to hear from me, anyway. thank you for letting me be with you here today. my friend, david vitter. >> thank you, john. let's get to the heart of the program, and your comments and concerns and questions. how first comes from married -- our first comes from mary, and let me mention the next three, charlotte, lanny, and david. if he could make your way to the floor. mary asks, how can you get health care to all without

financially destroying the nation? john, would you like to take a crack at that? >> we have other doctors and members of the house here. but this is an excellent question, especially in these economic times? is there enough money in the system? you can debate whether there is or not. we are spending one sixth of all the money in america. we know that medicare, a system that helps people who are seniors, helps them, but there is more waste, fraud, and abuse in that program than in any other government program. there is money that can be dealt with. drug deals in florida's big drug dealers are getting out of that in florida and getting into medicare fraud. the punishment is less. there are things that we can do to improve the system. but the president is trying to do is expand coverage to 47

million americans. about 11 million of these people are not americans to begin with. many of them have come here illegally. [applause] we can do more with prevention. david, with these economic times, the president says that we want to do it without increasing expenses. but then the price tag on the one bill is of $1 trillion, and the bill that i brought out in four sections, the telephone book version, the reason they have not down debt, even though it passed along partisan lines come up with the democrats voting for it and all the republicans voting against it, they have not bound together because then everybody gets to read it on the internet and they do not want to see what is in it. they also do not want to put a price tag on it because it will be much more expensive than the house bill. it is a trojan horse that we're

not going to be able to do it in the way that the president promises. he promises one thing and it is another thing when you actually read the pages of the bill. to me there is a gap between the president's rhetoric and reality printed in these pages. the pages are what i am opposed to. [applause] >> anybody want to comment on costs? >> in the senate, he pointed out some important points. according to the congressional budget office, you don't need to listen to what one side or the other says, but the impartial cbo says that h.r. 3200 will have to wonder $39 billion in increased national debt, in addition to $800 billion in new taxes in that bill. their bill that they filed has

$800 billion in new taxes, and there's still $239 billion out of balance. >> any follow-up? >> thank you, everybody. you answer the question, but those numbers are so overhead. for the sake of my family's future and prosperity, i cannot be according to be ideologically blinded i believe that death penalty -- they are promoting america's suicide. [applause] the most powerful weapon against america are not terrorism, but ignorance, complacency, and disdain of our history and guiding principles. we are close to losing our liberty. we're patriotic but had almost forgotten why, but we have this

moment in history to stop suicide. i have this moment to tell you, david, congress, and president obama, you were never given the right to destroy and enslave the populace. thank you. >> i thank you very much. [applause] charlotte -- will the senate be covered by the same lot that they an act for us plebeian? i find it reprehensible but a house committee rejected that amendment that said just that. charlotte, you are right. you are very right about that. as i mentioned, dr. fleming and i both thought that that provision. on the senate side, that will be my first amendment on the senate floor. if there is any government option in the bill, anything like that, then every house

member, every senator, all of their immediate family have to be in and government option, no other choices. [applause] no special attending physician at the capitol, no special privileges at military hospitals, nothing else. the government auction. -- the government option. charlotte, anything else to add? >> that is all i wanted to hear. >> john has often the same thing on the house side. >> thank you, david. i set forth house resolution 615, which some of you may be aware of. it simply says that if you vote for a government-run health care system, and you in congress are willing to forgo the waiver in this bill and you will sign up for yourself.

as david pointed out, he often said the senate version. to date, we have over 500,000 americans who are encouraging their representatives to do the same. we have 70 fonder -- congressman, including the gentleman behind me, who are also co-authors. i have reached out to every single democrat and house, including nancy pelosi, and not yet one has been willing to sign up. ba[booing] >> i am rodney alexander and i represent the fifth congressional district, lying to the north of baton rouge all the way to the arkansas line. i am also co op -- a co-sponsor of dr. fleming's legislation, but i personally believe that if any of these bills lying on the floor pass, it really will not be relevant anyway. i think we will all be under one

plan. i think that is the motive, to put everybody under one plan. i think it is even more misleading than having leaders, especially the president during his campaign, who often said, i want to make sure that everyone has access to the same type quality health care that members of congress have access to. well, i want to tell you, my wife and i have been here 42 years. my wife is a schoolteacher, a full and for over 30 years i have been a member of the louisiana state group benefits health plan, still am today. i do not have access to any more quality health care than the spouse of any other school teacher or state employees in the state of louisiana. the employee is that we have have to pick and choose from the cafeteria plan. some of the employees i have covered by blue cross blue

shield. if i got off of the bird benefits plan, i would probably have to sign up on blue cross blue shield. but we have to pay for the insurance that we have. we do not have this high in the sky plan that many lead you to believe that we have. >> charlotte, york exactly right that this very an amendment you were talking about was proposed in house committee. the problem is that the proponents of the bill defeated that amendment, killed that amendment, including one louisiana congressman voting against it. [booing] lanny, what are you doing to defeat this bill and can reconciliation succeed if they try that route? one thing -- dr. barrasso is joining with the only other doctor and the u.s. senate, doctor, -- dr. tom coburn of

oklahoma, and have a doctor show and they are doing an enormous amount of outrage about this issue because of their medical background. -- out reacreach about this iss. maybe you can talk about reconciliation. >> very few people in the united states senate note the rules better than david vitter. i have not been through reconciliation fight. but i am trying to visit with people across america. at the time of the revolution, benjamin franklin said that one- third of our nation was the tories. one-third were timid, and at third were true blue. that is all of you right here in the audience. [applause] franklin said that the battle is for the timid, to get to the people that have not made up their minds yet. and that is what i am trying to do, traveling around making sure that the boys of the american

people is heard and that the knowledge is there so that people will come to the same conclusions that we do, that this is not what we want for america, for our future, for our children or their children. >> do you have a follow-up? >> it seems like we're losing the more in the media. what can we do to solve that problem? >> i understand your concern. but i will be honest with you, i don't care how the media covers us. in august we have been winning the war, and we can go on and win the war if we keep at it. [applause] to me, the big question is this -- are we going to keep at it it, as in back -- as active and involved citizen? are we going to stave vocal and passion and? will we stay in everybody's faces, not just in august, but

september, october, november -- however long it takes? [applause] ok, as we go to donald preston, let me give the rest of the batting order coming up. jeane, joan, and barbara bailey. first, donald preston. ." and obama says at a town hall meeting that medicare advantage plans do not work. i have had people choice 65 for years. it works for me. zero charge for operations, including doctors, as an example. well, donald, i agree with you. that is why i'm opposed to cutting that out. but let me just say, one of the specific proposals from the proponents of this bill in terms of how to pay for it, it is a

$500 billion cut to medicare, $500 billion. and absolutely, medicare advantage is that the top of that hit list. please note that. >> i want had some. the president had a town hall meetings in montana, and then in colorado, and said if you have a program that you like, you can keep it. in the same speech, but we're going to eliminate medicare advantage, which is for 10 million american citizens. i am sure that there are people here today. we had 3000 in wyoming. when they put that program in the place, it was intended for people in the cities and people in rural communities. that is louisiana. i had the privilege today to tour the new louisiana state university medical lab area. incredible, stated the are, doctors all around the country

and maybe around the world are going to come there to learn to do with computer simulation, surgery. i'm an orthopedic surgeon for 25 years. it is beautiful what they have there. cardiologists learn how to put stents in the heart, taking out all platters, learning how to resuscitate prefer nurses and doctors, it is absolutely incredible. and they also have a program to help train physicians to travel -- to work in rural louisiana, to help put their tuition so that they will stay after they learned, to be the primary care doctors that we need in this country and in all of our rural areas. i think medicare advantage is very important. i also had the privilege to look at the community health center that tulane has. data not just toward their, 25 different community groups together, and it is a labor of love by these doctors and

nurses, helping their community. it talks about the people in this community, and with samarra being the fourth anniversary of hurricane katrina, to see what these folks have done and how they started with a tent. they are right after the hurricane there, and they will move into what used to be a steak house, a beautiful new clinic, designed to help people in the community. this community reaches out, one person helping another, and the community should be very proud of it. but that the universities, remarkable. but getting back to medicare advantage, it means a lot to 10 million people. what brought that to say that we're going to eliminated, it is not good. i take off -- i take care of a lot of people with broken hip with medicare advantage. lower out-of-pocket costs, it helps coordinate your care, it's helps prevent it care, medicare does not do it -- to a good job of that.

can medicare advantage be improved? sure, but to say that we're just going to eliminated is a mistake. >> donald, do you have a follow- up? >> i completely agree and banking -- and i think you for listening. >> jean, explain your part in the pro-life vote? i will put this to steve. -- punt this to steve. >> and commerce committee, i caused answered a number of the event -- amendments, including one that would have forced all members of congress to join the public plan, even though i don't like the idea. i think it is a bad bill but i do think that you put your money where your mouth is. it think it is a good plan, you join it, and they all voted against that. every member who voted for the

bill voted against that. we did have an amendment on abortion. there was one amendment to mandate abortion, as a matter of fact. there's a lot of dispute over whether abortion is in the bill. don't believe any politician. washington national to write -- right-to-life says that they express strong opposition because it would predictably result in the greatest expansion of abortion expansionroe v. wade. we turned around and brought up a next -- an amendment to ban abortion in the bill. we actually passed it on a very close vote. unfortunately, they turned around an hour and a half later, arm-twisting, a lot of games played, and you can go watch the tape on c-span, henry waxman, the chairman of the committee, brought it back up again and defeated our amendment using a procedural trick.

unfortunately he voted with henry waxman to allow them to bring it back up again and kill our amendment that bans abortion in the bill so that it reverted back of the form that it is, which according to the national right to life, would fix -- resulting expansion of abortion. we forced the vote and you can find husbands. we would be happy to get you copies of them. they did occur, unfortunately, the defeated our amendment. >> the you have a follow-up? >> i like to mention that i am very disappointed that the people of south louisiana, who are actually some of my flavor -- some of the most flavor ball in -- flavorful and well- respected people, are blinded by their liberal views. a good old boy is not the -- always the one that works.

>> joan --where is the republican health care plan? why is it not publicize? the democrats keep saying that republicans just say no. to the republicans have a plan? >> we have about five different plans. when we did the senate doctor show, he talks about his plan. i encourage you to come to our website and watch the show, possibly, we do reruns'. republican.senate.gov/doc tors but there are many other approaches out there, to deal with the pre-existing conditions that people have, designed to let people who buy their own health insurance have the same opportunities from a tax

standpoint as people to get their insurance through the big companies. these have been written about, but not really cover that often in the press. yesterday, as we would doing our senate doctor show, we had an interview with cnn, and dr. coburn was asked about it. why don't republicans have a plan? he went on about all things in the republican options. why are we getting the press on that? well -- [inaudible] you will be happy now that c- span is right behind you and they're going to play at this weekend. see the guy right there that say this -- that waved his hand? he is from c-span. there he is. [applause] >> do you have any follow up?

>> yes, david, i wanted to thank you. i think you are one of the most maligned at centers in washington, but you always stand up for yourself and us. i appreciate that so much and so do all of us. >> as we go to barbara bailey, we want ask -- the next batting order. >> that was an important question. there are a few house rules, competing proposals, and h.r. 3200, this is the bill that passed a house committee that i opposed. there is another bill, h.r. 3400, the bill that would put on our web site. republicans.house.gov

we have more co-sponsors on our bill than they have on this. there are 20 members of congress. it has pooling, and we have medical liability reform which they do not even talk about. [applause] estimates are that you could save $100 billion a year just by doing common sense medical liability reform, and we had just four precondition it -- pre-existing condition. buying insurance at a lower price without the government getting involved, and the rationing, and the abortion. [applause] >> as we go to barbara, i like to ask the questioners to make your way to the aisles.

our asks, will you vote no on the health care plan and no on cap-and-trade? my response is that, ditto and ditto, absolutely. [applause] these house members have already voted no on cap-and- trade, and i think everyone on the state agrees on both of those issues. >> i sit next to him on the environment and public works committee. and when barbara boxer glares at our side of the table, i am never sure whether it is set -- is at him or at me. but we are going to continue the fight against this program that will cripple our economy, and triple our energy, and make as more -- cripple our money --

cripple our energy, and make us more dependent on foreign oil. >> that is all i wanted to know. >> all right. you understand that we fight, each one, to be the cause of the clear. is there any hope for tort reform in this congress? [applause] doctor, i will give you my honest answer. in this congress, i think the answer is no. i don't think this congress will ever consider meaningful tort reform. but let me just remind you of the first rule of politics, which i think is relevant there, particularly as we think about the next election. in politics, it is a lot easier to change bodies than to change hearts and minds. just keep that in mind. [applause]

>> let me extend that. you heard howard been only a couple of days ago in a very candid moments saying, well, the reason why we cannot put it in the bill because it will never pass because of our trial are -- lawyer constituents. dollars we will give him a a for honesty -- >> we will give him an a for honesty. >> it is fascinating to me because some of the -- someone who has practiced money for 25 years, my wife is a survivor breast cancer, she has been to the chemotherapy, so i have seen both sides. and every doctor, if you ever

ordered a test that cost the patient money but did not help them get better, because of defensive medicine, we were afraid what would happen, every doctor telling you -- will tell you honestly that they have done it. and it costs all of us a lot of money. and then i see that as president of the medical costs -- american medical association, present obama of was talking about doing something about lawsuit abuse. now i don't mean capps, he said, but he kept it out of every one of the bills, kept it completely out. and it is just wrong. when it passed for reform in texas, rates went way down, a lot of doctors went there to practice. rick trying to deal with an issue of underserved communities, and they found that the number of these tests that were done, the defensive medicine went way down.

$200 billion a year is spent in defense of medicine that does not help anybody. it is an extra consols and an extra x-ray. if a kid gets hit on the head with a ball, you take him to the hospital to check to get out, and you would give the parents a sheet of paper to take, and say, waking at 2:00, when kim at 4:00, make sure that their eyes are focusing in another you are. if not, bring them back. you cannot do that anymore. they will all get a cat scan in an mri to make sure that there is not bleeding to go on so they are not the one in the million that results in a lawsuit. it is notçó only the financial ."costs but also these kids getting the radiation now. we do not want all that the buildup, either. we absolutely need to do something about this. the other thing is about 60% of all the money in the system does

not ever get to the injured person. if there is an entry, the person ought to get something to help them for what aulos is. but 60% of the money goes to the system, and that could be the plaintiff's lawyer, the defense lawyers, the expert witnesses, and it takes too long. he could take 10 years. you want to find a better way, make sure that someone is injured, but that the money gets to them in a timely way. 3"%zejjrjñrñi critical and isóñm something that really can help drive down the cost of health ñicare for all americans. >> absolutely. doctor, do you have a follow-up? ñino? alan ross, a retired marine air to serve his country at reduced rate. [applause]

he served this country at a reduced rate to earn retirement and health benefits. ñiwhat about that versus just giving the stuff away to non- productive people? the one to elaborate? -- to you want to elaborate? -- do you want to elaborate? >> the two benefitsñi that you look forward to is military pay after 20 years. ñibut also, if you've got health and medical benefits for life. those of the two big things. you're just going to give that away to ordinary purple that sat on the cat's their entire lives and have the same benefits that i have earned at reduced rates. you don't have to do anything

for it. what are you going to do to the thousands or hundreds of thousands of retirees in the same boat as me? there should be some kind of compensation. >> i hear you in can tell you this. if the obama plan passes, and the estimated cost according to the cbo of $2.40 trillion over 10 years, what deficits and debt already sky rocketing in terms of the federal government, you don't think that is going to ñisqueeze everything else in the budget, including what weñi have for our soldiers, and military retirements? of course it is when the squeeze all of that. -- is going to squeeze all of that. any follow-ups? bank you. thank you for your service. [applause]

john fleming was a military doctor in use of that first hand. >> i just visited with the va in shreveport and this issue came up. al this impact the va? active-duty military and their families? as far as i am concerned, no one deserves the best this country can get the nose to wear the uniforms of the united states of america. -- can get out ogive more than o wear the uniform of the united states of america. [applause] so why should we get free health care to people who do not belong in this country and deprive it of those people who of given the ultimate sacrifice? -- who have given the ultimate

sacrifice? [applause] bzñrçó from cecil bailey. it may pass this health care reform, will it cover illegal aliens? i would give you my answer. there is nothing in the bill that says it covers illegal aliens. under the four corners of the bill, it does not. but guess what? there is nothing in all of these other benefit programs that says it goes toñr illegals, either, d in practice it absolutely does, it always does. it always does. furthermore, when the other side talks about 45 million uninsured, awful quarter of that figure, 25%, are illegal aliens. i will be honest with you.

iñi think that is a problem, but ñiit isñi a law enforcement pro, not health insurance problem. ñr>> i was wondering why in go's name are we responsible for somebody's help is not supposed to be here to begin with? -- cal who is not supposed to be here with -- to begin with? >> every member of here agrees with you. i think that part of the motivation is a big and as the program can -- that can make those buggers and tip the balance in terms of every future election in this country -- that can make them voters and tip the balance in terms of every feature relation in this country. [booing] here next people.

mary asks, thank you for standing up for life. we all but a the same. -- we all but did the same. how can we be sure and what amendment can you put into the health bill that will ensure that taxpayer funds will not be used to fund abortions, since the hyde amendment is not a permanent provision? >> they are trying to do that in the help committee bill. there was a bill about how money would be spent. and then the republicans said, wait a minute. this sounds like it might pay for abortions. the republicans brought an amendment that said, it just to make it clear, no money in this bill will be used to pay for abortions. that was our amendment. and that amendment lost. all the republicans voted for the amendment as well as one

democrat the mukasey from pennsylvania. but that -- we have 13 democrats, 10 republicans on the committee. they can always let one go to vote on our side. the vote was 12-11 against the amendment, which meant the amendment failed. it makes me think that they plan to use federal money to pay for abortions, it sure looks that way because they defeated our amendment. now they're going to -- we're going to try to do that with the bill that is working in the finance committee. we will continue to try to make sure that federal money does not go to pay for abortions. right now, it looks to me like it does. the glare of the you have a follow-up? >> it is so important because most of the people in our country are pro-life, and it is important that you as senators

and congressmen, that you stand for life as i know that all of you have. make sure that you get something into the law that says that our taxpayer money will not kill unborn children. thank you and god bless you. >> absolutely. [applause] and again, i want to underscore what john and steve have said 3 ñabout this. i think it is so and porn. the proponents of the bill say, this is not about abortion. the abortion word is not in this bill. it is not there. fáand many conservativesñiñi sa, ñibutñi we want to make sure, so here is an amendment that specifically, clearly says, no taxpayer funds in this bill for abortion. and in the same proponents of the bill kill the amendment. what is going on? it is a clear conclusion to reach that that is a very valid

threat. ok, next questioner. how was the panel that will make decisions on treatments is selected, and what are their specialties and qualifications? that level of detail is not in these bills. but there is clearly a move for that. going back to the stimulus bill earlier this year, there was a panel set up, a so-called comparative health outcomes panel, that many of us here is leading exactly in this direction, which is exactly what they have in the national health system in great britain. >> there's also the independent medical advisory committee, to advise the president on where they should spend the money and how to use the comparative effectiveness that senator vitter has talked about. it will have to be approved by the president, some say the

group of five the company gets down to the point you just made. kathleen sebelius is the head of human services. [booing] i was on cnn with her and what she said is, don't be distracted by the details. [laughter] the american people are focused on the details. we care about the details. that is what this is all about. it is very personal. it affects everyone of us very personally. to do is to of hands, how many people they think you will be paying more at a pocket than you are paying right now? look at that. every hand is going up. and how many people, if this goes through, thinks that your health care will be worse than it is right now?

every hand goes up. so the details matter to everyone. a matter to everyone in this room and we're going to fight over the details. [applause] >> carolyn the nixon. the president said if we like what we have we can keep it, and he also says one way he will pay for his plan is to cut medicare advantage. how can he say both? >> i have heard him say both many times. he was to get rid of the medicare advantage, but he says that we can keep the doctors and what we like. we have medicare advantage through our social security. we have to mena and we have been very -- humana, and we have been

very pleased. my husband was pretty much saved by perry >> he has heard the president say that. you are exactly right. he is said both of those things. both of those things are completely contradictory. >> let me follow-up on this, a question about medicare is come up many times. as a doctor who is practice over 30 years, i went back to my clinic this week. this is dated day economics that doctors are involved with. medicare is a beautiful house on a very weak foundation. you need to understand that. by now doctors reimbursement has been cut to the bond. if the doctor has two many of medicare patients in his practice and not enough private practice -- private insurance patients to offset that cost, he

will go out of business. many of them at. as a result of this, if you expand medicare into the single payer option idea, a new poll more and more of that private insurance that subsidizes medicare, the whole system will cave in. that is the whole problemrb4($(+ that is why people on private insurance will not be on private insurance five years from now. it is like a black hole. but beyond that, if nothing is done to medicare in terms of damage to it, it is going to run out of money in eight years. the schedule for a train wreck. the president is going to take out $190 billion to help -- eliminating the 25% in medicare advantage. the president says that it will not come from the services but out of the providers. ok, a heart surgeon today is

paid 33% of what he was paid just a few years ago. an eye surgeon is played the same for cataract today as he was in 1964. if you take $300 billion added that system, what is the chance that it will come out of services? extremely high. if anybody should be concerned about going to government-run health care, you who have medicare are the ones who should be most concerned. [applause] >> this is a very important point. if you like what you have, if you can keep it. i strongly believe that but unfortunately some many people going around supporting h.r. 3200, and let me read the page number on page 15, a health benefits plan shall not be a qualified health plan unless

it meets the applicable requirements. do you know what this does? thi gives the health care czar --and by the way, we have too many of them. we shouldn't create another czar. [applause] it sounds like some of you may have read that section. it gives the health care czar the ability in a lot to take away your plan, even if you like it. he tried to remove that -- we tried to remove this from the bill. not one member who voted for the bill would vote with us to remove it. if you like what you have, the health care czar can take it away, and that is not right.

>> james bruce -- this is off topic so let's cut it quickly. my understanding is that acorn will participate in taking the national census. what can be done to stop that? unfortunately, you are right. right now acorn is an unofficial partner with the u.s. department of commerce in the 2010 census. [booing] i have that specific amendments on the senate floor to bar that. both times they were defeated by a near party-line votes. two democrats, but every other democrat voted know. we need to change that but outcome. -- that both outcome. let me go to health care. two points. for a form of medical mac -- malpractice and a cap on pain

and suffering, and a crackdown on fraudulent health care, what do we think about that? >> tort reform is critical. we have to get that under control. you have to get rid of a lot of these unnecessary procedures. in defensive medicine, there are $200 billion -- and save the system. we have one of these companies in nebraska, right across the road from iowa. in talking to the doctors there who delivered the baby, the same doctor, it is 30% cheaper than you are in iowa. there's tort reform and caps and the other ways to do that. as a postal iowa, it is 30% more for its and doctor, same skill, delivering the baby on one side or the other. it all has to do with the laws and we need to make sure that we do that. and we could dissect all the pages, but the trickery, the

financial trickery is something. to try to keep the cost -- what about the cost? trying to get the cost to $1 trillion, the magic number, they are going to collect tax money for this for 90 years. they are only going to pay for services for six years. that is true. you have not heard that before, probably. but those of the details in the bill. -- those are the details and the bill. the big numbers come in the plate tenures down the road when the cost really go beyond that. -- come into play 10 years down the road when the cost really come -- go beyond that. does the what you find in the specifics of this horrible bill. >> i have a message for nancy pelosi. this is a message. not only did nobody bribe me to

come here, which makes me wonder about her attitude toward bribery, but i gave up hours of overtime pay to be here, because it pelosis and and the obamas cannot be stopped, and take this country's to socialism, it is going to be nasty. that is my message. [applause] >> we will help deliver that, but all of you can deliver it much more effectively. you are doing it, so keep at it. ok, the next batting order, and this may have to be wrapped up. brian, armand, and glen.

we cannot afford i $1 trillion bill. how can we defeat this madness? but the real cost estimate, the best cost estimate is $2.20 trillion to $2.40 trillion for full implementation. any goes up from there. the nonpartisan cbo says that cost is a huge issue, and instead of bending the cost curve down, it has been in the cost curve up and making it worse. this is the cbo, a non-partisan body. they head is actually appointed by nancy pelosi. brian, do you want to follow up? >> thank you for taking my answer and i thank you for all of these town hall meetings. on like this so-called declared

opponents who seem to be afraid to hold even one meeting. i want to thank you for coming out day after day and being so forth right. [applause] >> this is 19 and counting this month. we will keep going on. it will not end, don't worry. [unintelligible] >> what can you all do? you have two united centers. one of them is going to vote against this thing. it is up to all of you to make sure that you're either united states senator votes against this bill. -- that your other united states senator votes against this bill. [applause] >> armand, why isn't anyone asking the question about

scrapping this bill and starting over, writing is so people understand the bill? i agree with you completely. i think that virtually any 1000- page bill, no matter what the topic, and no matter who writes it, is likely to be real dangers anous. however rather have five focused 30-page bills band -- that deal with specific problems, like pre-existing conditions, like associated health plans, like tort reform. [applause] there absolutely are problems to face and we need to fix them, but we need to use a scalpel and not a sledgehammer. follow-up? >> when you represent a lot of

people in your district a five- page bill is plane enough. we don't need 1000 pages. if i was going to my district, i would walk my constituents to tell me something come e-mail, tell me what you think, and that is the way i would bet. >> absolutely, thank you. william, is there anything the republicans can do to prevent the democrats from passing the 1000-page bill in the senate with only 51 votes? a great question it goes back to this issue that was brought up earlier called reconciliation. in the senate, where john and i work, almost everything has to pass by 60 votes, not a simple majority.

i came to the senate after the 2004 election and i was actually part of a big republican press -- freshman class that put us at 55 the republicans. i thought coming in at the 60- vote rule was ridiculous. but it had been growing on me since then. [laughter] so almost everything takes 60 votes. the biggest faction -- exception is the process called reconciliation. certain things, if they are directly related to the budget, can pass by a simple majority. clearly the democrats are looking at that option, and because of that, i have internal staff and a bunch of experts looking to figure out what about their overall plan could be passed through reconciliation