could not. and we're doing a lot of work to prepare for that possible fight. i will give you the broad brush impression, which is maybe half of the entire plan could be passed in some way through a simple majority. but the other half could not. it is a very imperfect tool to do everything they want to do. .

number two, what can we do to convince congress to approve -- to oppose the government option which could result in a socialized medicine. >> we are going to continue to offer options and continue to bring in bills. in the two years of barack obama was in the united states senate, he voted against giving insurance across state lines.

he voted against having individuals having the right to write it off their taxes. he voted against letting you use your health service savings accounts. there was item after item after item that we think is so crucial that the voted -- that the president and voted against. we're going to use every technique weekend. -- we can. we need the help of the american people. we need folks to contact their elected representatives so that the rest of america sees the danger the future for this country if either of these bills is adopted into law. this is breaking the glass that you will not be able to put back together. it will change your country for ever in a way that no one in this room once and is not going to be good for our nation.

>> these house members have already been pushing alternatives, have already been pushing amendments to take up the government option. do you have any thoughts? >> by the way, you have probably heard on tv that there are members of congress who have not read the bill. i have read the bill. [applause] we will be glad to leave you a copy this afternoon if you'd like to go over it. there will be moved to try to take the option out of the bill. the dialogue has already taken place. to get anything passed, they're

going to have to remove the public option. [applause] [laughter] i do not know if there's a specific bill yet that has been introduced. but i believe that we will be asked to vote on some type of health care plan between now and in the end of the year and i do not think it will include a public option. >> even if you take it out, the government auction, there are a lot of things in this bill there not good to be good for this country. >> in the last couple of weeks, we have seen an incredible citizen movement across this country. people are, fortunately, reading this bill in expressing their concerns about it. people are reading the bill and going back now and they are

saying that they will take up the option and will put in a co- op. but nobody is saying what the co-op is. you do not have anybody taking out the $800 billion in taxes to small businesses. let's scrap this the bill. let's go to these common sense alternatives and fix the problem without breaking this thing that works. [applause] >> let me underscore that. [chanting]

there's always a big push to be bipartisan and agree to some compromise. and you know what? a lot of times, that means the following. you have an absolutely horrible bill and we passed an amendment. now it is a really, really, really bad bill and now we should pass it. let me tell you, that is not one to be my status. [applause] >> [chanting]

kill the bill. kill the bill. >> what i just described, that may be washington's definition of a bipartisan is them. that is my definition of selling america down the river and i am not going to do it. [applause] glenn, any follow-up? >> there is one thing i wanted to share. i had a very wise step father who was a doctor. i asked him once why is it that doctors in england hate the socialized medicine so much? the question i got totally amazed me. i never thought of it that way until he said it appeared he said because they have to play

god. i said, would be a main play god? because they have limited resources y have to make decisions as far as who gets medical care and who does not. like the older people, do not send them home with a couple of aspirin. if they have to have an expensive procedure, they could save their life. they do not like to play dr.. >> that is wrong. there's one thing that is even scarier. that is government playing god. [applause] we're going to try to get through three more people. michael says, how can we be assured that our tax dollars will not be used to pay for

abortion. i think we talk about that. if i can ask for your indulgence, i am going to go on current michelle's what will be there matt -- the ramifications of obama-care on home health. i have been a therapist for over 30 years. do any of the doctors want to take care of that? >> let me approach that one more broadly. anytime you have a government- run health care system -- and all of these countries that we have talked about and even some states, you run into a budget limitation because there's always expanding demand. once they hit the budget, you have to simply decide how you are going to allocate those resources. we heard testimony from people from canada and the u.k. the stories we heard were spying chilling. the delayed care, the lack of care for people who have coverage was much worse than people werhere who do not have

coverage. one example was a child needed to than his years. he had a 15-month waiting list. in my mind, he developed a brain infection. -- in nine months, he developed a brain infection then he lost his hearing. one woman needed a spine surgery. when she asked why she could not have corrective surgery, the answer was, because you have not suffered enough. these are the realities in a government-run health care system where resources have to be allocated. this is even broken down to quality. if someone is 70 and has a little jealous, their life is less important than someone who is 40 who is perfectly well. to your question specifically,

those resources, as they become limited, they will be given out according to how productive and how valuable your life is. obviously, the older you are and the more secure, the less valuable you will be for the health-care system and for the government to give you resources. . >> 99% of my clients are in home health care. >> you will have huge cuts to medicare. thank you. [applause] howard dean says that there will be no tort reform. if a patient under a government health care plan has a legitimate malpractice suits, will he or she be able to sue the government or just be out of luck?

today, he can sue a private health plan or provider. i will tell you live here. and this is particularly significant to doctors and other providers. i think this proposal offers to doctors and other providers potentially the worst of all worlds. it potentially offers them socialized medicine, like in england, without malpractice protection. in england, doctors have that protection. that does not make the system did, but they have that protection. here, doctors and other providers could face the worst of all worlds, and i do not think it will be the government getting sued. it will still be individual provider's. -- individual providers. >> thank you, david, for that answer.

i still think it is good to be a bad bill. thank you for taking the time to come out here. [unintelligible] he must be in a fact-finding mission summer in south dakota or another country. thank you for voting against the the stimulus and thank you for voting against the clunkers. >> we're going to be able to take three more questions. bill, janet hayes, and don squeezebac. will you support legislation that will provide military retirees with benefits similar to the ones in place? >> certainly, i will do everything in my power to protect those benefits and make sure it or try to make sure a new plan does not erode those benefits.

but i am very concerned that a new big the government plan would end up eroding those benefits or even come eventually, collapsing that system into the bigger system. anybody else want to respond? bill, and a follow-up? >> david, first of all, and mike, thank you so very much. i want to thank you so much for everything you have done. i am a little confused, as most of us are. a lot of us here are on fixed incomes on social security. we have been told that social security will drop this following year because of increases in medicare and that there will be no cost-of-living increases. you have to explain to me why that is because medicare is going to increase and reduce our

social security benefits. we cannot sell their houses. where is our cost of living increases? >> you're right. with medicare cost increases, that means you're coming out behind. you're not even staying in the same place. that is a great point. i want to mention another cost- of-living adjustment, too, though. i have legislation about it. there is, under present law, an automatic pay raise of virtually every year for members of congress. [booing] a that is ridiculous and that is offensive. i have a bill to take that away so there is no automatic pay raise. [applause] we have actually put enough public light and public pressure on that issue that we passed that through the senate appeared now we have to pass it through the house.

-- past it through the senate. now we have to pass it through the house. real quickly, janet hayes, all hospitals are clogged up with the uninsured. we are in the red. you support the charity system and the charity hospital being reopened? >> i support that. it is long overdue in downtown new orleans. but i also support using a different, better model and having many follow the patient and not just follow big government institutions. janet, i am sorry, we need to wrap up. don says, which is being done with the is ours? is the people to do that -- is it possible to -- with the czars? is it possible to do that without oversight? >> i think they're absolutely unconstitutional.

[cheers and applause] any big presidential adviser like that, like a cabinet secretary, is supposed to come before the u.s. senate for confirmation. this is a complete and run around that. this is completely unconstitutional. i am going to fight that. unfortunately, i don't think that is going to change. the majority in the senate says it has to change. [applause] who pays their salaries? you pay their salary. we'll pay their salary. jeff. >> thank you all very much for being here helpmates thank you for bj for being here. tell me thank all of our guests -- thank you all very much

for being here. thank you all and help me thank all of our guests. [applause] >> as the congressional recess winds down, members continue to have town hall meetings. if you attend one of those meetings, you can share your experiences and thoughts with c- span on video. the long line to c-span.org /citizenvideo. >> as the debate over health care continues, c-span's healthcare cut is a key

resource. go on line, follow the latest video ads and links. what's the latest events, including town hall meetings, and share your thoughts on the issue with your own psittacine video, including any video you have gone -- with your own citizen video, including any town hall meetings to have been too. and there is more on c- c- span.org//-- and there's more. >> in about 20 minutes, interior secretary ken salazar speaks on the construction of a memorial for the pennsylvania victims of flight 93 on 9/11. next, three doctors and patients will talk on how the health care workers -- the health care system worse for them.

>> massachusetts gov. deval patrick announced that a special election to replace the late senator ted kennedy will be held next january. this is about 20 minutes. >> good afternoon and thank you for coming. in addition to losing a great political leader and friend, his passing leaves a big gap in our congressional delegation. under our law, it is up to the people of massachusetts to fill it in a special election. so today, in accordance with my responsibility under massachusetts law, i am designating tuesday january 19,

2010 as the date of the special election. massachusetts voters will have the opportunity to fill this senate vacancy. later today, secretary of state will issue calendar listing the applicable dates and deadlines for the events leading a to the special election, including the primary date. he will put that up on his web site before the end of today. i encourage the voters of our commonwealth to participate in choosing your next united states senator and i join with them in looking for to a robust and substantive campaign. in the meantime, without the modest change that senator kennedy himself proposed, massachusetts will not be fully represented in the united states senate. the issues before the nation are historic and unprecedented. from health care reform to jobs filled to climate change and education, the congress is debating some of the most historic and significant

legislation indicates, bound to affect all of us for decades. let me be clear. i wholly support the special election and the democratic process to fill the remaining two years of senator kennedy's term. but i will continue to work with the legislature on legislation authorizing an interim appointment to the united states senate for the five months. that special election happens. this is the only way to ensure that massachusetts is fully represented. the voters of the state elect our next senator in january. i understand that this option was proposed some years ago and that proposal, at that time, was voted down. i was not here then and i do not know all the reasons why. but on the merits, the proposal seems to me reasonable and wise. i hope the members of the legislature, regardless of their party legislation, will see

that too and will uphold the utmost interest of our citizens in washington continuously over the next five months. i am happy to take your questions. >> [unintelligible] >> i would strive to see where the holidays intervening would be minimized. >> [unintelligible] >> i have spoken with -- did you say this morning? i have been speaking with a the end senate and the speaker for the several days about this. obviously, the setting of the date is within their power. i think they have said it for as

soon as we can. >> [unintelligible] >> say it again, i am sorry. >> [unintelligible] >> i have it -- i think they have an open mind. they're trying to work with their members and are listening to their members. i do not think that' -- i think they're trying to find a path to honor the very reasonable request of senator kennedy. >> there is no way that everybody will say that this person would not be able to run. you could appoint an interim, but, in the income that they would want to run. >> i understand. the lawyers are when to try to legislate that.

it is my intention, if given this power to get a personal assurance from the appointee not to run in the general election, in the special election, out of fairness to the candidates. >> [unintelligible] >> do i have any names yet? it is too soon to talk about that. >> [unintelligible] >> it depends on how quickly the legislature acts. if they act favorably, in the interest of having to voices and a full representation for massachusetts, we will try to do that. >> [unintelligible] >> again, it depends on -- you mean at the end of september? it depends on how quickly the legislature moves. >> [unintelligible] >> hang on a minute. >> are they moving quickly enough? should they be moving faster? >> i think they are moving as fast as they can. i think it is important to move

as fast as they can. >> [unintelligible] >> this is also premature, but i think that what we want is someone who understands the issues facing the commonwealth, understands the importance of having those interests served by being a strong voice in the united states senate. i think we would want somebody who is up to speed or who can quickly get up to speed on health-care issues and the jobs bills and education initiatives and climate change, which is a -- which are the key initiatives before congress right now. >> [unintelligible] >> i was not here, like i said. i do not have to accept the premise of the question. my job, right now, is to think

about the best interest of the commonwealth. i think that having take full complement, to voices, in the united states senate is in the best interest of massachusetts. we have a stake in the climate change bill and in the education initiative. and i think that our interests advise in favor of having a voice representing s, two voices representing us in the senate at all times. >> [unintelligible] >> i am concerned about it. i know that harry reid is concerned about it as well. he and i have talked about that. but i think they are in recess until after labor day. i am talking about the united states senate. it is in recess until after

labor day. obviously, the longer they are in recess and taking of the regular business in washington without our having two voices in there, that is where my concern is. is that which you were getting at? >> why kit -- why cannot they come back this week. these are issues that are so important. >> maybe you should ask the legislative leaders about that. they're moving this as quickly as they can. and they have to end the do it to their membership to consult with their members. -- and they have to and they owe it to their membership to consult with their members. >> [unintelligible] >> i have heard from senator kerrey who is on board with this proposal and shares these concerns. >> did you end to the president speak about this? >> no -- did you and the

president speak about this? >> no. >> [unintelligible] >> well, i am a democrat. i believe in democratic values. i believe in the values that senator kennedy reflected and worked so hard for, caring about and being the voice of the voices, trying to give people a way up and a way forward and big government is not responsible for solving every problem in everybody's life, but they are responsible for helping everybody. i, as governor and as a citizen, will respect the will of the people. i think we will have a robust race. i think we have a lot of political talent in the commonwealth. i think a lot of that talent will come out and compete. >> [unintelligible]

>> i have spoken to mrs. kennedy and two staff members about this. i think they feel strongly about it because it was senator kennedy's wish. and i think they will get involved as much as they can and as much as is helpful. >> [unintelligible] >> say it again? >> [unintelligible] >> are you talking about the individual plan meant and not the law? >> [unintelligible] >> i am sorry. i have not spoken with mrs. kennedy or the staff about the individual apartment. mrs. kennedy is not interested in the position. >> would you run it -- would you consider running for the senate? >> myself? no, i have a job. i have my hands full with this. i will not seek the position, that you very much. i am running for reelection as

governor, just to be clear. >> [unintelligible] >> yes. >> [unintelligible] >> that is all we talked about. >> [unintelligible] >> yes. >> [unintelligible] >> no. [laughter] >> did you have a question? did you have a question? did you have a question? [unintelligible] ] no. he is very concerned. genet was -- it does as well. he is very concerned -- janet was very concerned about this as well. he is very concerned about the timeliness of this. >> [unintelligible] >> i get contacted by people

seeking all kinds of things. >> [unintelligible] >> all of the above and then some, all kinds of scenarios. anybody else? [unintelligible] >> [unintelligible] >> yes. [laughter] i have never had surgery before. it is a bit of a mystery. my wife will be there. i'm looking for a speedy and quick recovery. >> does the state of kennedy's staff standing bearing [unintelligible] >> i am not sure i understand your question. do you mean with my decision beat influence on what happens to the staff in place today? >> [unintelligible]

>> whether to seek to change the law? no. what is influencing me, first of all, is with senator kennedy asked and he made the case very thoughtfully, as he would, that massachusetts needs to voices in the united states senate at any time. >> [unintelligible] >> i have read that speculation. i think it is too soon to talk about any particular -- i have a huge respect for senator dukakis. i do not mean to imply anything other than it is too soon to get into that. >> [unintelligible] [laughter]

>> the answer to your last question is yes. i have worked my way through all that. i am there at 6:00 a.m. there will do the preparation and they will do the deed. there will be some time in the recovery room. if everything goes as planned, i will be admitted into a room later in the day and spend a couple of days there learning how to put my shoe on and get out of bed and walk upstairs. >> how long [unintelligible] >> it will certainly be a day, maybe two. >> [unintelligible] >> you want me to be honest?

the purely political business of saying yes to someone and no to a lot of other people -- like i said, the senator's interest and my interest are the interest of the people of the commonwealth. and the commonwealth needs two voices in the senate. this seems to be a nice and, actually, a rather elegant compromise. it leaves in place and respects $u.

pace of their actions and they have assured me that they're moving as quickly as they can, consistent with success. and that means that they have to take the time to talk to their members and build support and organize for the hearing and get the witness is there and except the date, as you heard, for next week. given the fact that it is summertime and so forth and some people are dispersed, that is quite quickly. >> did the legislature create a fire wall for the special election for the interim [unintelligible] >> i think it is a matter of fairness for the candidates in the special election. i think the question is can you legislate that the appointee could not run. i think that the legal opinion is that you cannot. is probably unconstitutional.

if given this power, i will have to get the assurance from the appointee. thank you. >> there are a couple of live events tomorrow. the former israeli ambassador to the u.s. will talk at the heritage foundation about the threat posed by the iranian nuclear program. that is at 11:00 a.m. eastern. at 5:30 p.m. eastern, there is a forum on how an election -- how the afghan -- about half japan's election can affect relations. >> the construction of a flight 93 memorial in pennsylvania will begin in november. he made an agreement with landowners whose property was in

the area. this is 15 minutes. >> thank you all for coming this afternoon. we will join again to remember the friends, family members, and fellow citizens we lost that day. we will remember the sacrifices of the firefighters, police officers, first responders, and all those who rushed into the buildings in new york and here in washington, d.c. and we will remember the heroes of flight 93, the people who gave their lives to bring down a plane in a pennsylvania field. one of our own employees was on that flight. our memories of that they are

still fresh today. the pain is still near. and we, as a nation, are committed to properly memorializing those we lost. that is why i am proud, today, to announce that we have taken a major step forward to properly honor the heroes of flight 93. thank you to the good collaborative work of many people, the united states and the national parks service have signed agreements with all the landowners for all the property needed to build the flight 93 memorial. this is a critical milestone. these agreements will allow us to break ground for the memorial this fall and stay on schedule by the 10th anniversary of the september 11 attacks. today's agreements are the results of herculean work by many people over the last several months. that includes the national parks service, the families of flight 93, local landowners, senator specter, and senator casey, and

others. i have been to the site twice in the last six months to join in these conversations and to try to find a way forward and to work for all the parties involved. our goal has been to reach agreements with the local landowners for the property needed for the memorial to ensure that they receive fair compensation for their land and to stay on schedule for completing the moral by september 11, 2011 -- completing the memorial by september 11, 200011. -- september 11, 2007. the parks -- september 11, 2011. this will allow construction to begin immediately in november. the park service will acquire a parcel owned by some of it incorporated as well. those owners have agreed with

the park service to establish fair compensation for that property. today's agreements are the products of good faith, collaboration at many levels. particularly, i want to thank dan wenk, the leader of the park service's and his staff and to senator case you go has been champions of this memorial. the passengers of flight 93 our heroes and to date is a milestone in their contribution to our country. i want to have dan renk, the leader of our national parks, make some comments. >> thank you, mr. secretary. i would also like to acknowledge the leadership of secretary salazar for bringing an emphasis

to this with the families and with the landowners that we were able to complete these negotiations and to acknowledge the families and the landowners for coming together with the national park service to complete the successful negotiations. thank you. >> thank you, dan. as part of the negotiating team we have on the field working on this, steve would selhitsell wok with us. i would be happy to take questions. yes. >> [unintelligible] >> the price tag -- i knew i had written that somewhere. the way that this will proceed is that there is phase one for the establishment of the

memorial. that will be a little over $20 million for land acquisition and the construction of phase one. that is essentially the heart of what will be the memorial for flight 93. for the lands that were acquired here will be acquired in these agreements. the total amount is in the neighborhood of $9.5 million. that amount is reflective of the appraised fair market value for those properties. >> the court settlements have yet to be determined. >> the $9.5 million is included in the appraised value. >> it is included? >> it is included. >> [unintelligible] >> other questions? are there questions on the line? >> if you'd like to ask a

question, please press *1. the first question comes from general migknight. >> i was wondering what exactly happened with negotiations with [unintelligible] >> i am sorry, the question again? >> i understand your and using eminent domain to get the land from the one landowner. >> there was an agreement that agree that the acquisition would go forward. the agreement also said that we needed to have the termination of fair market value. the agreement was that the court would make that determination. there will be park service appraisals. there will be the owner appraisals. then the court will determine

the valley. that is the appropriate way of doing it when you have an agreed upon servicprocedure. the land owners will get the constitutional agreement of the fair market value. >> so the negotiations were not going well without the courts? >> in the negotiations, on that particular parcel, had actually reached agreement back in january. that is when the determination was made that the way to get to the fair market value was to have an outside party determined it. in this case, it is the courts. that is exactly how it will have been. >> got you. >> other questions? thank you all for being here. one other question? >> can you go a little more about the conversations you had during the negotiations with the landowners?

what stood out for you? what were the most important things to them to make this happen? >> first and foremost, there was a recognition among the landowners themselves that they also were victims of what happened from the tragic events of flight 93. yes, the heroes who we honor here were very much victims as were their families. but so was the community of somerset. and the landowners that are being affected by what hat is happening in the creation of this memorial -- i think they wanted the recognition. we wanted to respect the property rights of this land owners, too. as part of that, there was a sense from the landowners that this was hallowed ground, a sacred site, a place that was inappropriate for a memorial and a sense that they wanted to get it done. also, i think they wanted to get it done in a way that would not

end up, as sometimes these things up in endless litigation that is very costly for everybody, but everybody would walk away saying that we have done it for the right reasons and we are going to move forward with a good neighbor policy. i was moved, frankly, but the people of somerset, pa. the two- time cy was up there in the last six months -- that two times that i was up there in the last six months about them wanting to do the right thing. there will now have a forever presence in somerset. that forever presence will be one that will have a good neighbor policy but we have had with so many of our other park units around the country. >> [unintelligible] >> the plan designs are ready to move forward into phase one.

that is basically a $23 million effort. there will be other phases of the moral overtime. but the plans have not changed. >> construction should start in november? >> yes. >> ok. >> thank you all very much for coming today.

>> over the next three hours, we have several perspectives on health care and the debate in congress on health care legislation, beginning with three doctors and their stories about treating patients and how the health care system works for them. in 45 minutes, the president and chairman of the virginia hospital center speaks on the health-care system. after that, the senate republican conference hold a town hall meeting in kenner, louisiana. >> tomorrow morning on "washington journal," we will look at this fall's legislative agenda with michael wilson. the vice president of news corp., mil. will discuss his opd piece on the obama administration.

"washington journal" is live on c-span every day at 7:00 a.m. eastern. >> there are a couple of live events to tell you about tomorrow on c-span. the former israeli ambassador of the u.s. talks to the heritage foundation about the threat that iran's nuclear program poses. then there is a forum on how japan's elections may affect relations between u.s. and japan. >> our coverage of the health debate continues with a panel of 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? 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 get in,ñi not the insurance companies or the hos

depending how serious the condition is, that is would have to not forget is that that is what broadest to medicine. what turns on is being able to care for the person and not have an adversary. the process can be either very, very simple or very, very complicated. we are really trying to do the best. yes, we make mistakes. yes, we do not know the answers to everything. we're fallible and we are human, just like everybody else. . 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, 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. will color the wholelebate. >>ñr if you could pick up

what is the one thing you would want to say to them? >> i would say do not destroy of what works well. we are all bowl -- we are all aware that certain things have to be changed and modified, but we have without doubt, and i can tell you without doubt, the best health care system in the world. it has its flaws in some things have to be changed or modified, but do not destroy what works very well for a vast majority of the american people. be gentle and take your time and think it through, but do not destroy something that works extremely well. >> would you say about this? >> i have a slightly different perspective as a primary care physician. it is really fading away and die in the united states. because of the way the american

medical system has involved, primary care has really been given short shrift. that has shown up in the choice is that medical students make, as far as they're specialty training. -- as their specialty training. if we do not change that trend, the system is doomed. if you look at every other developed country, which have better health statistics that we do and spend a good deal less money providing yet, is that they are primary care oriented. our system is much more oriented toward procedures in some specialty care -- and sub-specialty care. until primary care gets the serious attention and something is done to make it an attractive choice for medical students, they will not choose this. >> why did you take primary

care? >> intellectually i wanted to be a sub-specialist. i wanted to go in gastroenterology. i like working with my handsome wanted to be a surgeon. -- my hands and i wanted to be a surgeon. but i went to the national health corp., adding two years with a storefront clinic. i worked with a nurse practitioner, and essentially they taught me the outpatient primary care that i did not really get in my more specialty oriented training in medical school. >> what medical school? >> georgetown. those medical school and residency. by the end of those two years, i have learned outpatient primary care and i had a wife and child.

the g.i. fellows were making about 12,000 a year back then, and i could not see supporting a family on $12,000 a year. so i basically shifted gears, came back to arlington where i grew up, and started the practice here. >> dr. akbari, what about this debate? >> i would echo everything that dr. wiltz and drdr. wiltz said. nobody knows what they're dealing -- what they're getting. you do not know when you're getting a bill from the hospital, with charges and payment less than the charges, and am i responsible for that? nobody really understand the pricing and what you get for what you paid.

i think the most important thing here is to number one, define does everybody have our right to basic health care? and then he was 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 cuts specifically or for cuts to hospitals. it will involve multiple people, and it will involve the taxpayer. that is a tough nut 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 now in the economic times to health care. >> when you are doing an operation are seeing a patient, if you have any idea how much it will cost them? >> i do not. i know what my charges are and

i'm not paid what might charges are because i am under contract with insurance companies. i don't know what specifically that will translate to in patients in terms of co pay and the 80/20, 90/10, and for each patient i do not know what that would translate to, and the patients do not know either. the cost in the charts are different. >> what is the difference? >> the charges anywhere from $1,800 to $2,000, and the reimbursement is between $650.700 $50. >> is that money going directly to you? >> to pay my salary, my overhead, i have five employees working in my office, i will have two associates, another one starting next week, that covers

rent, malpractice insurance, supplies for the office, and one of the misnomers for dr. reimbursement if that does to my bank. that is not what happens. most businesses have overhead to cover, so doctors. helps to defray all those costs. babblers that will be paid for by the insurance company, did a beautiful? >> no, slightly more than medicare. if i am seeing patients and i am participating provider, i have agreed to except what the insurance company contract payment is. if the patient is seen me and i am not participating provider, i have the ability to build for the difference between what the insurance company will pay and what my charges are. but we do not do that. >> do you know what this is

going to cost the patient? if you remove someone's colon, what will that cost? >> you have to distinguish between hospital charges, which i do not have any idea what they are charges, but we charge for our services. we have no control, nor do we really know what happens on the hospital side. i add to what stephanie said, we surgeons are very particular what we use in the operating room. we will use what we need and are conscious of trying to be as frugal in terms of using what we really need and no more. there is a lot of reusable instrumentation, but there is also a single use which is very expensive. we usually charge for that it

differently. there are bigger and smaller surgery. a medicare patient, we would charge about $1,800 to $2,000, and we usually get paid about $800. you add that to the fact that we will cover the 90-day period after surgery. unless you have to intervene, if you are basically dedicating $900 to that procedure, and all the personal care for the next 90 days. private insurance has taken a idea from medicare and basically constituted to pay you medicare rates or 1.2% of medicare, 1.5%, i don't know any insurance that pays one and a half times medicare, but they are using medicare as baseline for the most part. if you can get equal to medicare, you are all right.

but we're very much underpaid for the procedures that we do, and the insurance companies have now taken that as an example and use medicare as their base line. compared to primary care, he will tell you if he -- about the rates for their visits, which are minuscule. you call a plumber and they charge you 10 times what we can charge you. they come to your home. it will usually start at $100 and up. and that is cash, no insurance. dollars if>> if i come to you, i end up paying? >> it would depend on link of the visit. -- doubling of the visit.

like stephanie said, the charges have very little relationship to what i get paid. i can be getting $50 to $250 depending on the extent of the visit. but what i get paid, it maybe a third of that. a simple office visit, i may get paid $30 or $40. maybe $50. if we do some laboratory testing, some insurance company said that they will not even pay you for that. you have to take it out of expenses. it is a significantly less than the charge. >> i am hearing that someone in a room decides that the medicare organization, what you're going to be paid. tell me if that is true or not for marc >> that is true. >> who does that? but where medicare rates are

established by an organization called medpac. it is formed of multiple stakeholders, but in medicine and from the federal government. they basically set rvrbs rates. they evaluate how much costs -- a cost to be a doctor, paid malpractice, and on the basis of that, they set a reimbursement rate. that is a deeply flawed system, and for the last four to five years, we get to brinkmanship with the threat that that formula currently being used will cause a 20% reduction in all this iphysician's

reimbursement. if that happens, the system will crash and burn. >> why do you say that? >> people will not be able to take medicare patients even if they want to. they will not be able to pay the rent and their employees. from our standpoint, it will get to the point where we cannot make ends meet. the amount of work it takes to run an office in reimbursement, if you have one under% medicare patients -- we do not, but if you have a lot of cancer patients, usually a lot of older folks, you have a very high population of medicare patient, that is already a low reimbursement. you cannot pay them visits. most of us cannot call and ask for a rebate or a bailout. that is not going to happen. we will not be able to maintain, and ended problem is

not the business going under. businesses go under all the time. but we will not have any doctors around to take care of us because they will not be able to afford it. >> it really comes out of congress and it is administered by the government accountability office. that leads me to ask whether what we have already is government-run medical treatment in this country i don't know if you can stretch it to socialized medicine. what do you think about all medpac thing? >> in a sense you are right. everyone follows the medicare rate. it seems, however, that as we move forward, there is interest in changing that even more to make it a much more controlling system, less choice, single payer, and not hellenic -- and

that will eliminate many things that we feel is important for patients. when patients come to my office o drr dr. wiltz's office, we wat offer technology, new machines, and gadgets, disposable instruments, that we use in the operating room one time and throw away, all that costs money. and if we change the playing field so that the highs and lows are eliminated, a lot of that will go away. i think there will be tremendous disappointment in the level of care that patients receive. >> is health care in this country a moral right? [laughter] >> i do not know if it is a moral right. i believe that people are entitled to basic levels of

care. i think the morality -- is a right to have somebody else pay for someone's medical care? in other words, currently there enormous cost shifting going on, okay? if you are a medicare patient in the hospital, you're care is being subsidized by patients who are on commercial insurance. and that is not right. if you come in without any answers at all, all the cost of your care are being subsidized by commercial insurance companies. as a hospital, it is critical, since medicare -- you have no negotiating power -- it is led to the insurance companies to make up the difference, because medicare -- you have to make it up from the commercial side. the immorality is in that

disequilibrium between the amount paid in the amount received. >> in my opinion, anybody that lives in this country, americans, should have a right to this health care. he gets murky when you figure out how to pay for. in a very simple way of looking in it, we are all paying for it. it is certainly not going to work by cutting what hospitals get paid, what doctors get paid, that will not solve the problem. now having said that, as mike is saying, it is a very complicated equation. but the question is basic -- do we have a right as citizens in this country to receive health care? and my straight answer to you is yes. how do we pay for it and how we allocate care and are we going

to restrict or limit what the patients can receive because of issues of funds and money? the example throughout the world is that we cannot do 100% all the time. we can put a liver transplant on every person because there is no country in the world where that is possible. in every system of health care, it does not matter where you look, they are all flawed. there is not one system that works perfectly. but in terms of answering the question, do we have the right to receive health care, in my opinion the answer is yes. >> dr. akbari? >> i would leave tomorrow part out by that date that they have our right to health care. but what are we talking about? what level does that mean? does that mean medicare for everybody or a basic level for preventative care, immunizations, screening tests,

and beyond that we allocate based on age and ability whether something is appropriate. that would be the hard part, to define what you get. everybody gets health care -- what does that mean? you get the basic level? and once we define what everybody is going to get, he will be easy to see how much that will cost. and then we can distribute that across the paying parties. >> as this turned out to be -- what year did you graduate from medical school? >> 1979. >> in georgetown. >> yes, i think that my practice still is as close to the market's welby -- marcus welby model, where i have the

personal relationships. i think that that is changing and i certainly think that medicine is becoming a little more of fame profession -- look a little more of a profession -- there is less commitment to the long-term relationship with the extra hours, the kind of things that the all guys did. i don't necessarily call them, but the younger people want a life, they want to be home for dinner every night, and they want to see their children grow up. so there is a loss. if i was going to work 40 hours a week, then that means 20 hours a week i would not -- i would be less available to my patients. i think that is changing, but i had been able to maintain the image that i wanted, by keeping the practice small and heading tight control. that does not mean that i have

not used by technology. i'm a huge proponent of information systems. i have done that at the hospital and around the country for many years. but you can be high tech and still be warm and friendly. >> what about in your case? did it turn up the way that you planned it? >> for the most part. i graduated medical school in 1985. i treated boston and then colorectal in minnesota. i had a great blessing to have my father, who was still around, as my mentor after medical school. it's different when you have your dad working, so it was a great honor. that was probably the best part. i was with him coming in now? but in terms of -- i was with him, you know?

all the minimally invasive technology that is still in the process of being developed, i never imagined. when stephanie started, i was a much older than she was, but we were starting the beginning of what turned out to be an explosion of laparoscopic surgery. i put seven years and a training and had to pick out a gallbladder through a tube. he continues to be an exciting field, and i am not sorry i did -- i chose what i chose. if i had to do it tomorrow, i would do it again. i love what i did. i think technology in all the fancy stuff that we do is really exciting, but the most important thing that gives me intense pleasure is to be able to take care of the peeper come -- of the people, i have friends, even

though you are the surge in an ad in face it stuff, it helps you come back to work with a big smile because you have test people lives. >> you knew each other before? >> we trained in boston together. >> has this turned out for you -- we don't have much time. tell us what to do here? this is the first time that your specialty has been in this area. >> i and the medical director for the center for breast health. it is the only multidisciplinary rest treatment center in northern virginia. we have amassed breast images, a medical oncologist who specialize in breast cancer, radiation all oncologist, nurse navigators, all in one location to provide comprehensive care for the breast cancer patient. and so this hospital has been at the forefront of enabling that to happen, because no one else in the area has stepped up to the plate to have that kind of

system in place. >> you are university of pennsylvania? >> i graduated in 1991. i would say that this has turned out for me personally better than what i would have thought. i love being a surgeon and what i do. like dr. wiltz, i appreciate being able to work with people and feel honored to become an intimate part of their families. even if it is a short period of time. i think as we look forward, there are significant challenges, and as dr. amedeo said, the crop up physicians coming out have different expectation levels in terms of what they're going to be paid in their work hours. patient expectations continue to rise, and at some point, something has got to give. there are huge challenges ahead. but patient and decision. but doctors, we thank you for

your time. [captioning performed by national captioning institute] [captions copyright national cable satellite corp. 2009] >> as the debate over health care continues, c-span's health care hub is a key resource. go online. all the latest week's and langes, what's the latest events including town hall meetings, and share your thoughts on the issue with your own citizen video, including video from any town hall you have gone too. and there is more at the web site. in a few moments, more about health care debate from the president and chairman of the virginia hospital center. in an hour, the senate republican conference hosted a town hall meeting in kenner, louisiana. after that all four on politics

in the middle east. -- 84 rahm on politics in the middle east. >> tomorrow morning on "washington journal," we will look at the legislative agenda in congress with the representative. the vice-president of news corp. discusses his recent opinion piece on the obama administration. in our series on health care continues from the va hospital center, with the chief and its officer and its chief information officer. washington journal is live on c- span every day at 7:00 a.m. eastern. a couple of live events to tell you about tomorrow on c-span. the former israeli ambassador to the u.s. talks at the heritage foundation about the threat posed by iran as nuclear program. that is at 11:00 a.m. eastern. at 5:30 p.m. eastern, a forum on

how japan's election may affect relations between the u.s. and japan. >> this morning on "washington journal," we began a three day series of programs from the va hospital center in arlington, virginia. our guest for the center's president and chairman. this is 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 hospitaloses 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. @@@@@@@@@ @ @ @ @ @ @ @ @ @ @ @ that number was derived from a study, which showed significant variation in medicare costs for beneficiaries across the country in different areas. for example, in most of the metropolitan areas of virginia, the cost of the beneficiary is about $8,000 per year. yet in south florida, the cost is about $16,000 per year. so there are variations in cost per beneficiary. how over -- however the proposed control is a bore -- across the board percentage cut spirit --

across the board percentage cuts. 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 willing to consider our views. host: let's take some phone calls. first phone call from new hampshire on the insured line.

caller: good morning. i listened to your interview last night. you were very informative and i learned a lot. my question is, two years ago my wife had a perforated ulcer in her stomach. she became spooked -- septic, spent two months in the i see you. because of complications, the bill was over $1 million. if we did not have insurance, in your opinion, -- i find you to be very honest -- which she had received the same care if we did not have insurance? mr. cole, i would like to hear from you as well. host: dr. garrett? guest: i can tell you 100% she would have received exactly the

same care. i do not know how to say that any clearer. we do it all the time. $1 million is a lot of money, but as a practicing physician, i do not check or know if people have insurance. all the other physicians are just like that. we come to work to take care of sick patients. in this hospital, last year we gave away $30 million in uncontested care. it is part of our mission. i hope your wife is doing ok, but she would have done 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, that is part of our obligation. 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 on malpractice 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 aren 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 th 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 ink@ @ @ @ @ you are paying premiums. next call comes from california on are uninsured line. please go ahead. caller: i appreciate you taking my call. just to give you an idea of my health care, i have been uninsured for 12 years. i've not seen a doctor in that time. i am not really been sick but i had a few 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. 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 is uni --wise is unwise. . .

i've seen in understand a lot of what the caller was talking about. but i 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 come 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? malpractice insurance rates? guest: it is huge. a k? so i would say -- host: exponentially? guest: yes. i would say 50 times more than she pays. host: is there a doctor anymore who has not been sued? guest: well, i think there are doctors. personally, in my entire career, i was sued one time, and it was dropped, ok? but that still does not change beefier regionthe fear -- the

fear that is ingrained in all of us. we just do things more over the top two -- somebody might say, "why did you not do that? you could have?" host: calling from michigan is tracy on the uninsured . go ahead, tracy. caller: i just have some questions. i had a heart attack. i ended up in the hospital. complications, the femoral artery in my groin blew open, and i lost 10 units of blood into my abdomen, and almost died. i spent two weeks in the hospital. i was starting to feel a little better, but i am weak and do not have a lot of strength, but i am doing the best i can. i cannot work. i now owe the hospital $218,000 b and i have no insurance. i have not had insurance for the

last five years -- i now of the hospital $218,000. i have no insurance. i had no medical leave. what are you going to do? 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 uninsured care? and our physicians monitor train themselves as well as they should? we have had many doctors here church was selling illegal drugs, false medicare, and several sexual assaults. i would like your comments on that, please. host: thank you.

first, medicare part c. she is the second of years to bring that up. does that come into your professional life at all? guest: it really has not been a major factor here. i cannot speak to that. 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. it 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? it is very unusual for any hospital to have at maximum one year's operating expenses and reserves.

host: dr., you said last night the people who ask the price are the people who can afford it but do not have insurance. is there a price negotiator here at the hospital? if somebody came in and said, "look, i need to have my opinions taken out. i can pay cash." guest: the people who ask about how much it is is not people who can afford it but people who have money, ok? not that they can afford it, but they have money, because you can afford to write a check for $50,000 for a hospitalization? but if you have some means, then you are going to be responsible for that bill, and said that is a scary thought, -- and so that is a scary thought, and that is

why people ask questions. 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. i mean, face it. insurance companies do not pay me what i charge. and so why should somebody who does not have insurance have to pay what i charge? we at least give those patients a break and let them be charged what an insurance company would pay you. host: jim? 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 doing now. 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 to work 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: d >> "washington journal" is live from the v.a. hospital center this week to examine the health- care system from the perception -- live from the arlington hospital center. they will be talking to the chief nursing officer. as the debate over health care continues, the c-span health care hubbard is a key resources. bill online, followed the latest week -- follow the latest tweets, and look in your own

citizens video, including video of any town halls you have gone to, and there is more at c- span.org/healthcare. >> in a few moments, the republican conference hosts a town hall meeting in louisiana. in about 1.5 hours, a forum on la jolla and politics in the middle east. after that -- a forum on politics in the middle east. then, the anniversary of hurricane katrina. and then a case on how the department of veterans affairs deals with disability claims of post-traumatic stress disorder. ? [captions copyright national cable satellite corp. 2009] [captioning performed by national captioning institute] a couple of live events to tell him about tomorrow on c-span. the former israeli ambassador to the u.s. talks at the the

heritage foundation about the threat posed by iran's nuclear program. that is at 11:00 a.m. eastern. at 5:30 p.m. eastern, a forum on how japan's election may affect relations between the u.s. and japan. >> the senate republican conference recently sponsored a health care town hall meeting in louisiana. this is 1.5 hours. [applause] >> thank you all for being here. well, good afternoon, and welcome to our health care reform forum. you know, nancy pelosi may consider you an un-american mob,

but i am delighted to see you here, each and every one of you. the more, the better. i am also delighted to be joined by four other members of congress. one of my colleagues from the senate, and three of our u.s. house members representing different parts of louisiana, so let me introduce them at this time. first of all, a senator from wyoming was elected to the u.s. senate in 2008 after having been appointed to fill a vacancy in 2007. john is known by many as the doctor of wyoming. during 24 years as an orthopedic surgeon, he has served as the president of the why yielding medical society and was named their position of the year. he also served as director of the wyoming health care, bringing a low-cost health screening exams all around the

cowboys did, and he also represented a county in byd and state senate for five years. please welcome senator john barrasso. -- and represented a county in wyoming in the state senate for five years. [applause] >> thank you. thank you. >> next, we are delighted to have congressman rodney alexander, representing the fifth congressional district in louisiana. he was chairman of the house health and welfare committee in the louisiana legislature, and in this position, he shepherded through the louisiana children and health insurance program which was a republican initiative initially. although he believes there are areas where we can and should

improve our health care system, rodney opposes the current house bill because it sets the tone in washington for a government takeover of the health-care system. welcome, rodney alexander. [applause] >> congressman steve scalise represents the first district and represents so many of you. and, of course, before being elected to congress, steve served 12 years in the louisiana legislature. steve is a member of the house energy and commerce committee, which has jurisdiction over the largest part of health-care legislation, and he has taken the position that individuals

and their physicians should be in charge of their health-care decisions, not government bureaucrats. steve scalise. [applause] steve, welcome. and last but certainly not least is congressman and dr. john flemming the represents the fourth congressional district in the breezy and. he has spent his career as a family physician and was named dr. of the year in 2007 -- the fourth congressional district in louisiana. he and i hav firste -- dni have both introduce legislation to talk about any government option that will be passed -- he and i

both introduced legislation. welcome, dr. john fleming. [applause] now, why do we not all get started in the right frame of mind and the right frame of heart by standing up again, if you can, for a prayer? and please remain standing immediately following the prayer. we will have the pledge of allegiance to the flag, but first, we will be led in prayer by the reverend al carter, from louisiana. reverend? >> heads bowed and eyes closed. father, forgive us of our sins of commission and omission, and help us to let go of sin and to

forgive one another, because we know, lord, that you will not forgive us unless we forgive of the recipien -- and as we forgive others. we know that your words says that the heart of the king is in the hand of the lord. you will turn this whichever way that you will, and we pray that that you will, and we pray that this will be healthy and let us remember that the healing of man is still in your hands. we pray for all that argued today and the families and the community. we pray that where there is sickness, there be healing. where there is poverty, let there be prosperity. where there is ignorance, let there be knowledge. where there is are in this, let there be peace. we call on our state and local leaders to as well as special

blessings or governor jindal, for all of our senators, congressmen, officials, and clergy present. we pray for the protection of unborn children as well as for the elderly. we pray for the piece of jerusalem. -- peace of jerusalem. and we pray that we will remain one nation under god, indivisible, with liberty and justice for all. all of these blessings we ask in the names of all other names, before the name whom every knee shall bow, our lord and savior jesus christ. amen. >> and now we will be let in the pledge of allegiance to the flag by our host, the mayor of kenner. here at the pontchartrain

center. >> thank you, senator. thank you for all the good things that you have done for us. for the last three years. join me, please, in the pledge. i pledge allegience 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, mayor, for all of your help in hosting us here in the center. i want to thank the police chief as well who has been enormously helpful and the entire city of kenner. we're going have some very brief introductory comments from senator and dr. barasso. since he is our guest. he has been working specifically with the only other end in the -- the only other md

in the senate, u.s. senate, tom coburn, trying to explain the health care bill before the senate and alternatives to it. john will give some of his overview and thoughts and then we will go directly to the part of the program which are your comments and your questions and your concerns. if you have not already, please use one of these simple pieces of paper we are handing out to jot down your name or comments and questions, and please pass them to staff. then we will go through absolutely as many comments and questions as possible. if you could move to the microphone in the aisle, and be ready for our conversation. we certainly want to follow up on the conversation. let's get started. welcome, dr. john barasso. [applause] >> thank you.

thank you. i want to thank all of you for joining me along with senate term vitter who is a great american. we went to afghanistan to visit the troops of last easter. it is a privilege for me to serve with him in the united states senate. [applause] we have such respect for our military. i like before we start, if we can ask all of those who are with us here today who have served our nation to please stand and let us thank you. [applause] [cheers and applause] i have had that chance as one of only two physicians who serve in the senate to talk about the issues we are facing.

as the reverend said, these are vital issues, personal issues, issues that affect all of us. health care is such a personal thing that will affect, no matter what they do, every person in this room, every person in america, and it is one sixth of our economy and it is something that we must all take very seriously. i can tell you, ladies and gentlemen, we do. i walked out with his briefcase because i wanted to show you some of the bill. -- some of the bills. people say, had you read the bill? this is house bill 3200. i held this up at a town hall meeting on monday night, and someone in the front row yelled, burn it. [applause]

this is just part of it. a paper clip was only big enough for this one. one minute. [laughter] and then in wyoming, i held us up, and they said, start a[applause] and tom coburn and i have been traveling the country with our senate doctor show, we were in omaha, neb., we were in northern mississippi, northwestern arkansas, and we're getting crowds of people like we want. there is a member of the house

of representatives from michigan, and they asked him when he would read the bill. he said it would take two days in two lawyers to explain to him. if it takes that, we should not be passing such a bill and nobody should vote for that kind of a bill. [cheers and applause] i don't know how many of you watched fox news on television. [cheers and applause] i had the opportunity to be on there this morning bemegan kelly on "morning show." -- with megyn kelly. we were talking about these bills. i will tell you, we are at a 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 -- [booing] she thinks that people are coming here because it is contrived. and that there are people paying you to be here. people are here because we are here for the right reason. we are trying to protect our freedom. [applause] i could go on and on but david has a whole list of questions that are your question. -- your questions. it is better for us to hear from you before hearing from me. thank you for coming here today to hear me and my friend david vitter. thank you. >> thank you, john.

ok, let's get to the heart of the program, your comments and concerns and questions. our first comes from married, if -- from mary. if you could find your way to the floor, and let me mention the next three up in the lineup. charlotte, lanny, and donald. the floor. mary asks how can you make health care for all without financially destroy in the nation? -- without financially distorting the nation. john, do you want to take a crack at that? >> we have another physician and other members of house if they want to jump in. it is an excellent question. how did you do it with all of this money? especially in these economic times. is there enough money in the system? you can debate whether there is are not but we are spending one sixth of all the money in america and we know that medicare is a system that helps people who are seniors and

friends, but there is more waste, fraud, and abuse in that program than any other program. there is money that can be dealt with. drug dealers and in florida are getting out of drug dealing and getting in the medicare because it is more profitable, less chance of being caught, and if is less. -- they are moving into medicare fraud. there are things that we can do to improve the system. what the president is trying to do is expand coverage because he said up 47 million americans, 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 and we can get into a discussion of all of these things. but, david, but any economic times, when the president says he wants to do it without increasing expenses, but then the price tag on one bill is $1 trillion, and that bill that i've just brought that is not

bound together yet, the telephone book version? the reason they have not done that, even thoughit passed along partisan lines with all the democrats voting for it in the health committee and all the republicans voting against it. they have not done that because then everybody can read it on the internet. then everyone can read it. they do not want to put the price tag on it. it is more expensive than the house bill. what i am saying is that this is a trojan horse, and we cannot do it the way that the president promises. he promises one thing and there is a gap between the president's rhetoric and reality of what is printed in these pages. these pages are what i am opposed to. [applause] >> anyone want to comment on cost?