house committee hearings and 65. host: and counting call? analysis by martin bond. guest: well, in the last year or on friday night, where the issue two i've not been taking calls. stands in the senate. so that's made life a little bit sunday, a comparison of health easier for me. care systems from around the my partners that do take call world with t.r. reid. work in excess of 80, 85 hours a week. host: why did you stop taking >> this is debris in our series them? guest: they said i was mature enough to deserve that. on hospitals and health reform. today, from the va hospital host: do you work too much? center in arlington, virginia, guest: well, i enjoy what i do. about 10 miles to the west northwest of the u.s. capitol. my wife might tell you she thinks i work too much. . . but as i said, i don't think so. guests about what is going on in i enjoy what i do. host: first call up comes from dc and around the country. gaston, north carolina. bernard, on our insured line. here on our set is the director please go ahead. caller: how are you doing, doc? of the program, dr. john sverha. i make about $60,000 a year. how many people come through the i don't have any children. basically i pay about 30% in virginia hospital system every year? taxes every year, pretty high guest: every year we see about taxes. i'm thinking that y'all guys 55,000 patients. with this whole insurance that equates to 150 per day. debate, i'm a single payer host: what is the peak time? advocate myself even though it will probably never go through.

we can resolve this problem if guest: we track that. people would just stop being cheap and pay a little more in it ramps up by about 11:00 a.m. their taxes, 1% 2% and we could in the afternoon. cover these uninsured people. about 10 people per hour were your hospital, that's not a good coming in our doors until about example because american medicine is good, but only if you can afford it. 10:00 p.m. it never stops. if you can't afford it, it's no we see people through the night. good. we see people through the night. host: have you to and the people with money or got a little bit of money like track why it rahm. myself, i'm ok, kick in a little at certain times? guest: i think that is when the bit more and then we could help need arises. alleviate the cost for the there's some components to people being awake and needing uninsured coming through. you know what i mean. care and realizing that. there's also a component or host: thank you, bernard. other access to health care let's get a response. closing at 5:00 p.m. or 6:00 p.m. dr. zimmet? that's probably why are volumes guest: i think universal coverage is a clear goal that we continue into the evening and as a nation need to move to so into the night. host: into the evening and on that people do have access to care. and i agree with you, how it's the weekend, do you see an increase in using the emergency financed, you know, obviously room as a primary care unit? it's a very complicated guest: there may be some component of that. question. truthfully, there's a spectrum we don't discriminate in our of emergencies that, and every hour of the day. hospital whether patients have it is hard to generalize. insurance or not. they get the same care.

but it's a difficult situation host: is there a doctor on duty in hospitals, in communities that don't have as many insured in the emergency room 24/7? guest: yes. patients or suffer even more than we do. in this department, during peak hours, we have four emergency host: i just wanted to follow up physicians and two physician on his call. he is an advocate of the single payer plan. what do you think of that assistants. overall, what you think about host: do you have to treat it? guest: part of the problem with these buzz words is your everyone who comes in by law? definition of single payer may guest: yes. be different than mine. host: does everybody have the i think competition in the opportunity to see a physician? insurance plans is a good thing. guest: that is correct. i think people giving people choices would be a good thing. access to a physician is but i do think we need to cover irregardless of your ability to everybody. pay. it was established over 20 years host: if you had your druthers, would you like the government ago by federal law. completely out of health care? guest: well, from what i read it is something that really defines what the emergency about what happened with department is. medicare, before medicare came online, when senior citizens we do not ask you any question didn't have coverage, that was related to insurance status pretty sad. until we see the reason why and i don't know that it would you're here and we initiate treatment. be nice not to have the it is something that defines the government involved. but i think there is a role for

emergency room and makes this a government in providing a safety great. host: place: -- and makes this a net for everybody and providing coverage for people who can't afford it. great place to work. host: of those 55,000 people, host: as somebody on the board of correctors, in charge of how many get sent on their way? i.c.u. and in private practice, this might be delicate. but does the i.c.u. make money guest: about 20% of patients. for the hospital? guest: i don't think it's a delicate question at all. i'm sure we don't. it just represents the illnesses in the community here. host: at $3,500 a day? if you have a high gear guest: well, first off, that's pediatric population -- if you our cost. we don't get that money paid in. reimbursement is not that high. have a high your pediatric i think that's the first issue. population, the rate is a lot lower. secondly, i'm not sure that very much in-patient business makes we are about 20%. money for hospitals these days. i think most of hospital income that is pretty constant month to comes from some of the ancillary month throughout the year. and outpatient service that they host: there's a large hispanic provide. but i.c.u.'s are necessary parts population in arlington, va. of hospitals. so what we try to do is be cost do you have people who speak spanish on staff? effective as well as obviously guest: if a staff member is provide high-quality care. bilingual, that's a great asset. host: our next call comes from

we are more likely to hire them. kansas. we have volunteer interpreters ryan on our uninsured line. here through the week. guest: yeah, hi. as you said, i am uninsured. during off hours, we use a language line. i am 25 years old, single. i'm self-employed. host: dr. john sverha is the so obviously by definition i am a capitalist. i'm all for making a profit on chairman of emergency medicine things. i do believe that certain things at the virginia hospital center. we will put the numbers on the should not be for profit. screen. we will be talking with him and we will be talking to the head of the icu and the director of i've only heard this opinion from one person, which is howard nursing in the next hour and 15 dean, who has talked about minutes in day three on our treating the insurance companies series on hospitals and health care reform. as public utilities and basically making them not for profit, which is what the netherlands has done, for example. what i wanted to ask the doctor host: when the emergency is what his opinion would be as to dealing with an insurance company that is technically a medicine become a specialty? guest: over 30 years ago. not-for-profit public utility that is just regulated by the

it is an often misconception. government and not, you know, i'm often asked where's my making any kind of a profit office and when do i plan to stop doing this. whatsoever. honestly, it is a career that i chose. guest: if i didn't have to deal with insurance companies every day, that would make my life every physician in this department really chose this. terrific. certainly in the outpatient host: you are an employee of the hospital? setting, virtually every guest: it is slightly different patient, every test, the concept of preauthorization for testing, than that. there are some models were the the concept of having to get physician is an employee of the medication as proved, hospital. particularly newer medication or a physicians group a can that come out that might benefit the patients. contract with the hospital. host: you work with a group of we have people on my office staff at 1-800 numbers calling, physicians? guest: that is right. trying to get patients i'm part of a group of emergency authorized. insurance companies have a large physicians that basically has a margin. contract with the hospital to i think they make about 15% of provide services. host: at the same time, you're all the premium dollars. they only pay out about 80%, the chairman of the emergency medicine department. guest: i worked closely with the 85%. so i'm not a big fan of insurance companies. hospital. i think they need to be more they're my partner here. some days i feel like a hospital competitive. how that's done i'll leave to employee. i am certainly very active in

other people to decide. the hospital here. but is it a problem to deal with i know all the medical staff on now? various committees. yes. host: in your private practice do you employ people simply to who writes my paycheck -- that deal with insurance and medicare is someone different from the and the paperwork? hospital. host: why is that the guest: yes. host: is that a pretty big arrangement that's best for you? expense? guest: oh, it's a substantial guest: that is a good question. expense. yes. i mean, we have -- we take up a there are groups that have done lot of staff time doing that. it both ways. there's a lot of work that goes host: next call comes from into managing a physicians group a and motivating a group of culpeper, virginia. kirk on our medical professionals line. physicians. please go ahead. caller: good morning. good morning, doctor. that is something the hospital i'm a health care professional has traditionally left to the of 25 years, working in physician group. host: you volunteered here when radiology. also an advocate of single you were 15. guest: that is how i got my payer, another of the millions of people out here who are start. advocating for national health@ i had trouble getting my life guard license in time. that is the short answer. i still remember some of the things i saw in my first days as it is expanding medicare for all. a volunteer. it happened to be in this that would be very simple. hospital, believe it or not. many years later, i came back for the government to take. looking for a job.

host: did you know you wanted to i wanted to ask you, i heard be a doctor at 15? guest: i was not for sure. questions related to the single my father was a hospital payer. administrator. my mother was a nurse. host: you're a graduate of even your interviewer has asked the question and you made a stanford, yale university medical school. response, you responded to his question regarding simplifying, and then you came back to arlington, virginia. what is the easiest into the to our first call for dr. sverha is do with as far as reimbursement and you said medicare. from michigan on the injsured the question is is it not line. caller: good morning. obvious, there are many cases to be made for national health i do not understand why we have insurance, would you not say such a healthcare crisis that simplifying, getting rid of situation when anybody has the private insurers will access to go to a hospital to simplify and save so some -- so see a doctor. as you mentioned earlier, much administrative costs and whether it be a head cold or your job would be easier and we someone who needs to be admitted to a emergency surgery -- i had could lower that $3,500 a day i see you costs by cutting out a similar situation happen to this insurance reimbursement me. they saved my life. challenges we deal with that was the bottom line. everyday? they treated me just as good as payer

advocate, sir? thank you. if i had insurance at that time. guest: , well, a couple of things. even during that time, all i i said that administratively needed to do was go to the medicare was easiest to deal urgent care clinic. with. they only provide about 80 cents of the dollar of our costs. but there's still little pay as you go. so if we have a hospital that has 100% medicare, we would probably be out of business in a if theyou need a little help, ty relatively short amount of time. so medicare administrative easy to deal with. medicare reimbursing not will give you a sample, or a prescription for $10 at the drugstore. adequate. so that's the problem there. if everybody had medicare and dental insurance needs more work. medicare provided coverage, and i have a big medical problem now. that would include a margin -- i host: let's leave it there. let's go to the emergency room think mr. cole and dr. garrett as primary-care facility. talked about it yesterday. what would you respond to that? to allow capital reinvestment guest: yes, we are kind of a for equipment and things that we need, maintaining buildings and safety net for folks who do not things like that, that has to be have medical insurance. added in. i think in fairness, though, there will always be a role for even if they provided enough, we have to change the fundamentals the emergency department in that spirit as to whether the system of how people are reimburse sod is working well, i think it that incentives are appropriate could work better. we can all give you antidotes on both -- reimbursed so that

incentives are appropriate for a daily basis whereby it would lifestyle and effective care on the physician and providers have been better if the patient would have had insurance. side. host: how quickly does the technology in an i.c.u. change? people sometimes delayed coming to the emergency department even with a serious problem because guest: often very rapidly. they're concerned about the bill. it's a very dynamic sort of there are circumstances where we thing. i think in the last maybe five may diagnose your problem in the emergency department, but years we've had some treating that problem is not dramatically improved ability to something we can always monitor patients in real-time, accomplish in the emergency department. sometimes getting the next part to keep tabs of data and things of your care is difficult if you are not insured. like that. and that has really provided a host: do you encourage people to use the emergency room as more effective and i think more primary care? cost effective care. the technology costs money, but sometimes if you call your i think at the end of the day it doctor's office, you'll hear the message that if you're very does help. sick, please go to the emergency room. guest: i never encourage people host: when we started this conversation, you mentioned you to use it as their primary care. work with the nurses or are responsible for the nirses as that is typically not the best setting for continuity of care. head of the i -- nurses as head of the i.c.u. i'm also very understanding of what's their relationship and the people who come in. what's their role in the i.c.u.? every once circumstances are

how specialized are they? different. if you probe underneath, guest: well, my concept of the nurses in the i.c.u. is that the sometimes because they work 12 i.c.u. is a nursing unit. hour shifts and it off at 9:00 they are the people who run the p.m., no one can see them, or if unit. the doctors make cameo they're out of town. there's always something behind appearances there. this. there is some misuse. provide services that we there's often a decent reason. provide. the nurses do the hard work. that's my experience. host: next call for dr. sverha. host: and do they become, in a caller: good morning. sense, the patient advocate also? guest: they become the patient i have an issue with the advocate, the bridge between the hospital itself, where it is patient, families and the physician. they are the glue that keeps the located. i.c.u. together. i do not see many poor people host: so are your duties up living in that area. there administrative more than patient, one-on-one? it is an empty hospital. guest: well, i have two roles. i have been looking at it for as a practicing physician, we three days. have patient care the emergency room is empty. responsibilities for the patients, particularly ones seen how can you have uninsured by my group. and then also as the i.c.u. people coming to the hospital when they do not live in that area? host: thank you. director. so the nurses will come to me guest: i think we are empty with issues that need to be because the tv cameras are here this morning. resolved in terms of how the if you came back a few hours patients are being cared for, later, i think you'd find this

to be full. even with those that i'm not as far as our location, yes, we directly involved with. we also have a policy here where we can intervene if it looks are in a more affluent area than like there's an emergency and some hospitals. things need to happen quickly, we see a significant number of people without insurance. where we can be more direct in we see about 20% people who come the intervention. into our doors to do not have health care insurance. host: what's the importance of family members? host: dr. sverha, does your guest: family members -- family group lose money when people are and friends are vital parts of uninsured? guest: yes and no. the patient's universe and needs if you provide services and you to be parted of their care and do not receive compensation, you recovery. are not making any amount of host: are there instances when money and you cannot sustain the the squeaky wheel gets the operation here. grease? it is variable. guest: i think the squeaky wheel some folks come in without always gets the grease. that just happens. insurance and receive a bill and but i think part of the issue -- they work hard to pay off the entire bill. we're very thankful for those people. part of the job with the nurses host: next call, fresno, calif. and the doctors is to manage expectations in the i.c.u. "think we watch a lot of you are on with dr. sverha. television, see a lot of people have major surgery at 10:00 and caller: i would like to ask the eating lunch at 12:00, and people think that's going to doctor's opinion. i read an article that the happen. and i think -- particularly as

medical industry as a whole has we get into discussion of end of been -- they more or less treat life issues -- i know dr. garrett discussed it the other day -- appropriate expect the symptoms of the patient it's as. and the nurses are often very, rather than preventive care or very useful, very, very helpful and effective in that regard. host: last call for dr. zimmet trying to find exactly what the disease actually is. from providence, rhode island. cindy, please go ahead. the medical industry as a whole is set up that way. caller: yes, hi, doctor. the reason i'm calling is it it's not really set up to cure a patient. sounds so easy on the tv when i just want his opinion on that your doctor gets on tv and explains all of these things. . guest: it's an interesting point but there is people that really do suffer. be made that perception if you like i have a husband, had an have a disjointed interaction with the medical system. it points to the value of having a primary-care physician, someone who knows you. operation. another time he had a blockage. then an imagery on his brain. you could get that impression if you had different interactions and i brought him to the hospital, 5:00 in the morning. and the doctor came in the with a variety of different doctors. i could see how you could have that impression. i.c.u., intensive care, whatever they call it the emergency room. it is my first time meeting you and until 9:00 at night they and i may not know you well enough to give you the best didn't see him.

the reason why i'm calling is judgment or address all of your concerns. because everything is so easy host: is it fair to compare what for you doctors to say that this you do to triage? is going to happen, we're going guest: to some extent. to do this, do that. but once you get in the hospital, no matter if you're covered, not covered, they push it comes from the words to sort. you on the side and they take their time to sigh if you're die organize not dying. we try to see everyone in this in italy, my country, my husband hospital within 30 minutes of arrival whether it is a sprained ankle a heart attack. went in on vacation. he got sick, was having chest there will always be some pains, was having a heart sorting process in the front end attack. he went to the hospital. to identify the sickest folks. he didn't belong over there. he was an american citizen. they took care of him for three host: how many hours do you days. they did everything for him. work? and when he asked to pay for a guest: about 20 to 25 in the bill, they said, no. when you go back to the united states, you tell your president this is what italy does. clinic and about 20 administratively. it doesn't abandon people no host: so you do have a life matter if they're italian, outside the hospital? american citizens, any kind of guest: yes. citizen. we do not charge. host: are you satisfied with let them know what they do. your salary? but the other doctor before you guest: yes, i enjoy what i do. said that it cost him

it is a meaningful job. about $100,000 to become a i feel lucky to have this job. doctor. a doctor could make in a couple i feel like i am fairly of days his $100,000. compensated. they make a lot of money to take care of people. i enjoy the job. but they make it sound like they're not making nothing. host: is there high tech to that's why they own villa, emergency medicine? yachts, all of these things guest: there is high-tech. because they overcharge everything. blue cross doesn't want to know there's a lot of low-tech. nothing. host: all right. let's get a response to your comments. what we are trying to get better guest: well, i think the example at is patient flow. of italy is an interesting one. we do see waiting times. we'll talk about that first. there's a lot of tech to that. i think there's a lot we can it may not be the radio device learn from our allies in europe and canada in terms of providing we are operating, but there is health care. whether that model would be useful in this country or not, i don't know. i can tell you that most doctors technology in running a successful operation such as this. people really need to go into today graduating from medical school have debts closer t the system, and go through it, and got out of it quickly. host: next call is a medical to $200,000. the doctor was lucky, as he

professional. said, that his personal debt was you are on with dr. sverha. a lot lower. caller: good morning. but i think in today's world. @@@@@@@ @ @ @ and i don't think physicians and physicians salaries are as abundant as the caller might think. if it is true in that area that particularly in the specialties of primary care and the you have what is called the golden hour. when people come in to the pediatricians and psychiatrists and people who really spend emergency room with gunshot or their days taking care of people anything, knife wounds of that one-on-one. sort that you have when you consider a golden hour. host: dr. zimmet is in charge of the i.c.u. here at the virginia hospital center. thank you for spending time with host: what you ask that and what us. guest: thank you. host: up next, the director of kind of medical professional are nursing. but first we talk to a surgeon you? about getting reimbursed for an caller: i am a nurse and continuing my great uncle's -- operation. >> i don't. i know what our charges are. he was a doctor. i know that i am not paid what in an era -- in the early 1900's our charges are because i have contracts with insurance companies, as do most in arkansas and he used to go out into the mounds on physicians. but i don't know specifically what that will translate to horseback and three people. patients in terms of what their -- treat people. co-pay is, the 80/20, 90/10.

so for each patient i really that is why i am a visiting nurse. don't know what that will host: bgolden hour? translate to. and the patients don't know either. host: if you're doing a radical mastectomy what does that cost? guest: it is typically used in what's the total cost of that? the context of trauma and the guest: the cost and the charge are different. injuries from trauma need to be >> what's the difference? >> so the charge is anywhere identified as quickly as possible in the patient needs to from $1,800 to $2,000. be resuscitated as quickly as the payment is usually a possible. medicare reimbursement for a it pertains to other medical mastectomy is usually concerns. time is of the essence for part between $650 and $750. attacks, strokes -- time is of >> is that your -- that money comes to you, the doctor? the essence for heart attacks >> that money comes to me to and strokes. help pay my salary, my overhead. the patients we try to identify i have five employees working in my office. early on is those related to i will have two associates. i currently have one. strokes. . i have another one who's starting next week. that covers rent, malpractice insurance, supplies to the office. so one of the miss nomers for physician reimbursement is that money goes right to my house to my bank. that's not what happens. as most small businesses or big

businesses have overhead to cover so do physicians. and so that payment helps defray all of those costs. >> so it's $600 and something from the medicare if you're paid for by the insurance company, do they give you the full -- >> no. typically the insurance company rates are maybe the same or slightly more than what medicare will reimburse. guest: not too many but we do and so if i am seeing patients see them here. they come not through e.m.s. and i'm a participating we have the front door, we provider, i have agreed to arrive. accept what the insurance and there's a backdoor, all the company contract payment is. paramedics come. we see 30 paramedics a day, 120 if the patient is seeing me and i am not a participating walk-in patients a day. provider, i have the ability to we might get a gunshot victim every month or two, maybe every bill for the difference between three months, perhaps. what the insurance company will but if that was the case, they pay and what my charges c-span.. would come through our front door which creates a scene. host: back live at the virginia host: flu season is coming up. hospital center in arlington, we've heard a lot of talk about virginia. we continue day three here of h1n1. a, are you worried about it? our series on hospitals, health b, what's the prep that's been done for it? care, and health care reform. guest: i'm concerned. in our set in the emergency room i don't know if i'm worried, per here at the hospital we are joined by the vice president and

se. it's a focus in the hospital. chief nursing officer. the good news is we're able to build on our emergency planning that's been done over the last how many nurses work at the seven or eight years here. there's been a big focus. think it's part of our mission virginia hospital center? to be a very well prepared -- in guest: we have over 500 nurses regard to a lot of different here at the time. that is not -- that is have you scenarios. had individuals, full-time, we've had a pandemic flu pan for part-time we have a robust staff. years here. host: how specialized as nursing gotten over the years? we're not process of tweaking as doctors specialize, nurse is that plan, working with local the same. correct? hospitals. all the hospitals in northern guest: absolutely. nursing has evolved into medical virginia to heap sift in different specialties. i think it's been a real benefit planning -- help assist in for both nurse and patients it planning. we try to get a consistency on gives the nurses an opportunity what the hospitals are doing. to find their specialty niche it's a complicated problem, the and really become specialists in issues of getting the staff the event that patients need that kind of care. immunized, anticipate staffing and nurses are attracted to be shortages that may occur if our staff gets sick during this. specialists and that kind of where you would surge patients level of care to patients. host: i just want to mention into if our volumes went from that we have set up our third line for this segment, for 150 a day to 250 a day. nurses only if you're a nurse,

the number to call is a lot to talk about but a lot to be done. host: do medical staff tend to 202-628-0205. again, nurses only on that line get more sick since they're so we have a chance to hear your exposed to the different story. viruses? tell bus some of the guest: my own personal experience is i think i've been exposed to just about everything specializations. under the sun. guest: right now in the virginia but as emergency physicians. hospital center we've been but, yes, they do get sick. spending these last few days in i think the concern is to get as the emergency room. few of them as sick as possible. obviously we have emergency room nurses here. a very important group in our and if they do get sick, they can't come in and work. nursing department as they often they'll only add to the problem. see our first line of patients so it's a two-part message. here. throughout the hospital we also to make sure that you don't get have cardiovascular specialty sick and use all the appropriate means to prevent it. nurses, cardiovascular intensive and then if you do get sick, you care and stepdown unit, critical have to own up to that and not come into work when you're sick. care nurses. host: what was 9/11 like? dr. zimmet talked about their role. we also have a robust women's you are six miles from the and infants program here. pentagon. we deliver 3,700 babies a year guest: right. i was on duty that day. it was an interesting day. so those nurses are very it was a challenging day. specialized in labor and a sad day, obviously. delivery, postpartum care. we have a 16-bed nicu care here. when i was working in the emergency department, i guess we received a phone call through the radio that a plane had gone neo-natallal intensive care down somewhere near crystal city. unit. our departments are strong.

we didn't know what it had hit. we have a center of excellence for stroke. we have a center of excellence host: which is in arlington. for hip and knee. a center of excellence for breast care. guest: that was the last along with each of those centers communication we received until we started receiving patients of excellence we have nurse that from the pentagon itself. are qualified to work there with their education and their focus they had come by vehicle and on those specialty population eventually by e.m.s. we saw about 40 patients or so patients. host: back in the day you could in the hour or two after the become an r.n. with a three-year attack on the pentagon. the hospital responded diploma program. correct? guest: yes. wonderfully. i had a lot of support. host: what did today? host: and like you said, did that change your emergency guest: today, someone who wants to sit for the licensure has to procedures here at the hospital? be a graduate of one of three guest: yes, it did. i think it woke us up to the different state approved different things at the schools. there is still the three-year hospital, in the emergency diploma school of nursing department, to be prepared for. i think that was the usually associated with introduction to that thought and hospitals. but those only make up about 4% of the schools that are out that conversation. there today. there are also with it-year a.d. certainly there's a great focus graduate programs. and there are the four year bsm on that. host: chris in new york city. programs. all of those programs qualify uninsured. please go ahead. caller: thank you for taking my for the examination which our call. many years ago i worked for the state government boards of new york city emergency medical. nursing licensure examination.

host: is that an l.p.n.? guest: it is not. there are several practical the amount of care, prehospital, nurse programs that range in the time frame of about 18 months. and nursing has always been just to anybody that gets hit by looking at itself carefully to a car or anybody that dials 911 identify what level of nursing is quite extraordinary. really makes up the professional better than anyplace else. nurse. there is more and more really in the world. conversation on a professional america does a great job at that. level and movement towards the and, also, when we look at public hospitals versus private b.s.n. that's actually observed hospitals, the caller earlier and recognized the professional made the comment, public nurse. can i tell you -- i can tell that you in this organization we hospitals are not well run. i don't think that we want to have all of the nurses here use them as a model for how to practicing. we have all the nurses of all of go forward. think if we really want to the schools of nurse who's are absolutely excellent. understand how to -- there is no we do encourage our staff nurse crisis, really. at every level to seek and pursue the b.s.m but delivery of quality medical care is terrific. i think the real issue is, how host: what are the doody do we manage that properly? differences? i think the private hospital >-- the duty differences? systems is a good example of what the public should model themselves after. thank you very much, doctor, for taking my call.

host: what do you think of his >guest: there is a different comment? guest: can i only say good things about the paramedics and the e.m.s. service here. we're blessed with a very professional e.m.s. service here level of responsibility in in arlington. relation to greeting the plan of care and have higher level host: is that a public service, funded by arlington county? responsibility for medication guest: it is. we're the only hospital in administration especially when it comes to advance protocols. arlington county, however. we work in tandem of a team to so we are where they go when they transport patients essentially here. provide that best care for but we work hand in hand with patients. them. one of our emergency physicians . . here actually serves as the medical director for the arlington county e.m.s. service. guest: i heard him say that. i see these guys every day at i think he's being very work so they're really like gracious. i like to see the i.c.u. and colleagues to me. almost any unit within the host: that caller also brought up health care reform, you know, hospital as a real orchestra. some aspects. yes, the physicians are in and when you watch and listen to the out. health care reform debates and the nurses are there 24/7 currently going on in d.c. and with our patients. around the country, what are our physician colleagues set the your thoughts? what are your fears? roadmap. and together they partner with us and we set the care plan guest: well, i guess i'm with us and we set the care plan together and most people in that i think things can be better. best care for patients. that's the real combination of in the emergency department, i efforts of the whole team in a have a little skewed view of the hospital. the physicians are obviously at world in that i see a safety

the front end of that, with net. work in the safety net every nurses partnering. day. although, as i mentioned before, it's not an ideal system that we host: has the relationship have set up right now. between doctors and nurses i think most emergency changed over the years? physicians would like to live in guest: i believe that relationship has improved. and improved for the patient. a world where everyone had i believe that nurses have insurance, basically who came always had a great respect for in. the people weren't really worried about a large bill. physicians. and as the education for nurses i think we'd all love to work in has been -- has actually grown a world where it was easy to refer someone for ongoing care. and responsibility has grown that's not the situation we're along with that, physicians have in right now. always respected nurses. that's been my experience. but the level of education now host: what scares about health is equalizing to some degree in care reform? guest: i guess that it could be that the level of conversation, done wrong. i think that's everyone's the planning, the complexity now concern here. from your emergency department that is involved in taking care standpoint, i don't really ever see a changing that we are not of our patients, that has going to be the safety net here. changed greatly. so the dependence on each other, i don't think -- i haven't i think, has increased. and relationships and looked at all the proposals on communication is always where capitol hill, but i'm sure none that health care can improve and of them say we're going to collect payment up front before where the best outcomes are you see a doctor in the emergency department. i don't think any of that will achieved. host: what's the starting base change. so i think my role in the salary for a nurse here? emergency department will stay guest: the starting base salary intact. host: do you set the cost? for an entry level graduate

nurse is somewhere does your group set the cost for around $53,000 plus. the emergency medicine? host: that's pretty good. guest: yes, it is good. it is very good. guest: not from the hospital side of it. i think it's a reasonable -- from the emergency physician side of it obviously we have particularly in the economic some controls as to what our downturn that we see people who charges are. are really taking a second look if you come into the emergency at all health care professions. department, you'll typically get a bill from the hospital and then from the physician group. we have a clinical track nurse, and obviously the bill is related to the intensity of the track here for those people who service you required when you progress through the hospital were here. host: what's the minimum? and their experience. if somebody walks in and sees somebody from your group, what's and the salary gets graduated with experience and performance the minimum they will pay? outcomes against that clinical guest: good question. i think it's about $20 or $30. track. a nurse who's been long in the that's for the simplest field and is very specialized in their field can move upwards complaint. as the conversations previously from that quite significantly, revealed, it gets complicated. up to $80,000, $90,000, plus. just like the hospital, we have so people are paying attention contracts with insurers and to this field more in these payers and so forth as well. times. host: and salarie salaries for s we negotiate rates with payers has improved over the years. just like the hospital does. correct? for the lowest level of service, guest: yes, it has. that's the ballpark we're and, again, i think it has talking about. tracked along with the host: that includes you negotiate with medicare also as education, the responsibility that we have to manage. a private group?

guest: i don't think medicare negotiates too well with us. host: let's take some calls. i think they set our rates. darlene is the chief nursing but with some of the other office and vice president of the insurance companies we do. virginia hospital center. host: next call from cliffside our first call up subpoena is a nurse in kansas. park, new jersey on our insured line. go ahead, joe. -- call up for her is a nurse in kansas. caller: hello. i have been a nurse for 34 caller: i -- i'm a marine vet. years. i graduated from one of the old diploma schools of nursing where i've got the v.a. to fall back we were hospital based, on. but i found in the state of new three-year program. i actually made that decision jersey that because of the because i was so unimpressioned different programs, the care, the way the hospitals operate with the bachelors degree program coming out of k.u. med center nurses because i was with each other and state, not working as an aide and i was unimpressioned with their clinical ability once they got to the floor in pediatrics. everybody can get health care because they may not have so i went into this school of insurance. but god forbid they have a nursing and was immediately into i.c.u. right after graduation. really big problem, they'll pick them up off the street, take them in the hospital. i have had a career in emergency they don't ask them how much money they have. they just fix them. rooms, i.c.u., transport team, this may be an inefficient way

to do it, but we've been doing pediatric i.c.u. it this way for 30, 40 years. and i've been in the caj lab now for seven -- cath lab now for seven years. my question to you is, do you something along that lines has find there are any possibility to be fixed but i don't think a for us to finally go to whole revamping of health care universal health care for the will do it. host: an interesting comment. i agree it's not going to american public? and how can we nurses facilitate change. we're not going to start scooping people off the street that happening? or bringing them in the i have witnessed too many emergency department. we have people who fly into reagan national airport with uninsured people coming in to their sick relative overseas and the emergency room. will come directly to the i know that we will bill them emergency department and we will start treating them. later, after we take care of that's not going to change. i don't foresee that ever them. but i know that they will changing. i think there are problems on the other end of it. probably be unable to meet that how does the hospital and the obligation which puts a lot of physicians get paid for that financial drain on the hospital. service? and how do we keep that person from getting a tremendous bill we serve a huge community, that they work years to pay off? outlying community. those aspects i think still need i'd like to see this hospital survive. but they seem more interested, to be fixed. host: do you know overall the and i see other hospitals also cost of your education? in the country, in building. building new buildings.

building new facilities, new equipment. kind of the bricks-and-mortar instead of actually hiring better nurses, more nurses. guest: i was lucky enough some and i would like to see how we of it was paid for by my can get away from the parents. host: we've talked a little bit about a physician shortage. money-making aspect of hospitals do you see that at all? guest: i guess i can see that and get back into just providing coming to some extent. if we expand coverage, i'm sure to all the folks that don't and care for all of the american there's a demand in other public. thank you. services as a consequence of that, can i see that the number of physicians, nurses and host: patricia, two questions. everyone would increase. do you enjoy your work? and could you give us an idea of there would be a greater need how much money you make? for that. caller: i enjoy my work. host: in our conversation with the chairman of the board here, the cardiac surgeon, he and his very much in the cath lab. i think it's a great combination wife, who is a pediatrician, pay of i.c.u. and e.r. vast index malpractice insurance rates. what's the rate for an e.r. it's exciting. the patients are basically physician? guest: it varies state to state. conscious. so we get acquainted with each can i tell you in our circumstances, i think i pay

of them. we get to actually fix a lot of probably $7 or $8 per patient i what their problem has been, see. goes to covering the malpractice kind of immediately and see the for that patient. end result of that. host: per patient? so that's exciting kind of guest: yes. host: two more questions. what is facep on your jacket? medicine for me. and it also is challenging. guest: fellow of the american and it's the best patient carry college of emergency physicians. can give because i have three host: is that a good thing? staff members to one patient. guest: it's a good thing, yes. and when you go home at the end it means that you've done a of the day, you never feel like little bit above and beyond the call of duty besides simply you have given poor patient becoming a member of this professional society. care. but my cohorts in nursing, i host: we were talking earlier about your mission trips to honduras. tell us a little bit about this. guest: it's something to get would say, by and large, are not involved in in the hospital. there's a group of about 75 physicians and nurses. happy people. all sorts of folks that come they are not in the cath lab. down -- go down once a year for they work on the floor. they're under staffed, over the week-long trip. we see several thousand people worked. and their management is from a primary care standpoint. unsympathetic to that. in fact, management changes so we do about 100 surgeries, give out eyeglasses, physical therapy rapidly often times managers of services. then we come back. it's a great thing. particular units stay only a year or two and then they are host: who pays for it? guest: we pay for it ourselves. we get some donations, but all replaced.

so there's no consistency there. of us take a week of our own vacation time, pay for our own flights, food. and it's a very frustrating host: when you compare the two systems, u.s. and honduras, situation for nurses. maybe not a fair comparison but host: are you satisfied with what do you see? your salary? guest: they're very different here. there's such a great need, guest: no. as your guest said, the starting obviously, where we go. we go outside of the major nurses at $53,000. cities to some of the smaller and i'm making that at 34 years towns. their access is very limited to of nursing. medical care. they have some clinics that are host: thank you very much. a lot to work with there. very poorly stocked. they're always very happy to see guest: you bring up many, many the american doctors roll into key points in your relationship town. it's something we enjoy doing. to your experience as a nurse and where we are with health care today. host: the doctor runs the i, too, first started out with a medical emergency department here. thank you. three-year dloam i can't school coming up next, we're going to and then went on to get my degree and masters. talk with dr. zimet, head of the so we have about the same amount of tenure in the field. and you're saying that you've seen an awful lot of change. i.c.u. here at the virginia and you've had the opportunity hospital center. to try a lot of different things first, we talked to a couple of in nursing and in the health doctors here and we asked them whether or not health care was a care arena which you found your moral right. niche and where you're able to make the most difference. and i'm always one that supports nursing, finding that

opportunity. that doorway to the patient care, to the arena which they love and have a palings for. you ask a question to how nurses guest: currently there's an enormous cost shifting going on. can impact health care reform. my response to that, patricia, ok? if you're a medicare patient and you're in the hospital. is that we're over three million your care is being subsidized by strong in this country. nursing, as you know, makes up a patients who were on commercial vast majority of caregivers at insurances. the bedside and caregivers in and that's not right. the health care industry. if you come in without any so we need to be well versussed insurance at all, all of the on what the issues are related to health care reform. costs of your care are being we have a lot of professional organizations. i'm sure that you've subsidized by commercial participated in and your insurance companies. colleagues have participated in. so as a hospital, it's critical and you're probably following, as i am, and as we are here, since medicare you have no what those reforms are looking negotiating power. like, what kind of impact it's so it's left to the@@n going to have on nursing. as i was preparing this week and thinking about what message for virginia hospital center nurgses might be most appropriate for me to convey with an opportunity like today, and nurses throughout the organization here at virginia hospital sent rer concerned as you are. what is it going to look like in

the future? between the amount paid and the how is it going to impact the number of nurses we're able to provide the resource that we amount received. have to deliver the high-quality care at the end of the day that we're satisfied with? this is on everybody's minds. and to that i would encourage guest: anybody that lives in us, as some of the nurses have this country, americans should said here in this hospital, as have a right to health care and an industry to take stock of where we are to appreciate the this question gets murky when you say you was going to pay for gains technically that you have seen and i have seen so that we this and the answer is we are do have people surviving through all going to pay for this. the cardiac caj rizzations and - it's certainly not going to work by cutting what hospitals get paid outcomes. what insurance -- what take a pause. look at what our achievements physicians get paid. that will not solve the problem. have been and don't lose that ground. build on top of that ground that having said that, as mike is we've work sod hard for, doctor -- worked so hard for. saying, it is a very complicated people attached to the health care for these many years have equation. but the question is a very basic question. do we have a right as citizens of this country to receive driven our outcomes to places that other countries in health care? my very straight answer would relationship to what we're able be, yes. how are we going to pay for it to achieve with our and how are we going to allocate interventions and our treatments care and are we going to that are still out of reach for them but comes at a cost. restrict or limit what patients and it is a large dilemma. can receive because of issues of but stay tuned to what's going

funds and money? on. be a part of the voice in the example throughout the world relationship to making decisions. is most likely we cannot offer the other message i heard from the nursing staff here at 100% all the time. virginia hospital center is to we're not going to be able to have a liver transplant placed on every person because there's urge our legislative people to no country in the world where not rush to an end too soon, to that is possible. and the second message is that be thoughtful to take their every system of health care, it time, to think about what needs doesn't matter where you look -- to happen next with the sense of england, canada, whichever ones urgency. we talk about recently are but not to rush people to a place where they're fearful of flawed. what's coming next down the line there's not one that works with health care reform. perfectly. do we have it right as citizens of this country to receive that some of what we're seeing health care? in my mind, in my opinion, the in the public might be because answer is yes. it's so personalized in relationship to the outcome of where this health care reform is host: the virginia hospital going to land. center in arlington, virginia. but, again, nursing is going to our set is in the emergency be a big component. room. we've been a big component of we've taken up a bit of the emergency room here at the health care in the past. we will be in the future. and actually, it's an exciting time. if you are energized around hospital. we've left plenty for patients. providing patient care to have your voice heard and be part of we appreciate their allowing us where we're going as a nation. in here. now we're joined by dr. steven host: nurses are first-team zimet. medical care. doctor, why does the i.c.u. have do they know whether a patient

a doctor who is in charge of the is medicare, blue cross-blue i.c.u.? shield, united, uninsured? guest: , well, i think i.c.u.'s around the country have medical guest: no. directors. i would say we have an awareness and our jobs in general are the of it in relationship that we're to set poll i is is and make part of the team that's also helping manage what is in the best patient care interests sure -- policies and make sure protocols are followed. related to the length of stay. there are teams in the hospital responsible for that and working with the physicians and the hopefully provide effective uses of resources. nursing staff together to coordinate that activity. guest: are you employee of the hospital or private? when we're in front of patients, we don't have that awareness. guest: i'm private practice. nurses in general, and i believe i have a contract with the physicians as well, that's not hospital. so i am reimbursed for those what we're here for. hours that i spend as medical we're here for meeting the director. patient, where they are, what host: so i would guess that most their needs are. patients that go into the i.c.u. the ability to pay or not pay is have their own primary care not something that is ever in physician who's work with them. the forefront of our minds. host: how did you decide to correct? guest: that is correct. become a nurse? host: so how do you interact in guest: i had the advantage of that situation? growing up around mentors who guest: well, i work with the were very influential. nursing staff primarily in terms my mother, my father were people of father, of compassion, and of of making sure protocols are great service. followed. my father is a world war ii and that people are having veteran who came back, had a appropriate scultdions -- job. but also served in our community consultations with specialists of the town council, as fire in the intensive care unit.

chief, as a county official. i had the advantage of seeing my host: how big is the i.c.u.? how many people do you see there mother and my father extend a year? their hand to people throughout guest: well, we have 24-bed unit my growing years. at our hospital. i also volunteered in the we have four sort of emergency hospital. as many of you heard, physician beds that we could use in an colleagues of mine. i volunteered. i saw this as an opportunity. extreme emergency, thinking i enjoyed the sciences and just about the flu season coming up. wanted to be with people and it it makes you think about those things. grew from there. i had a mentor, an aunt as well. we see about 1,100 patients a year in our i.c.u. there's many nurses in my family as well as physicians. host: and what are the reasons they're in the i.c.u.? host: jack, savannah, georgia, insured line. guest: we have what's called a medical surgical i.c.u. so we see patients with medical guest: my daughter is a registered nurse in the state of problems, heart attacks, surgery michigan. she works in delivery, neo-natallal and i.c.u. for problems, trauma. and people just overwhelmingly babies. she's been there 18 years. sick from infections, things like that. i support single payer, host: what's the minimum cost of staying in i.c.u. overnight? universal health coverage for all. guest: one day in our i.c.u. i'm a big-time supporter of that. but i also support tort reform. costs $3,500.

host: why? guest: well, mostly what makes and not only limit the amount of it an intensive care unit is not damages for some of these that the geography but the service that are provided to the people have, bunt i think that a panel should sit down and work patient. and we have primarily nurse that's are there. out loss of foot, loss of hand, loss of whatever and say this is there's a concept in health care the maximum that the courts can allow to be paid out. called nurse-patient ratio. i also believe that the lawyers we operate pretty much on a one-to-one or one-to-two ratio with our nurses. should get their hands out of then we also have the monitoring that goes on. the pot. and that cost includes test and that should be included in it. other things that are done. so it's not strictly just the we have all of these allies around the world who have i.c.u. cost. that's sort of the hospital-wide already went through this whole cost. those patients usually demand thing, canada included back in the need of lots of services, the 1950's. we don't have to pick a blood tests, images, things like particular one. that. we can pick and choose the best host: is it difficult -- what's of all of these plans and come it like to deal with the up with a uniquely american insurance company and with plan. medicare and convince them that host: thank you, jack. two issues. patients need i.c.u.? single payer and tort reform. guest: great question. guest: first of all, jack, you mentioned that your daughter is medicare is actually our easiest

a nurse in nicu, neo-natallal insurer to deal with because they just pay in an arbitrary intensive care. i believe that nursing has a way whatever they want and don't feel for excess throughout the bother us in terms of what we nation because so many people do know nurses. therthis is a really good examp. do. the other insurance companies we have actually have case manager i'm sure a lot of jack's opinion that have to call the insurance is based on what he hears his companies and justify the daughter come home and say. in the nicu we've seen great admissions, continued advances in the last 10, 20 admissions, of those patients there. host: on a case-by-case basis? years. we're seeing baby that are -- guest: on a case-by-case basis. and some insurers on a even 15 years ago were unthinkable of being able to survive at the age and gestation day-by-day basis. host: of that $3,500, how much that they have, how early they're born and the weight that is medicare going to pay? they are. but also an arena where legal guest: well, i can't really give issues are a concern. you a direct answer on that. in general, we get about 80% or it's a fine balance between what 80 cents on the collar costs -- parents expect or@@aá@ @ @ @ @ p dollar costs hospital wide. i would presume it's pretty close to that in the i.c.u. i expect when they come through the door, what we are able to host: we've got the numbers on the screen. if you would like to talk to the do. everyone that arrives is director of i.c.u., also the expecting the best of outcomes. respiratory care director. those expectations, when they

are not met, can turn into legal dr. steven zimmet, trained at georgetown, also a professor of issues. tort reform is something that medicine at some of the universities. we'll ask him about that in a the health-care industry and second. the numbers are on the screen. physician practices have been impacted in how they make besides being the i.c.u. director here what else do do decisions, how we operate in you? guest: well, let's start with my this society. day job which is i'm in private tort reform has taken hold in practice. i have a group of nine different states across the nation. i think there is a lot more work providers. to be done there. we do pulmonary critical care, host: duke nurses carry internal medicine, and some malpractice insurance like sleep work in our practice. doctors do? i certainly do. host: sleep work? guest: one of my partners is in hospitals there is an director of our sleep center insurance coverage for all here. practitioners, all clinicians within the hospital. guest: so there's your day job. but beyond that, in this guest: then i do the i.c.u. job. society, i encourage every nurse that's also part of my day job. i also have the honor of serving to carry their own individual on the board of directors of the insurance. hospital. host: how significant is the host: you're also a professor at overall comprehensive georgetown and g.w., george malpractice insurance that the hospital pays for? guest: that would be an answer washington? guest: i'm a professor of that would best come from robin georgetown. i have a associate professor at g.w. host: how often are you at normand. i know it's very significant. georgetown or george washington university? it's something that needs to be

guest: we actually teach their budgeted into the hospital. students and house staff when certainly any increase in that they're here at our hospital. arena limits what we do and are host: so this is a teaching able to do with other resources hospital. guest: this is a teaching hospital. we rotate -- georgetown rotates in the hospital. everyone in the hospital, our health care business and nurses, interns, residents, sometimes we'd much rather see the doctors fellows come here to our be spent on patient outcomes and facility. that's where we do our primary patient care. teaching. host: but you also carry the host: how many hours a week do you work on the average? malpractice insurance. guest: not counting call, about guest: absolutely. host: is that an expensive proposition? guest: not as expensive because we are not sued as much. but i do carry over $2 million. host: nurse in columbia, connecticut. her name is judy. you're on with darlene, vice president and director of nursing. . caller: we were in the hospital and did our schoolwork from 11:00 to 3:00.

i am disappointed that in connecticut there are very few hospitals that do that anymore. now i am in geriatrics. ic nurses coming in -- i see nurses coming in. they are thinking of it as a job and not taking care of people. i just wanted to say that you have to work with what is in your heart. my son right now is in a burn unit. those nurses are absolutely awesome. there are a lot of great new nurses out of there. they are taking care of people. thank you. host: what are you -- what are your duties? caller: the only thing they rn

can do it in a nursing home is start and i.v. i cannot run them and hang them and change them, but i cannot start o one. that basically is the only difference of a floor nurse. guest: well, i agree with what she is saying. one is the cost of education. it has increased. another point i would like to focus on that judy brought forward is the fact that we need to meet with our hearts. nursing is a noble profession. most people are choosing it because they want to make a difference. it requires a demanding intellect, strength of character, up flexibility, and compassion. they lead it with their head and

their heart. you need to care about. patients know that difference. people who come to this profession without that realization usually do not stay. we are not here for the money. we are here to make a difference nine times out of 10. she saw some graduates that do not have their head and the heart of wind with patient outcomes. -- they did not have their head and heart aligned. they have a lot to learn tactically. it is up to us as mentors to bring us to a level of nursing that integrates the higher level of caring for the populations. that is why i believe patients

connect with nurses. they do so on a level. we breached some of the gaps of knowledge and with their physicians if it exists. it is a demanding a place. host: my mother is an old nurse. she went to the three-year diploma hospital school in 1903. you went to the diploma school. they are going away. d.c. something missing with the level of technical expertise with hospital in training schools? guest: as we move to a degree programs, there is not as much time. they do not have as many hours as the old schools of nursing did. that gap is being addressed as we're bringing in new graduates. our average age today -- this is

excluding the leadership team -- is 30 years. that has dramatically changed. we have a lot of graduate nurses. we have made accommodations. mentor programs. they are in the form -- nurses are not on their own for a good number of months, depending on the field they are specializing in. we know it is a challenge and an issue. also, it is a utilization of resources. what it costs to bring a nurse up and running is significant. it is important that those resource chefs are thought about carefully in relationship -- those resource shifts are thought about carefully.

whether it is providing time to have them adjust to their level of ability. host: what is the philippine pipeline when it comes to a nursing backs guest: that is in reference to burning nurses in from other countries. the philippines have been one of the focus to fill in the gaps of the nursing shortage. i am sure many of your listeners have heard about it. we are in a little bit of a reprieve with the economy down. we do not have as many nurses who are retiring in relationship to their retirement plans. therefore ones have changed dramatically. we are having people stay in the field longer. if we look of some of the projections, as far as 2020,

when maybe half a million nurses short. as baby boomers leave, and they are becoming those that use the health care system the most. you have this duality of baby boomer impact to what is going to happen in health care. addressing the nursing shortage with nurses coming in from the philippines is not the answer. it is not the answer in taking nurses away from the philippines because it is a global issue. we want to provide the best care we can. there are plenty of qualified people who should look to a nursing as a qualified profession. i seek good support from government-supported programs for governments -- for scholarships and grants.

host: darlene vrotsos, before we take this last call from karen, we want to make sure we thank the virginia hospital center for allowing us to become part of their system and to conduct interviews. everything we have done here is available on our website, at c- span.org. go to c-span.org. it is all available there of the website, including some of the short interviews with doctors we have done. you'll be able to sit everything there. karen, maersk, please go ahead. caller: good morning and thank you. thank you for your focus on health care providers. i am retired. i put not be if it had not been

for an injury. i am an old nurse like your mother. emphasis on "olds. " i graduated with a bachelor of science from the university of missouri. does that qualified me as old, i think. my last of time in nursing, over 40 years, has a perspective of all the changes that have taken place, it for good or ill. i would agree with the director, who was not called a director anymore either. that is fine with me. i want to address you respectfully. i want to emphasize the business of the parts. i have never known anyone who comes into nursing and stays in nursing that does not have a

hard to. i know many times -- that does not have a heart. many times i've wanted to leave. this is who i am. there are some things i agree with and disagree with. nursing education. at the time i was going to school, we had a lengthy program. there was an earlier bsn programs and there were including clinical experience. it was a solid five years. we went to school year round. the argument about the basic entry level was all print them. we had long -- we're long past that time. host: i apologize. we have run out of time.

in your 40 years as a nurse, how has your relationship with doctors changed? caller: i love working with doctors. it was part of the work. i respect them greatly. host: we have run out of time. thank you for calling in. guest: in relationship to producing nurses, we have a significant shortage of nursing faculty. in any given year, but we're turning away almost 50,000 qualified applicants because we lacked the faculty. if you have great experience, i encourage people to become a faculty member and help us address this gap that is facing nursing. host: darlene vrotsos the chief nursing officer and vice president for virginia hospital

center. thank you for being with us. we also and thank you to all of our guests. the [captioning performed by national captioning institute] [captions copyright national cable satellite corp. 2009] >> and a few moments, a health- care town hall meeting with house majority leader steny hoyer. in about 2.5 hours, speaker nancy pelosi says the house version of a health-care bill will include a public auction. -- a public option. tomorrow morning, the head of

unity healthcare on providing health services to the uninsured and homeless. we will take your questions on japan's recent election with michael greene. also joining us, the author of "to good to be true." "washington journal" is live on cnn every day at 7:00 a.m. eastern. it -- is live on c-span every day at 7:00 a.m. eastern. >> we are doing our final days of shooting hour documentary on the supreme court. we have been in there for about two months or so. we talked with nine of the justices about their job and to give us an inside window of how the court operates and humanizing and it. we are grabbing a couple of

final shots that we are going to add into the documentary. >> supreme court week, starting october 4. >> steny hoyer held a health care town hall meeting in his district on tuesday. he met with constituents for an hour and a half. [applause] >> good evening. i want to thank you for all coming out tonight. i am the administrator of calvert memorial hospital. i am honored to be asked to moderate tonight's health care town hall meeting. for the last 22 years, i have been privileged to work at a nonprofit hospital serving our community.

the men and women who work in our hospitals are on the front line of delivery of care every day. we see the places where insurance coverage can and should be improved and where health care delivery can and should be improved the purpose of tonight's town hall meeting is to listen and share our communities and views on health care reform our elected leader. i think all of you for being here tonight to join our discussion. two weeks ago, congressman steny hoyer personally called me and asked me to serve as tonight's moderate. we agreed that my role would be non-partisan and neutral, that i would not take sides, and that everyone would be treated fairly and respectfully.

in order to keep the meeting tonight moving, and because we want to hear from many people as possible, we need to establish some rules. i would like to review them with you. they are going to be listed on the screen up here on the stage. if this sounds good to everyone, i would like to begin. first, there will be no signs in the auditorium. second, please stay seated until your number is called or you need to leave the room. also, make every effort to keep the aisles clear. so that we can get as many questions tonight as possible, please if you ask a question, keep it brief. it no longer than two minutes. please respect each other and everyone's opinion. to save time cannot no applause, cheering, or shouting.

i ask you not to interrupt, yell, or use profanity. lastly, i asked you that you refrain from personal conversations and allow your neighbors to hear the questions and answers. does the majority here tonight agree on these rules? great. here is how we will do the question and answer session this evening. people who wished to ask the congressman a question have been given a numbered ticket. it is a red ticket and looks like this. if you wish to ask a question and you do not already have a ticket, please raise your hand now and we will have usher's bring the tickets to you. i will randomly draw five

tickets at a time from the box right here. i will call the last three digits on your ticket. if you have a to get an want to ask a question, i am going to call the last three digits. i am going to call those numbers twice so everyone can hear it. when your number is called, please come forward and lined up for the microphone. until it your turn to ask the question. terry is the congressman's chief of staff and he will help you with that. if your number is called, please come down here. please state your name and where you are from followed by your question for the congressman.

if needed, i may interrupt you if you go over your time. we make every effort to answer as many questions as possible so it is very important to keep your questions concise. as we will not get to every person who wants to ask a question. there are cards at each seat. please complete those cards so the congressmen can respond to you after tonight's meeting. there is staffed throughout the room that will come by and gather those cards after you leave here tonight. you can return them while you are exiting the auditorium. our program is as follows. congressmen steny hoyer will speak 15 minutes to give a brief outline on the bill, and then we have a few members here from our

community who will make very brief statement. then we will move to the question and answer period. please join me in welcoming a congressman steny hoyer. [applause] >> good evening. we are at a wonderful high school in a week -- in wonderful southern maryland. i have been in office for 29 years in the congress, 12 years before that in the state senate, and i have never had a town hall meeting as large as this. what a wonderful celebration of democracy. [applause] we have just been through an extraordinary week. you have seen on the screen, and

i am going to quote from some of them talking about health care, how we needed to make sure every american had access to affordable, quality health care. health care is not an option if we are a mother or a father. it is essential. it is and is essential assurance for us and our children. there are many in the room who are health care providers. thank you very much for all that you do to assure us that health care is available to us. tonight, i am here to talk about how vital health reform is. what the proposed reform bills will and will not do. and how it will ensure that you have affordable health care that

you can count on. there is not one bill. there are five different bills. we have not completed the process of consideration which is why this town hall meeting is so important so i can hear your views and get your input. i have been getting that at the grocery store, in the neighborhood, i have been hearing from many of you. health reform is vital to you, more than ever, the center for our families, our businesses, and our country. our families need help care reform. if we do nothing, the average american family can expect to spend $22,200 per year on health care in 2019, up from $13,000 now and $5,400 in 1997. across america, families are

dealing with the same of control costs. right now, 10,000 americans a day are losing their insurance. premiums have risen three times faster than wages this decade, meaning that health care eats up a bigger and bigger share of your family budget every year. at the same time, middle-class families who thought they could count on their insurance are losing it. right now, 10,000 americans today are losing their health insurance coverage. most people without insurance have jobs. 28 million out of 47 million people are independent. most people without health insurance have jobs.

the ranks of the uninsured will continue to grow unless we act. our businesses need health care reform. starbucks spends more on health care than it does on coffee. american companies pay twice as much for health care as their foreign competitors, which is a serious handicap. small businesses are struggling to cover their workers. their premiums have gone up by 129% just in this decade. the average family premium rose from $5,600 to $12,000. our country needs health care reform. in 1994, health care took off 14% of our economy. today that is up to 17%. by 2025, health care will eat up a quarter of our economy if we do nothing.

eventually, one of every $2 spent in america will go to health care. our country needs health care reform because our economy loses more than $2 billion a year due to poor health and a shorter life span of the 47 million uninsured. the problem is growing. the cost of car broken system have been with us for generations. every president since harry truman has called for health care reform. in 1945, over half a century ago, president truman said we should resolve now that financial barriers in the way of attaining health care should be removed.

in 1962, president kennedy said this. whenever the miracles of modern medicine are beyond the reach of any group of americans, we must find a way to meet their needs, fulfill their hopes, let this be the measure of our nation. in 1974, president nixon said this. "we must have legislation to ensure that every american has financial access to high, quality health care." he also said that health care was necessary to be adopted in 1974. as we know, it was not. what is congress proposing we do about the unsustainable cost of health care? first, a quick update. before that, i mentioned it three former presidents. let me mention one present

president but let me mention as well the republican candidate. this has been and continues to be as i quoted richard nixon, not eisenhower, a non-partisan issue. john mccain during the course of the last election just last year said we should have available and affordable health care for every american citizen for every family member. he does not support the bill that is pending but obviously was for health-care reform for all americans. mike huckabee said if they're real health care system exists, it has three components. it has affordability, quality, and it has accessibility. mr. romney said the right answer is to get people in shirt, all of our citizens in short it said they do not have to worry about losing their insurance if they

change jobs or had a pre- existing condition. fred thompson said every american should be able to get health insurance coverage that is affordable, fully accessible, and portable. rudy guiliani who did not support and oppose a government-mandated government insurance, he said what we should do is increase the number of people who have private insurance. i mention these not because they are supporting this piece of legislation but just to indicate as a think all of you know how universal and the bipartisan has been a call for health care reform. in the house, we have had 80 hearings over the past two years. we have seen an number of discussions on television. after months of intense work, the bills were passed down to

the three committees of jurisdiction in the house. staff have been working over the august break to combine the three so we have a bill that we could consider. your discussions here tonight will be helpful. in the senate, one committee has passed out a bill, the bill that senator kennedy when alive chaired. the two senate bills will be combined. they will be in a discussion to how that will be done as well. as all of you know, each chamber has to vote on its own bill and then they will have to sort out their differences before a vote on a final bill that the president has to sign into law. let me explain a little bit about where the substance of the proposal in the house stands. we keep what works.

and we fix what does not. if you have it, you like it, you keep it. building on the current system of employer-sponsored insurance. we have a unique system in america and we are building upon it. what is being proposed is not a government-run system. all americans can find peace of mind with health care they can count on. for seniors, we want a more efficient medicare with stronger benefit, and we want to level the playing field for small businesses. qualified insurance plans offered by employers would be unaffected. that is an important point. i know people are concerned about losing the insurance that they have. an insurer's plan has to cover basic services like hospital coverage, prescription drugs,

and general health. even though it builds on the system of employer-sponsored coverage, the bill make sure that if you lose to a job, you do not lose access to insurance. 10,000 people are losing insurance. many of those are losing their insurance because they lost their job. that means more peace of mind for millions of americans. as a parent of three children, four grandchildren, and one great grandchild, i want to make sure they are covered by insurance and have access to the best quality health care in the world. according to the nonpartisan congressional budget office, health care reform will mean millions of more americans getting employer-sponsored insurance. because it will be more affordable for small businesses to offer. small businesses will find it

easier because the bill creates an insurance exchange which lets them leverage the purchasing power of their larger competitors to get cheaper group rates and more affordable insurance for their employees. how many people are in the federal plan in this room? essentially -- thank you very much. essentially, that is an exchange. it is private sector insurance. it is managed by opn. i think that that model has worked well for me and for millions of federal employees, some 11 of whom are included in the health benefit. secondly, and this is critical and overlook, we reform health insurance to provide security and stability for the middle- class. these are the changes we make. first of all, we protect you

from medical bankruptcy. no matter how sick you get, he will never pay more than $5,000 out of pocket for yourself or $10,000 for your family. a high percentage of bankruptcies are caused by health care costs that are absolutely essential and cannot be afforded. if you lose your job or want to start a business, you will have access to affordable, high- quality insurance through a national exchange with private plans complete for your business. the exchanges will offer the choice of a public option to increase competition. i support this option because i think it will provide another affordable choice to those who want it. nobody has to take it. this is an option. no one would be required to join

the public plan. we and discrimination with those with pre-existing conditions. -- we ended discrimination with those with pre-existing conditions. everything from cancer, diabetes, pregnancy, and asthma. we eliminate caps as well so no insurance company can tell you that you have gotten to sick. we will stabilize your health care costs. right now, if you have insurance, about $1,100 of your premium. $1,100 of that premium goes to subsidizing the care of the uninsured.

by covering the uninsured, we can and that hidden cost. third, medicare. i know seniors are worried about access to your doctor and keeping benefits. let me be clear the bill preserves your access to your doctor by reversing a huge doctor pay cut that is scheduled to hit january 1. that is a 21% decrease in medicare reimbursement. doctors cannot afford that and they may not take medicare if that happens. we can inshore in this bill that it will not happen. it also waives your co-payments for preventive care. we want to encourage people to get preventive care. we think that enhances health

and saves money. it helps medicare provide more efficient high-quality care, and rewarding doctors who coordinate their care. it does have some cuts to medicare by 60% of the savings are put back into improving their benefits, and help the program stay solvent. indeed for another five years after 2019. those cuts eliminate unfair over payments to medicare advantage plans, some of which get paid up to 50% more than it cost traditional medicare to provide the same service. fourth, small businesses. the reform bill creates and insurance exchange that will help small business owners cover their employees for less. it makes it easier to cover employees by providing a tax credit to 50% for small

businesses. finally, 86% of small businesses, those with payrolls below $500,000, are exempt from any mandate to provide coverage. 86% of small businesses are exempt. i want to expose some of the many myths about health insurance reform. this is what it will not do. first, it does not create death panels. i don't know how that got started. i have seen so many different people -- [yelling] >> [inaudible] >> if a patient chooses to

discuss advanced planning board and of life care with their doctor, medicare would reimburse the positions for that counseling and time. right now, doctors are not reimbursed for such costs. we want to encourage them to give the best advice and counsel to the patience that want it. [applause] [boing] -- [booing] >> i personally hope that these provisions give more americans peace of mind knowing that they and their families have had the opportunity to think about the choices that are right for them. those of us who have been to the

experience of losing a spouse know how difficult these times are for families. we know how much they count on good counseling and good advice. that is what that is about. this is based on legislation that was introduced by a republican senator from the state of georgia and builds on a provision passed during the republican congress a few years ago. it was passed and signed by a republican president. this is not radical legislation. this is sensitive to the needs of people. a conservative republican senator said this. how someone could take an end of life directive or a living will as a deft panel, he said, is nuts. you are putting the authority in the hands of the individual

rather than the government. i don't know how that got so mixed up. second, the bill does not put government between you and your doctor. right now, of course, insurance companies are between you and your doctor. [applause] [booing] >> deciding what they will or won't cover you ask your doctor, the conversations that they need to have not necessarily with insurance company executives but people that work with the insurance companies about what they can and cannot do. if health care reform passes, everybody will have insurance. if you get sick, you will get care. all decisions about care, all

decisions about care will be between you and your doctor. [applause] [booing] >> third, this bill does not provide health insurance to illegal immigrants, period. [yelling] i have read the bill. >> we really have to get to those folks who want to ask questions tonight. if not, we will be here all night. >> thank you, doctor. let me say this. read the bill, page -- first of

all, ladies and gentlemen, there are five bills. line three of page 143 of 3200, section 246. no federal payment for undocumented aliens. that is what the bill says. [yelling] >> we have rules that we talked about. i see a lot of students in this audience tonight. it is not showing a good thing for our students here. [applause]

we want to get to most people's questions tonight so we have to keep moving. >> fourth, the bill does not ration care. it does pay for what is known as comparative effect of research which is like consumer reports for health care. many of you read consumer reports to find out what works best. it gives doctors and patients information on which treatments work best. it makes that information widely available but it leaves the choice and the hands of doctors and patients. it does not require or forced doctors to deny or ration care in any way. the bill spells that out clearly. to ensure that we always have enough doctors and nurses, the

build invest in training and scholarships for new health care workers. that is essentially what the bill does. . . thank you very much. i will be back. [applause]

>> thank you, congressman hoyer. before i introduce our panel, we need special thanks to principle though, vice president wilson. let us give them a round of applause. it is a beautiful city. we are very proud. we have a wonderful resource. our life experience -- the experiences will be informative for all of us. each member represents a different voice and the health care reform discussion. that includes small business, seniors, veterans, and health- care providers.

i would like to introduce carolyn. carolyn, her friends called her could become that is the founder and owner and president of charles county office furniture which started as a home-based business in 1985. last year -- please, please -- remember the rules that we agreed to.

last year the office furniture was named to the top 100 minority enterprise of maryland. [booing] the longer we shout, the longer this evening will take, folks. please, refrain from shouting. in 2002, the president of the chamber of commerce after being a member 20 years. she is also co-founder of the charles county small business network. [chanting and intelligentlyin a]

we would get to the questions. >> i do not care what she has to say. >> at this time, i'm going to ask her to say a few words. please, show her some respects. thank you. >> thank you everyone for being here this evening. i am a small-business owner. i get you want me to rest, so i will. my husband and i are getting toward the retirement age. with all the talk that we have had for so many years, it has

not helped us. we are getting there. right now as a small-business person, my rate are astronomical because there are only three of us. we cannot compete in the big insurance game because we are just not bring in enough money for them. every year my rates go up 18% or 20% more. i have hired a college student this year. i am ensuring her. i wish it could have done this with anybody i had hired. i hired her. i pay your premiums. it has drawn to my monthly payments $600. the time is drawing near. we need to do something. we can work them out. we have got to start. we cannot keep talking about it.

charles county is small business. that is the majority of the people here. please, look at the broad picture here. thank you. >> annette panel member is bob, a medicare beneficiary. he grew up in calvert county. for 23 years, he served in the air force and was mostly stationed in germany. after retiring from the air force, he worked for the national weather service as a meteorologist. since retiring, he has been an active member of our lady of the stars church, the american legion, and the knights of columbus. they have three children and four grandchildren. he is enrolled in medicare. as a veteran, he is also

enrolled in try care -- tri- care for life. he is also very active in the civic association and the national association of poise. >> thank you very much. it is an extreme pleasure to talk to you today. my name is bob priddy. i'm happy with my medicare coverage. as a veteran, i also have tri- care for life of this supplement my medicare. thanks to last year's improvement in this program. i think health insurance reform is imperative for the future of our country.

it'll make our economy much stronger in a better america. health insurance reform is essential to keep medicare strong for seniors like my wife, myself, and for my children for all the years to come. this reform bill does not, i repeat, does not cut medicare benefits like some people have been saying. it guarantees that we keep seeing our own doctor or doctors. i know that medicare has long- term challenges. i am glad that the democrats are doing something about it by making sure that the money --

>> [booing] >> this money in the medicare program, which goes to paying the seniors benefit and not paying the private insurance companies, keeping medicare solvent means that we can count on it for the rest of our lives. this bill also increase medicare benefits for the seniors. it closes the doughnut hole over time and makes it hard for seniors to for the prescription drugs. it makes it more affordable for us to have access to preventive care and get checkups so we can have a healthy and longer life.

all in all, of this bill gives me as a senior peace of mind that my medicare is safe and stronger. i think sometimes what an amazing accomplishment that medicare has been and it means that for generations to come seniors will be able to live out their lives in peace of mind and dignity. it will take the weight of their children. [booing] >> just a little bit more now. it is what i and many of us here have chosen for our grandchildren.

i want to make sure that medicare lasts for many generations i also feel that this is a moral obligation that we continue to support this program. thank you very much. >> thank you, baba. -- thank you, bob. >> we have to more panel members and then we will get to questions. -- we will have to to more panel members and then we will get to questions. she is a board certified pediatrician. she has worked in emergency rooms and has a private practice in general pediatrics. she served as assistant medical director for the transport team at the indianapolis children's hospital and chaired the

pediatric morbidity and mortality conference. the plummeting to marilyn, she has worked in the -- after moving to maryland, she has worked at the general hospital and the pediatric practice. >> i will be brief so we can get your questions. i am here to tell you that doctors support health-care reform so that we can increase the affordability and quality of the health care that all a few are getting are not getting today. every day in my practice, i take care plenty of children who are insured by the state of plenty

who are not. all of them are missing some part of the health care that they should be getting. it takes too long to get appointments with specialists. it is too hard for me to get their insurance companies to give them the benefits that they are already paying for. they do not have access to their doctors when they need to them. i know that this health care reform legislation will fix those things and will take the first few steps forward and fixing these problems so that all of our children and our families can get the health care they deserve so we can move toward our true better future as a nation. [booing and cheering] >> our next panelists is a retired colonel of the united states army. he participated with great distinction, including the

vietnam battle of the green valley. during his 21 years of active military service -- >> he did not come here to hear me. >> i just need to say one thing. about tri-care v.a. benefits. there is a provision in this bill that exempts military veterans and their dependents from any penalties or whatever that are in this bill. that is all i need to sit. how many veterans are out there? you are protected under this bill. [cheers and boos] >> thank you. now we will move to the question

and answer time. [cheering] all the members who are called, -- out of five numbers at a time. i will call each number twice. it is the last three digits on your ticket. 782. 782, please come right here in the section of the auditorium. the second number is 738. 738. the third number is 736.

the next number is 114. >> how about 666? [laughter] >> the next number is 038. those of the five numbers. 038 is the last number. >please, step up here. please state your name and where you are from. >> my name is april. i am from st. mary's county.

>> my neighbor. >> congressman, when you are on our local radio station, you said that you have not read the bill at that time. >> that is correct. >> that was about three weeks ago. have you taken time to read the bill and why are we you looking for federal health care rather than using what we have for the state also? at the state we have right now, my son and daughter in law are both out of jobs. they are covered through the state. i pay income taxes to the state so that they are provided on health insurance. why should i want to go and have the government get into my business? [cheers]

>> i said i had not read the bill. i have read it since. it is a long bill. it is a complicated subject. on the second part of your question, you are not in a state program now, are united? it is state, not federal. you have lost your son or lost his job -- i'm not sure what you said. >> both of them have lost their jobs. >> both of them have lost their jobs. i would think if you would very much want to be for this program, because what it does is provide for private sector insurance to be in an exchange to which they could go and if

they cannot afford it right now, there is a federal program called cobra or if you lose your job you can keep your insurance by you have to pay 100% of it. the problem with that is they probably cannot afford that. the proposal that is being made is that you could go through the exchange ended the cannot afford it you get additional help depending upon your income or what capability you have, and you'll be guaranteed access to health care insurance. while the state has a policy now -- i'm not sure exactly how expensive the policy is -- the state is facing very serious economic challenges itself. so is the federal government. i think that you'd find this plan one that would give your son and daughter more confidence. i do.

>> know, we do not. my whole family does not believe in this bill. we want the government out of our business now. >> let me make a comment if i can on that last comment. obviously, i am sure all of you know that well over close to 100 million people have some kind of health insurance that is related to the federal government, medicare of course been the largest component medicaid being the second. the federal employee health benefits. you have a government insurance not your on medicare. other people do not have access to it. notwithstanding the fact you

have medicare, if you could to a private doctor and hospital of your choice. that is what we are talking about. >> i am from here in charles county. i want to keep this a very simple and easy for you. if this bill is so good, then went to commit right now at this town hall under a national audience that make every member of congress subject to the conditions of this bill? [big cheers] >> sit down. let him answer that question. >> that was a simple question. every member of congress will

have exactly the same choice you are. >> my name is john from st. mary's city. i have a couple of family members here that are in the medical profession. they are doctors. i see one reason for a lot of increased health costs is related to medical liability. it is a culture that doctors have prescribed this that and the other thing. how is the ama and congress grappling with this particular issue? >> the ama has had substantial discussions about it. so have congress. i believe that this issue is

being grey's all-around the country. although it is not in any the bills at this time, i expect to certainly be considered as we move forward. -- expect it to certainly be considered as we move forward. >> my name is bruce. i'm from california, maryland mr. hoyer, it is a pleasure to see you at work. >> thank you. >> this will set an all-time student meeting where we raise hell until midnight until people leave. nothing has worked better in my life and the medicare system of this country. [applause] -- than the medicare system of this country. i made the appointment for them to take my call over the telephone. it happened at the time it said it would. it took exactly the amount of

time they said would. everything comes on time. no questions, no nothing. everything works well. i happen to be forged a. i have worked for a union for 36 years. my wraparound coverage covers everything. i never pay a dime. i want all my friends and enemies to have the same great system that i have. thank you very much. [applause] >> this is a serious debate. i know you are angry because you think members of congress or the president wants to take over your health care. they do not.

that is why i read to you the five republican candidates for president last year. not to say this bill that bill is important, but to say they recognize as i hope you recognize that the status quo will not work for as long term. that is why they talked about it. that is why obama talked about a. that is what clinton talked about a. [w/ó6i]/>ñ.3iusithe next s. 339. 708. 356. 349.

717. if you could kindly come up to the front of the stage. thank you. >> well we are waiting, to give you a sense of timing, the three bills in the house have not yet passed -- they are considering the other -- theirs.

i would expect the next eight weeks or 10 weeks will be very involved in focusing on health- care legislation. the reason i say that is the key to not get a question tonight, you have significant opportunity to get those cards to me and we will try to respond to all of them. >> good evening. thank you for holding this forum tonight. i am from southern maryland. i live in london town. as the sea before the opportunity. i have a 21-year old son who graduated from a local college on an associate degree. he got a job in a small business. the employer cannot afford to pay health care. i have an employer that pays a fairly decent health care. he is forced to stay at home and go back to college and continue

his education, which i do not mind, they cannot go out on his own. he has to live at home to be covered under my policy. under the proposed legislation, and i think the kind of covered it, how is that going to help my son as well as the employer that he works for to provide a decent health care coverage for both my son and cost efficient for the employer so they can provide for the rest of the employees as well. >> it is working for a small employer, and it is less than 15, under one of the amendments, the bill is not a final bill at this time -- under one of the bills, he will be eligible to go into the exchange. the exchange will have a op numbera number of options, all

private and public option. your son would be able to have reasonable insurance. if he did not make sufficient funds to afford the insurance, he would get some assistance. the reason he would get assistance is because we deem it more efficient and cost- effective to have everyone in the system. the private insurers to build a 20 million new people who will be covered. if your son is unemployed and does not have insurance, and dr. betty gets in an automobile accident, the people prang p. manzi will be paying for his health care. -- does not have insurance, and god forbid he gets in an automobile accident, the people paying premiums here will pay for his accident. >> we paper co for insurance. that was $1,300 to $1,500 a

month. it is cheaper to put my son through college than paying healthcare $1,500 a month. thank you very much for this proposal and this legislation. >> thank you. let me again just reiterate what we have on -- under current law if you lose your job. [unintelligible] there is a provision some years ago that said for a year you can keep the insurance your employer has given to you, but you must pay 100% of it. obviously, if you lost your job, lost your income, it is very doubtful you'll be able to pay for that insurance. that is the problem. that is what that gentleman was referring to. >> thank you. my name is charlie from

hollywood, md. a want to make a comment. >> welcome to st. mary's county. we have a lot of people from st. mary's county year. >> we also have a son and i have three wonderful grandchildren. my son paid $800 a month and has a $5,000 deductible to be able to buy insurance on a group rate now. this is unacceptable. his children are infants. that is why the high cost. we need a public option without -- public optin. without a public option we will never have insurance reform. >> thank you very much. i support a public option. it is exactly that. it is an option. not a mandate.

no one has to take. if we give to the concerns companies a competitive model and would bring down premiums for all of us, private or not. >> good evening. >you pointed out republican presidents in the past, as well as mr. thompson as stating that all americans should be covered with health coverage. correct? >> yes. >> the underlying thing is that is that all americans. it did not say illegal or undocumented. in this case, there are several issues relevant to verification. you can say there will not be illegal under the coverage, but

will they be verified? >> i do not know that this language on the top of my head deals with verification. however, it does -- it is a very clear -- as a ready -- "no illegal aliens are covered." you also all understand -- hopefully understand -- i think all of our face, i am a christian, take the admonition that when a brother or sister is in real trouble we are going to help. [cheers and boos] as a result of that philosophy, we have in our country a duty to serve so that if somebody is in an autumn of bill and is very

bad the injured and taken to the hospital, the hospital will see them. they will not ask questions. they will try to help them and lifted them up. -- and liveift them up. when jesus asked us to walk across the street, he did not ask us to say who are you, a stranger? having said that, let me reiterate of a " no illegal aliens are covered by this bill. >> before we ask this next question come out of like to call the next five speakers. 103.. 301. 301.. 049.

196. 372. thank you. >> i live in chesapeake beach. i want to thank you for holding a town hall. i appreciate your leadership i am never ashamed to say that i represented by steny hoyer. [cheers and boos] >> thank you. >> i am concerned. i am very happy we are moving forward with health care finally in this country. i am deeply concerned about costs, that we are not want to do enough to hold private insurance companies accountable for the deeds they do. the deeds they do are wrong. the rescissions are wrong.

the denying care is wrong i am deeply concerned that if there is not a public option on the exchange that we will not have enough ability to keep insurance companies on this. what additional measures are there in the bill to keep insurance companies accountable for the stuff they do so we get our money's worth out of them? >> as i think you know, the public option is included in all the three bills that came out of the house. it was also in the bill coming out of the senate. i support a public option for the reasons you describe it. we need to keep insurance companies on this. we need to have the competition. there are numerous divisions in the bill that will exercise

oversight. having the competition of the public option will be the best check. >> my name is michael. i am a physician. i live in and water, md. but i'm glad to have you with us. >> as a physician, i know many tests are ordered on a day-to- day basis that more less physicians have order to cover themselves. they ordered them to cover themselves, to prevent lawsuits and so forth. i know it is a drain on the system in regard to time, that patients are running around doing these tests, efforts on the physicians and all the people doing the tests, as well as money and the cost to the system.

i know many physicians in texas who have implemented tort reform and a cut down on the base expenses and time it ever the patient had to utilize to get these tests done. you kind of glossed over this before and one of the other questions. i want to know what specific plans you have to help implement tort reform in this state -- [general crowd noise is] if you do not have any specific plans, why do you not? >> as i said in my previous answer, which you said i've lost over or something like that, this question has been raised not only this year but in years

past. as you also know, there are a number of states including maryland that have adopted a cap, which is what i believe you are referring to. california did the same. the fact is that i think there is concern in congress. there is not a provision in the bill, but as i said earlier, i am concerned about it. i know you are concerned about that. i think we have talked about before, have we not? >> no. >> i thought you were at my meeting. the fact is, it is of concern. it is also a concern that if you cap and on economic damages, somebody that is hurting -- a young mother who does not work. her economic damages may be very slight. yes, you'll get medical bills paid, but she may not get anything substantial of value

for it through the years. it is an issue. it is a controversial issue. there are lawyers on one side and medical professionals on another side. not everybody is simply by definition on the same side. what i said was, doctor, i think you raise a very serious issue and we need to look at it seriously. in answer to your question, i do not have a specific proposal. i guarantee you and will tell you tonight, i intend to look at this seriously and discuss with my colleagues. one thing we do want to prevent, speeches suits. i think we can all agree on that. >> thank you, doctor. >> good evening. thank you for coming. my name is sharon eagle.

i am and are in. i work in the local area. -- and i am an rn. i worked in the local area. as far as illegal immigrants of using our system as we have now, and they are not. whenever i have seen anyone comment, and they have been harmed or their child is very very ill. we deny knowing health care to our emergency room. -- we did night no one health care in our emergency room. we do not have positions in southern maryland. they do not exist. my primary care physician cannot afford the insurance. i have doctors that have retired. there is no one for them to go to.

doctors go on vacation. there is no one to cover them. we have the lowest coverage per 1000 residents in the state. on the issue of the continued coverage,, continuity of coverage, i have a 23-year-old son who has had three back surgery is. he is still on our insurance because he is continuing through school. right now he has no insurance when he walked out of my door. this plan has to be done. it has to be done right. we have been paying for it. >> thank you very much. thank you very much of that observation. i agree with you. your son doesn't need to have an option available.

-- your son doesn't need to have an option available. -- your sons do does need to hae an option available. the shortage of doctors in southern maryland is a critical issue. my neighbor is here in the audience. he talks to me all the time about having to get new doctors and getting people on the system. they are overwhelmed. some of the things in this bill are directed exactly at ensuring that people can go to medical school, and nurses can go to medical school, nurse practitioners can go, and grants for training institutions, so that we can produce more medical personnel so that the shortage we find a more rural areas -- we have a shorter of doctors. you make a point. this bill tries to address that.

absolutely essential. thank you. >> hello. thank you for coming tonight. >> thank you. where you from? >> waldorf, md. i am on social security disability. i cannot afford a secondary insurance. i actually had to drop it with $400 a month. i have had net surgery's. i will have to again. i cannot afford it. the doctor will not even take me now. so, how is this helping going to tell me? >> i think it will help you a lot. first of all, you'll be

guaranteed access to a policy. number two, you'll be given help if you cannot afford it. number three, you'll be capped on your out-of-pocket expenses. you cannot be bankrupt. secondly, you will not be capped in terms of the expenditures that can be made in your lifetime so that somebody was a lot of illness, catastrophic like cancer or need an extensive surgery, will not be capped. this bill will help be very substantially. -- help you and very substantially. >> i want to tell you that in a minute. >> thank you, mr. hoyer.

my name is matt stone. healthcare reform is an important topic. part of me -- pardon me if i distract for a moment -- i cannot understand why health care is such a concern to this administration when there are people who are living in tents and banks are collapsing and our economy is in shambles. timothy geithner just said that there are things of the fed does that should be privy to political review. why does that not in great congress? >> i could not hear you. >> timothy geithner -- secretary treasury -- sorry, i'm nervous

-- he said that there are things that the fed does that should not be privy to political review. a question for you is, ron paul has a bill -- why are you not cosponsoring that bill? but i'm not familiar with the bill. what is the bill say? >> it is to audit the fed. >> to solve the fed? >> to abolish the fed. >> please, let the gentlemen finish his question. >> my presumption is that obviously they deal with information that if -- it is the sort of like public disclosure of when stocks go up or down -- that is illegal. it is illegal because it would skew the trading market and those that did not have the permission would not be dealing in a fair market.

unfortunately, that has happened. i assume that is what is referring to. the information that they have may radically affect the market. on ron paul's bill, i have not looked at it. i will look at it. i think secretary geithner may well be right in terms of information that may have an adverse or impact on the markets fairness and stability if they disclose what they may or may not to do. >> there are 282 other co- sponsors. >> i will look at it. do you know the number? >> i would like to ask the next five question years. your number is 040, 033, 365,

785, and 489. thank you. >> a good evening. i live right here in charles county. i am 3 miles from here. i m a lot concerned about what is going down with their health care system. my sister just had breast cancer. she had serious surgery. her whole concern was getting back to work because she did not want to lose your health insurance. to not be able to finish her treatment that she needs -- to not be able to finish her treatment that she needs issue lost interest. what is this bill do to protect a person in that type of situation, to relieve the stress that a person should not have to go through as they go through a

serious illness? >> if you lost your interest, she would have immediate access to the exchange to obtain alternative insurance. in the bill, there are minimum coverage is that the insurance company would have to get her and her pre-existing condition would not preclude her from getting insurance. others are the critical aspects. she has such a catastrophic illness and the other thing that would help her would be the cap on an annual basis and the no lifetime cap. she cannot be denied coverage or have it taken away from her because of her illness. >> good evening. >> how are you? what i'm doing fine. -- >> i am doing fine.

collins bailey from waldorf, md. do you see this bill causing a tax increase or an increase to the deficit? >> denied there. [booing] -- neither. as you know, under the policies that were adopted in 1993, we have a balanced budget for the last four years of the administration before that. there is a $2.9 billion surplus. the last administration ran a very substantial deficit as you know.

as you further no, \ / \ know, n president obama was elected president, he inherited the worst economy -- [booing] mr. bailey, i know that people do not like to hear that. >> we have all these fine people here waiting to ask questions. let congressman hoyer into the question. >> it is the truth. it is a fact. you can look it up.

as a result, we have taken some actions in the previous is ministration. we took actions which made the debt go up. in this administration, we have also done that, as you know. very substantially. i'm very concerned about debt load that we put on my three children and four grandchildren and my great granddaughter. as you know, i was a democrat -- i was not the majority of my party who voted for a constitutional amendment to balance the budget, as you know. the fact is though that on this bill, we have said "aa, it wille paid for. if it is not paid for, i'm not one to avote for it.

-- i am not going to vote for it. thank you. >> a good evening. >> lexington park? >> yes, sir. i am pleased to be one of your constituents in many ways do you have done a wonderful job taking care of the navy. i want to thank you for that. i do not completely agree with their social positions. i have never voted for you regretfully. it is clear from the division here tonight and from looking at what is going on that less than half the people in this country what this health care bill. [applause] a base this on polls that i have seen -- i have a base of this on many polls i have seen. in march, you stated that of

good democrat[unintelligible] i understand that to mean they would not override the bill or force it through with only democratic support. i want to know a direct yes or no answer. to stem by year for their statements and override -- do you stand by your earlier statements? >> i do not think that is a yes or no question. the reason it is not a yes or no question -- first of all, i do not accept your premises in terms of ramming it through.

max baucus in the democratic chairman of the finance committee. he has been working for the last 10 months with charles grassley, republican of iowa, to reach an agreement on the health care bill. i hate to reiterate this. i understand the country is divided. you are correct. i accept that. they have a lot of misinformation. these meetings are to try to get better information. we are trying to get as much information as people need and they can disagree, of course. the fact of the matter is that there is a reconciliation process. there is a reconciliation process that provides for a majority of the net state senate to pass the health care bill. -- the united states senate to pass the health care bill. under the rules of the united

states senate, they can pass legislation with the majority. that is not ramming something through. it is doing what democracy calls for. >> next question. >> i am don shaver. i drove 46 miles to be here. thank you for coming. thank you for your 29 years of service. >> thank you. thank you for coming down. >> my question is this, will the public plan premiums be less expensive than the private plan premiums or will the public plan b free or based on one's ability to pay? i have a grandson who is 23 in

california. he works part-time. he goes to school part-time. political science. he does not have health insurance. will the public plan paid for his health insurance? >> the public plan will not pay for his insurance in that sense. the public plan will be like the private sector plan. it will have premium competitiveness. it'll have cost competitiveness. it will operate under the same rules and regulations as the private sector. to that extent, we will try to correct this basis. hopefully, it'll create a level playing field. what your son can do is -- excuse me, your grandson. you and i have been around a long time. i have a great grandson. what you are great-grandson can do is choose a plan from either

the private sector or the public option, which ever he deems to be best for him and his situation and then depending upon his income, he may be able to get help with either plan. >> thank you. >> i am from maryland. i am for health care reform, but i'm not for government run health care reform. [cheers]