was working as an aide. i have had a career in emergency rooms, icu transport-team pediatric team icu, and i have been in another area for several years. do you find there is any possibility for us to finally go to universal health care for the american public? and how can we nurses facilitate that happening? i have witnessed too many uninsured people coming into the emergency room. i know that we will bill them later, after we take care of them, but i know that they will probably be unable to meet that obligation, which puts a lot of financial drain on the hospital,

and here, we serve a huge community, an outlying community. . survive. but they seem more interested, and i see other hospitals also 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. and i would like to see how we can get away from the money-making aspect of hospitals money-making aspect of hospitals and get back care for all of the american public. thank you. host: patricia, two questions. do you enjoy your work? and could you give us an idea of how much money you make? caller: i enjoy my work. very much in the cath lab. i think it's a great combination of i.c.u. and e.r.

it's exciting. the patients are basically conscious. so we get acquainted with each of them. we get to actually fix a lot of what their problem has been, kind of immediately and see the end result of that. so that's exciting kind of medicine for me. and it also is challenging. and it's the best patient carry can give because i have three staff members to one patient. and when you go home at the end of the day, you never feel like you have given poor patient care. but my cohorts in nursing, i would say, by and large, are not happy people. they are not in the cath lab. they work on the floor. they're under staffed, over worked. and their management is unsympathetic to that.

in fact, management changes so rapidly often times managers of particular units stay only a year or two and then they are replaced. so there's no consistency there. and it's a very frustrating situation for nurses. host: are you satisfied with your salary? guest: no. as your guest said, the starting nurses at $53,000. and i'm making that at 34 years of nursing. host: thank you very much. a lot to work with there. guest: you bring up many, many key points in your relationship to your experience as a nurse and where we are with health care today. i, too, first started out with a three-year dloam i can't school and then went on to get my degree and masters. 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. and you've had the opportunity to try a lot of different things

in nursing and in the health care arena which you found your 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 can impact health care reform. my response to that, patricia, is that we're over three million strong in this country. nursing, as you know, makes up a vast majority of caregivers at the bedside and caregivers in the health care industry. so we need to be well versussed on what the issues are related to health care reform. we have a lot of professional organizations. i'm sure that you've participated in and your colleagues have participated in. and you're probably following, as i am, and as we are here, what those reforms are looking like, what kind of impact it's 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? how is it going to impact the number of nurses we're able to provide the resource that we 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 us, as some of the nurses have said here in this hospital, as an industry to take stock of where we are to appreciate the gains technically that you have seen and i have seen so that we do have people surviving through the cardiac caj rizzations and outcomes. take a pause. look at what our achievements have been and don't lose that ground. build on top of that ground that we've work sod hard for, doctor -- worked so hard for. people attached to the health care for these many years have driven our outcomes to places that other countries in

relationship to what we're able to achieve with our interventions and our treatments that are still out of reach for them but comes at a cost. and it is a large dilemma. but stay tuned to what's going on. be a part of the voice in relationship to making decisions. the other message i heard from the nursing staff here at virginia hospital center is to urge our legislative people to not rush to an end too soon, to be thoughtful to take their time, to think about what needs to happen next with the sense of urgency. but not to rush people to a place where they're fearful of what's coming next down the line with health care reform. that some of what we're seeing in the public might be because it's so personalized in relationship to the outcome of where this health care reform is going to land. but, again, nursing is going to be a big component. we've been a big component of health care in the past. we will be in the future. and actually, it's an exciting time. if you are energized around

providing patient care to have your voice heard and be part of where we're going as a nation. host: nurses are first-team medical care. do they know whether a patient is medicare, blue cross-blue shield, united, uninsured? guest: no. i would say we have an awareness of it in relationship that we're part of the team that's also helping manage what is in the best patient care interests related to the length of stay. there are teams in the hospital responsible for that and working with the physicians and the nursing staff together to coordinate that activity. when we're in front of patients, we don't have that awareness. nurses in general, and i believe physicians as well, that's not what we're here for. we're here for meeting the patient, where they are, what their needs are. the ability to pay or not pay is not something that is ever in the forefront of our minds. host: how did you decide to become a nurse? guest: i had the advantage of growing up around mentors who were very influential. my mother, my father were people

of father, of compassion, and of great service. my father is a world war ii veteran who came back, had a job. but also served in our community of the town council, as fire chief, as a county official. i had the advantage of seeing my mother and my father extend their hand to people throughout my growing years. i also volunteered in the hospital. as many of you heard, physician colleagues of mine. i volunteered. i saw this as an opportunity. i enjoyed the sciences and just wanted to be with people and it grew from there. i had a mentor, an aunt as well. there's many nurses in my family as well as physicians. host: jack, savannah, georgia, insured line. guest: my daughter is a registered nurse in the state of michigan. she works in delivery, neo-natallal and i.c.u. for babies. she's been there 18 years. i support single payer,

universal health coverage for all. i'm a big-time supporter of that. but i also support tort reform. and not only limit the amount of damages for some of these that people have, bunt i think that a panel should sit down and work out loss of foot, loss of hand, loss of whatever and say this is the maximum that the courts can allow to be paid out. i also believe that the lawyers should get their hands out of the pot. that should be included in it. we have all of these allies around the world who have already went through this whole thing, canada included back in the 1950's. we don't have to pick a particular one. we can pick and choose the best of all of these plans and come up with a uniquely american

plan. host: thank you, jack. two issues. single payer and tort reform. guest: first of all, jack, you mentioned that your daughter is a nurse in nicu, neo-natallal intensive care. i believe that nursing has a feel for excess throughout the nation because so many people do know nurses. therthis is a really good examp. i'm sure a lot of jack's opinion is based on what he hears his daughter come home and say. in the nicu we've seen great advances in the last 10, 20 years. we're seeing baby that are -- even 15 years ago were unthinkable of being able to survive at the age and gestation that they have, how early they're born and the weight that they are. but also an arena where legal issues are a concern. it's a fine balance between what parents expect or patients might expect coming in the door for care, what we're able to

actually do. every person who arrives in the hospital setting or is working with the physician is expecting usually the very best of outcomes. those expectationses when they're not met, whether they're realistic or not, can turn into legal issues. tort reform is something that i'm not an expert in, but certainly health care industry and physician practices have been greatly impacted in how they make decisions, how we operate in this very litigious society. tort reform has taken hold in different states across the nation. i believe there is still a lot more work to be done there. host: darlene vrotsos, do nurses carry medical malpractice insurance like doctors do? guest: nurses should. i do. i certainly do. in hospitals there is an insurance coverage for all practitioners, all clinicians within the hospital. but beyond that, in this society, i encourage every nurse to carry their own individual insurance. host: how significant is the overall comprehensive malpractice insurance that the

hospital pays for? guest: that would be an answer that would best come from robin normand. i know it's very significant. it's something that needs to be budgeted into the hospital. certainly any increase in that arena limits what we do and are able to do with other resources in the hospital. everyone in the hospital, our health care business and nurses, we'd much rather see the doctors be spent on patient outcomes and patient care. host: but you also carry the malpractice insurance. 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: the pressure is great. they're thinking of it as a job, not as 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? your duties? caller: the only thing they rn not start and i be in the state. i could years ago. i can hang them. then i can change them from the economic start one. that is basically the only difference of the foreigners. guest: i agree with what she is saying with relationship to many things. one is the cost of education that has increased. another idea i would like to focus on that she brought forward is the fact that we need to leave with our hearts. nursing is a very noble profession. most people who enter this field are choosing it because they want to make a difference. it requires a demanding

intellect. it requires strength of character, flexibility, and compassion. when it is done right, it -- you leave with their head and heart but if you need to care about patients. patients know that different. people who come to this profession without the realization usually do not stay, because we are not here for the money paid their we are here to make a difference. she also said new graduates to not have their head and their heart aligned with the caring element of providing nursing burda i believe she might be looking at the new graduates. they have a lot to learn technically first. that first year at the need to get their feet on the ground. 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 [captioning performed by national captioning institute] [captions copyright national cable satellite corp. 2009] in a few moments, a town hall meeting with house majority leader steny hoyer. in a little more than two hours, a justice department briefing on the largest medical fraud settlement in the u.s. issue. after that, how japan's elections may affect relations with the u.s..

>> on washington journal tomorrow, the head of unity healthcare on providing health services to the uninsured and homeless. we will take a question on the japan's recent election with michael green from the center from strategic settings. also joining us is the author of "too good to be true, the rise and fall of bernie madoff." will live on c-span every day at 7:00 a.m. eastern. a couple of live events to talk about tomorrow morning. the center for strategic and international studies hosts a forum, analyzing afghanistan's election. >> we reviewed the health care

debate tomorrow night with highlights from house committee hearings and analysis by martin vaughn. sunday, a comparison of health care systems from around the world with former reporter tr reid. >> steny hoyer held a town hall meeting in his district tuesday. he met with constituents for 1.5 hours. i went to thank you for coming out tonight. i am the it minister of the

memorial hospital. i am honored to be asked to moderate tonight healthcare 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 and are three hospitals are on the front lines of delivery of care every day. we see the places where insurance coverage could and should be improved and more health care delivery can and should be improved. the purpose of tonight's town hall meeting is to listen and share our communities use on health care reform with our elected leaders. thank all of you for being -- i thank all of you for being here tonight. two weeks ago, congressman hoyer

personally called me and ask me to serve as tonight's moderator. 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 to 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 appear on the state. if this sounds good to everyone, i would like to begin. first, there will be no signs from the auditorium. second, i ask that you please stay seated until your number is called or you need to leave the room. also, make every effort to keep the aisles clear.

that is so we can get as many questions as possible. if you ask a question, i keep it brief, no longer than two minutes. please respect each other and everyone's opinion. that will save time -- no applause, cheering, or sheltering. by -- or shouting. i ask you not to enter, yellow, or use profanity. lastly, -- i ask you to not yell or use profanity. last the, to not interrupt people. -- leslie, do not interrupt people. here is how we will to the question and answer session. people who wish to ask congressman hoyer a question having given a numbered ticket. the red tickets looks like this.

it you wish to ask a question and you did not already have a ticket, please raise your hand now and we will have usher's bring the ticket to you. i will randomly -- i will stress randomly -- dropped five tickets at a time from a box. i will call the last three digits on your ticket for do if you have a ticket and want to ask a question, i'm going to call the last three digits. i will call those last three digits twice. that is so everybody can hear it. when your number is called, please come forward and line up on the microphone. until your turn to ask the question -- carry lieberman is there.

if your number is called, please come down here. please state your name and where you are from, followed by your question. if needed, i may interrupt you if we go over our time. we will make every effort to enter as many questions as possible so it is very important to keep your questions precise. as we will not get to every person who wants to ask a question, there are cards at each table. each of you should have a card at your seat. please complete the card so the congressmen may respond to you. there at our staff throughout the room who will come by in gather those cards for when you

leave here tonight he can return them while they are exiting the auditorium. our program is as follows, congressman hoyer will speak approximately 50 minutes and give a brief outline on the house bill and then we have a few members here this evening of our community who will make very brief statement. then we will move to the question and answer time. please, join me in welcoming congressman hoyer. 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 small businesses will find it easier b it lets them leverage the purchasing power of their larger competitors to get cheaper group operates in more affordable insurance for their employees. how many people are in the federal employee health benefit plan in this room? essentially, thank you very much -- essentially, that is an exchange. it is managed by the first amendment but it is private sector insurance. i think that model has worked well for me and for millions of federal employees.

many are included in the health benefits. this is critical and overlooked. we reform health insurance to provide security for the middle class. beazer the changes we may. we protected from a medical bankruptcy. it no matter how sick you kick, you never pay more than $5,000 out of pocket or 10,000 for your family. a high percentage of bankruptcy are caused by health care costs that are absolutely essential nor should they be avoided and it cannot be afforded. if you lose your job or want to start a business, you will not have a job loss. you have access to high-quality insurance. 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.

@@@@@@@ @ @ @ @ @ @ @ @ @ @ @ @ will get to the questions. we will get to the questions. these people volunteered to say a few words. we will let them. at this time, i'm going to ask mrs. dixon to say a few words. please come and 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 the@@@@@@@ @ @ @ @ @ 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] @@@@@@@ @ @ @ @ @ @ @ @ @ @ @ @ 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@@@@@@@ @ @ @ @

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]

there was a lady that came up before me that talked about keeping the insurance fee -- insurance co. on this. i am concerned about who is going to keep the government on honest. but i think this gentleman asked a question. >> can i did make a comment? as ronald reagan said, [unintelligible] >> the question is, with social security and medicare going bankrupt, what makes you think that the government can run a health care program? how were they going to pay for it? . .

your point is well taken. social security and medicare clearly have a funding problem. no doubt about it. you are right. why did they have a funding problem? in one respect, they have a funding problem for good news. for good news. and all of you probably know what that good news is. we're living a lot longer. as a result of living longer, when we adopted social security in 1965, the average age expectancy was 65.5. we have changed the age to 67.

however, people are living longer, drawing from social security a lot longer, and it is more expensive. the options are, revising that so we can sustain it t. all of us want to make sure that our children have security in old age, both in terms of health and in terms of basic standard of living. i think we need to look carefully at those programs. i will reiterate, this program is going to be paid for. let me tell you how. we're going to make medicare more efficient, more effective, we're going to put 60% of the savings back into medicare to make it more solvent. we increased its solvency by a

number of years. there are various different sources being discussed, some of which are very unpopular, probably all of which are very unpopular. paying for things is not popular. the fact is, we have one funding suggestion in the house, another funding suggestion -- and no funding suggestion out of the senate. one is taxation without benefits premiums. i don't think anybody is too hot on that. you're absolutely correct, they need to address the funding source so that they will be there, because i believe the overwhelming majority of americans, not all americans -- but i believe the overwhelming majority of americans strongly

support social security and medicare. @@@@@@@ @ @ @ @ @ @ @ @ @ @ @ @ >> high. >> hello. i would like to thank you for standing strong and continuing on with these town hall

meetings. i know some of them have been very difficult for you. to the panel, i want to apologize for some of the disrespect you have had to endure. i appreciate you being here. i appreciate you being here. i work for the united health care workers. we are labor organization that represents health care workers and home care workers. their wages go from $10.50 on top, not a whole lot of money. if these health care workers to have to pay for medical insurance. it is very difficult for them because they can't afford it at

$10.50 an hour. they need help. this public auction will help them -- public option will help them. before friend can have the surgery, they want $600 up front. she does not have a $600, nor can she saved the $600. that is an outrage. especially for someone that is dealing with taking care of patients, and they themselves can't afford health care. health care, i believe it is our right to and not a privilege. -- a right and not a privelage. i say it again because i mean

it. it is a right, and not a privelage. >> ladies and gentlemen. >> i just want to say, i appreciate your support. i hope you can convince as many as possible to pass this public option. >> thank you very much for observations. i understand the plight -- i understand the plight of the individual you have discussed. whether you are for or against this option, or your for doing nothing, you cannot deny that there are people in this country who are confronting very

serious situations. they can't help themselves because they do not have the insurance they need and can't afford it. we are trying to help. >> good afternoon, congressman hoyer. i am a public-school teacher, an entrepreneur. i am also an advocate of medical awareness -- medical record awareness. i have worked for a company where i was not provided any insurance. i had cobra, a pre-existing condition, and i had to get cobra. i have also been a victim of medical errors. i have no problem with health care reform. as a teacher, i want all my students to have health

coverage and their families. what i do have a concern with, whether or not congress or president obama will enforce the health care facility to raise awareness for citizens to request, review, and revise their medical records. i have visited your office in d.c., and i have asked one of your legislators whether or not she had a copy of her medical records. she said no. i visited your other office, and i got the same answer. are you aware that citizens really don't know that they have a legal right to their medical record, or even how to request their medical records? >> you are absolutely correct. citizens to have a legal right to see their records.

if they are not getting their records, it happens one of my staffers -- you may have talked to her, and we will pursue that on their behalf. there are two things about records -- three things, really. one of the provisions of the bill was in the recovery and reinvestment act, dealing with medical records, medical paperwork and getting into the twenty first century so that we have the information of technology, where we have the ability to transfer records immediately for diagnosis and for history. we can get a better health-care record and results. second, privacy is a very significant concern. while a patient may have our right to their record, nobody else does.

i appreciate what you're saying. >> good evening, i am from maryland. i have a couple of questions. is there anyone here who does not have health care and is against this bill? just curious. next, as i understand, much of the issue is that it is the federal role out of this program. if it were a state program, would it be as much of an issue? also, it seems as though the marketing of this plan was done in a way to antagonize. it seems as though -- there are some many ways to market, -- so

many ways to market to get it out in a way that looks favorable to the party. >> i do not of the party affiliation of any of the panelists. i do not know political affiliation. you do? i do not know the political affiliation. i agree with you. i would hope that we would pass this in a bipartisan way. ladies and gentlemen, i know some of you don't agree with this. that is our system. again, and a bipartisan way, major leaders of our country --

not me -- have said that the health-care system is not accessible to enough of our people. you may not like the way we propose it here. the objective is an important one, and we need to work together to get to where we need to get. >> how are you. --? i have read all the things that the plan is trying to accomplish. there are a lot of them. each one of them seems to cost money. yet, you keep saying that it is going to pay for itself. i am a businessman. i have won it -- i have run a business for 40 years. i tried to give better service, better products, more amenities, but i also know that

every time i try to provide something more, it costs more money. it isn't something that you look at it to just say, this is what i would like to do. as a businessman, i like to find out if i can do it and not go bankrupt. >> i agree with that. >> i did not see how the government can provide all of these things and still say they're going to save money. it does not make ordinary common sense. >> what i said was that the bill would be paid for it, not that it would pay for itself.

we score bills over a shorter term, and over the long term, i think the bill will save us all money. in the long term. understand that we're spending today, $2.50 trillion on health care in america. and we do have the best health care. the gentleman is absolutely right. everybody doesn't have access to it, but we have the best health care. the fact is, that is going to double, and is going up at four times the rate of inflation. i do not know of your profits go up four times inflation. i doubt it. that means they are getting further and further behind, or they're paying a greater percentage to pay for their premium and there health care.

part of it will be paid for by wringing out and making more efficient medicare. we get some dollars from that. that will be a savings that will be applied to the cost of this bill. there will have to be other revenue sources so that we pay for it. it is not for free. you are absolutely right. we believe -- if you look at one of the graphs, you saw that graph house deeply it is going up? frankly, by 2080 when my great granddaughter is still alive, we will be spending 80% of our gdp on health care. we can't afford that. you know that, i know that. our kids can't afford it. we have to make changes that will save us money and make it a

more efficient system. in the short term, let me give you an example. in the short term, you invest. you may borrow to invest to build a restaurant, a garage, an office building, or what ever is. you invest so that you can make a profit in the future. the cost of treating that facility over a longer term. we're going to pay for this bill, but i think a long-term -- i did not say it will pay for itself. it will pay in the longer term. it takes a long time to get the system as large as ours changed to make it more efficient and cost-effective. your right. we need to pay for it. >> congressman, before you respond to the next question, it is getting close to time. i would like to call the next

five speakers. >> we will take those five, and that we will close. >> 761, 167, 394, -- >> i know some people are leaving. thank you for coming, whether you agree with me or not. i love this process. i am glad you're here. thank you for coming. >> 044, and 185. sir, you have a question? >> yes, i am from solomon's island, maryland. i am going to repeat some of the things you have heard from me before.

let me put it this way. i finished my@@@@a+@ @ @ @ rv8r program. i also feel that the idea of a cooperative is being sorted out

in the senate to and it is not very sound. it started as a producer cooperatives, so did it delta dental care. they have become nothing more than the standard insurance program. how you feel about the cooperative ideas being floated in the senate? >> i am for the public option, which i believe is a better alternative than the co-op option. you are correct, red cross, blue shield started out as that. we will not pass a co-op in the house. i think we can pass a public option. america is divided, but i don't think it is divided on the fact that the present system simply is not sustainable over the long

term. maybe we have to make changes in the bill to make that happen. but we need to make changes. on the single payer option, frankly, americans are very concerned about a single-payer option. you heard the concerns about government-run health insurance, and a single payer is the quintessential government run. medicare works very well, and it is government-run. as you heard george forest indicate, it runs very well. men and women of the armed forces have all of their health care delivered by the government. the federal employee health benefit plan is managed by the office of personnel management. frankly, i don't think that is a legitimate concern. legitimate concerns are how is a structured -- it does have

substantial proponents. americans are concerned about losing the insurance they now have, and we're trying to assure them that they will not lose their insurance. they will have the types -- the choice to keep it, and thank you for your advocacy. >> my name is james mcgregor. congressman, i think you for holding this health care town hall meeting. when i read your article in the "usa today," i trust -- i

thought you might not hold a meeting. i trust you know that is american for opposition to be heard. how you plan to make the bill understandable to the public? as you are aware, a news report this morning stated that 2/3 of americans do not understand this bill. it is posted on the internet. we saw many stats displayed tonight. you said that we want to get as much information is needed to the people, but it appears that the majority of the people cannot get it. they are wary of it. speaker nancy pelosi has a clever pr web site, "daily myth busters." the site posted the following mess. the house bill will force taxpayers to pay for abortions.

the fact is, from the web site, the bill clearly spells out that no federal funds can be used to pay for abortions except in the case of rape, incest, or to save the life of the woman. with such an important issue, i examined the bill h.r. 3200 that is posted on the website. i saw no language on abortion. i saw no language about maintaining the status quo. with such confusion, what will you do so that the people truly understand all that is in this bill? is it wise to push this bill through congress with some much misunderstanding? >> thank you. thank you very much for questioned.

i will answer the second question second, and the first question first. that is a good order. first of all, the comments you refer to, when i said was not consistent with democracy's values is shutting down the opinions of others. we need to listen to one another. our founding fathers thought that the way for us to succeed was not for one can or one dictator to say that this is what we're going to do. we found out in any event, that government doesn't work. the kind that does work is when we come together, and sometimes you're angry or animated, but we come together and get our opinions. we discussed and disagree. that is very american. what is not consistent is shutting down others when they are having their chance to speak. that is what i was referring to. i can't believe, and certainly hope that there is anybody in

the room that disagrees with that sentiment. we ought to be civil to one another. we ought to be courteous to one another and we ought to listen. i think you all for coming. i know there are some of you that don't agree with me and don't agree with a lot of things as well. that is the system. i have been at it long enough to know that i get people to get up in my face and say they do not agree with me. in terms of the -- in response to the second question, with reference to the bill itself and the understanding of the bill, it is a complicated bill. why is a complicated? because it is dealing with a subject where americans spent $2.40 trillion. the private sector spends about half.

you spend all of it. we, as a country, spend all of it in one light or another. -- in one way or another. how can we get people to understand? when you read the bill, it is complicated to read because it references a lot of other existing law. if you don't have all of them in front of you, it is tough to understand. on the web site, there is the explanation section by section in english. not in references' or statutes, but in english. i will certainly get that out to people. as a matter of fact, that outline that i just spoke of was on your chairs i hope. it is a pretty short document, 37 pages long. a lot shorter than the bill. i think you can understand it

and read it. because i want you to understand it. frankly, i think it is a pretty decent bill. it is not perfect, but i think it is decent. but because i think it is a decent bill, i want you to understand it. that way, i to argue why it is decent bill. if you disagree, that is a great democracy. >> thank you, sir. you asked about abortion. i'm glad you reference that. on the abortion issue, nothing in this bill -- understand this is a base bill that is being worked on by three committees. there is nothing in this bill that changes existing language

in the law that says no federal funds will be spent on abortion. that is why you don't read anything in the bill, because it does not do anything to affect the law. >> my name is paula pippen, a widow of a naval aviator in the vietnam war who flew three out of every nine weeks in the skies of vietnam. my medicare i really like. i really like the government plan. my question, because i obviously have such good and reliable care is, dealing with the cost of the program -- this is my

question. the public option seems to offer a mechanism for controlling health-care cost inflation. have you and the congress considered other means of reducing health-care costs that you feel to be equally powerful? i have discussed some of them this evening -- >> i have discussed some of them this evening. we want more competition and more transparency. in maryland, most of us have one or two policies. we do not have a lot of competition in our state. those of you that are federal employees have 15 or 20 options in that program. the fact of the matter is, transparency is important in the

marketplace. we need to know the value. what the exchange will do is bring that together and make the information from the private sector available to you. you can't have all little language here that exempts a this or exemption that. -- or execs that. the language on that footnote says it wasn't covered. we are also providing for everybody being included. there will be millions of more people participating in paying for the system which means that the cost per person will be less. we now spend two times per capita one of eight -- what any

other country in the world spends. we have the best, but it is not accessible to all of us. third, what we're going to do, as you heard me say earlier, the system needs to work better technologically. there are health care dollars spent on administration. it is a complicated system. we need to simplify it. by the way, the insurance companies agree with that. there is no reason why you have to have different insurance companies having a different form that needs to be filled out by the doctor, you, and the hospital. that means you did those 30 or 40 or 50 options. that is a very inefficient way to do business. those are some of the things that we will try to do to get bring some cost out of the system -- to wring some cost out

of the system. another thing important to know, this bill -- a large portion of this bill deals with preventive care. there will be no copays, and no deductibles for preventive care. the problem is, when people did not have insurance, they did not go until they get really sick. the problem is, it is more expensive. if they are really sick, it is more expensive. colonoscopy ies, there are no copays or deductibles. i mentioned it mammographies -- i mentioned mammographies. one of the reasons that expenses are going up is because of our diagnostic tools are

extraordinary, but expensive. @@@@@ @ @ @ @ @ @ @ r'a,)@ r,@ r further questions. please feel free to complete the questionnaire card that was that your setting this evening.

you can write their congressmen's office. you can call his office. his e-mail address is hoyer.house.gov. >> i am from maryland. i just want to thank you for coming on behalf of everyone. i really appreciate you have taken the time to do this. i really appreciate obama's efforts to work and a bipartisan manner on this. however, i think it is really clear that republicans are not going to support health reform in any way. i would like to know if you will commit to voting for health-care

reform with a public option, even if you don't get republican support. >> if the question was, do i intend to vote for the public option with or without republicans, the answer is yes? -- is yes. thank you all very much. >> i know people are leaving. i want to thank everybody for coming out this evening and participating in this very important discussion. i would like to recognize and thank panel members this evening. we appreciate it. i am encouraging you to contact the congressman's office if you have additional questions. thank you, and good night.

[captioning performed by national captioning institute] [captions copyright national cable satellite corp. 2009] >> don't give up on the public option, will keep the cost down, ok? [inaudible conversations]

>> i apologize for some of these folks. >> don't apologize for me. >> not you, some of these folks. >> you have my support. this is not about health care. it is about barack obama. racism, bigotry, all that stuff as part of the problem. >> the far out left, that is my question. >> write it on there. i thought it was a good meeting. >> i spoke at the memorial service. i want you to think of not changing healthcare, but

changing tax law. they are trying to take a different square pegs of different sizes and putting them into a round hole. i want you to change the laws to let the governors -- make it in writing for the insurance companies to change so that everybody can get into a group of some sort. there is a reason why all the blanks -- all the banks flood in the delaware. -- flood into delaware. they changed i-95 for it. there will be no discussion, hollering down. check that out. i sent you and e-mail, but you did not respond except for an email. >> i get a lot of e-mail. >> think about it.

>> you helped me back then. why don't you take and put a cap on these lawyers. --? it will drive down the health care costs. all of these doctors have outrageous prices. >> the doctors don't have outrageous prices, there are outrageous costs. >> i was drafted in the service. i resent the thing that you stated about us being un- american. >> read it. what i said was, it was unamerican -- you believe our democracy should encourage shouting down? >> why didn't you say we're going to burn the flag in

california? i never heard you or anyone up there, including what's-his-name -- >> everybody needs care. >> thank you, i would really appreciate it. i was born and raised in southern maryland, all the way back to the original colony. >> people want a public option, they are just louder than us. past that public option, and we will put you back in office. >> see ya, bye bye. >> president obama is thinking about a speech to the joint session of congress, do you think it will be useful?

>> you'res till m -- you're still mic'd. g

>> thank you for joining us today. i oversee litigation across the country including the effort to combat health care fraud. i am honored to stand here today with dedicated colleagues from within the department of justice to announce the historic settlement with pfizer inc. and its subsidiary pharmacy company. there are allegations relating to them to give illegal promotion of drugs. pfizer has agreed to pay $2.3 billion, the largest health-care

fraud settlement in the history the department of justice. within that $2.3 billion is a criminal fine of 1.19 $5 billion, which makes it the largest criminal fine in history. today's settlement is an example of the department's ongoing effort to protect public rest and recover funds to the treasure from those who seek to profit from fraud. it shows one of the many ways that the government can partnership with our local our rigid allies and help the american public at a time when costs are increasing. before i turn this over to my colleagues, i want to highlight three things about what we are announcing today. first, i should be obvious,, budding health care fraud is one of this is ministrations top law enforcement priorities. every year we lose billions of dollars to medicare and medicaid from fraud. those billions represent healthcare dollars that could be

spent on medicine, elder care, emergency room visits. instead there spent on medicines and devices that are not necessary for the patients they describe. when a drug is marketed are promoted for non authorized off label uses, and used not to provide the fda, as was the case here, public health may be at risk. there is a real danger for patients at the medical providers that they do not have full information about the risks. because health care fraud is such a significant problem, the department of justice and health and human services reinvigorated our partnership by launching the healthcare enforcement action team, or h.e.a.t.

it is led by people at the top level both departments. we have worked to increase coordination and to secure our indictments against dozens of tents. -- tenants. second, we are working hard to protect the federal treasury and american taxpayers. almost medical and pharmaceutical providers want to do the right things, when they cause false claims to be submitted, that is real dollars of the american taxpayer's pocket. it affects the federal treasury. enforcement through the false claims act and in this fiscal year, before today's settlement, the department recovered 1.5 $7 billion in settlements and judgments under the false claims act.

they recovered an additional $470 billion to state medicaid programs for a total impact before today of $2 billion. today's settlement increases c- span.orecoveries under the false claims act. the third thing i want to highlight before turning it over is this settlement is a testament to this department of justice's approach to law enforcement, which is about a broad and coordinated effort with their state and local partners. the efforts here and many people who worked so hard reflex coordination, and cooperation between the civil division, the attorney's office, and the

eastern district of pennsylvania. [naming offices] that listed demonstrates the broad reach of health-care fraud as it cuts across many federal programs of to a state programs and the importance. from the attorney general on down, we know that we can do amazing things like recovering $2.3 billion for federal and state treasuries one with

partner with their sister federal agency and the american public. we are deeply committed to working collectively with federal, state, local, and trouble partners on many issues with healthcare fraud being at the top of the list. the press release will talk more detail about many of the people who have been involved in the settlement. in particular, i want to know the critical commitment of mrs. civilians. their focus on stopping health- care fraud. with that, i to introduce the secretary of the department of health and human services, kathleen sibelius. >> thank you. you are only going to hear from five of us this morning. if you heard with everyone, many are in the room, this may take

all day. we want to represent the good work that was done by agencies across the government. this really was a team effort. the departments of justice come at the guy, and other groups were involved with this extern very work. we are charged with keeping american help in making sure they get the best health care possible. that means part of irresponsibility is pending health-care dollars wisely. it also -- that is part of the responsibility is spending health care dollars wisely. part of the mission is fighting brought. that is a job are retired department take seriously. the office of the inspector general and those on the stage spent four years in the conduct

of this investigation. they did not just implicate pfizer. they identified in charge of the senior managers who were responsible for the fraud. some of the agents are here today. i would fight to acknowledge them along with the man who has been a tremendous leader of this office. aig leaders are here. come on. i know you are back there. i can see you. congratulations. the investigators also helped put this case together. americans have tremendous confidence in the medicines they take. that is a treated to the great work the fda does every day. -- a tribute to the great work the fda does every day. thanks to the attorneys from the fda, we now have a safer drug supply available to the american public. this event marks the conclusion of just one investigation. it is another step in the it

ministrations ongoing campaign to prosecute any individual or organization who tries to rip off health care or consumers and the federal government. you have already heard general pirelli in may and a general holder and i were together to announce the antifraud initiative called h.e.a.t. that is already paying big dividends. one in houston led to the arrest of 32 doctors and health care executives and four cities for treating medicare out of $60 million. the ongoing work of the task force can be monitored on the web site which is www.stopm edicarefraud.org the settlement is historic not only because it is the most

money taxpayers have recover from a drug company, but because it includes the most comprehensive corporate integrity agreement that a drug company has ever signed in the united states. the agreement requires that pfizer's audit committee conducts annual reviews of their compliance program. the senior executives in nearly -- that they create a mechanism for doctors to report question will conduct by pfizer sales representatives. pfizer must post information on its website about payment and get to doctors. this is the first ever -- time ever that a drug company has agreed to look at the risk associated with marketing on its own and develop a plan to deal with those. we are going to continue to closely monitor pfizer's performance. these steps represent the obama administration still focus on prosecuting and for pending health-care fraud. we do not want to just catch crooks. we want to stop them before they

strike. that may be new ways to trim medicare claims are prosecutions like this one that make companies think twice about bending the rules. to give you another example, on monday, they are creating a national data base to track our efforts to crack down on medicare fraud. the data base will help us identify where we are doing well and where we can do better. -- and where to find the best practices. we no mistakes are extremely high. when companies or individuals are deprive medicare and medicaid, they are not this feeling it from taxpayers. they are stealing and jeopardize in the long-term finances of some of our most importing government programs. in some cases, america's health suffers also. unnecessary or dangers procedures to not discuss dollars, and they can cost lives. we are working aggressively to

make sure americans get the care they need and that the dollars are well spent. like the rest of our partners here, we are committed to doing everything we can to keep americans and their health care say. i look forward to continuing to work with this extraordinary team in the months ahead to do that. i would like to turn things over to tony west, the assistant attorney general. >> thank you. thank you for your leadership on this issue. my name is tony west. i am the assistant attorney general for the civil division of the department of justice. today's announcement represents the largest criminal and civil settlement of the health care fraud case in u.s. history. this landmark $2.3 billion settlement with pfizer and its subsidiary pharmacy yet is important not just because it includes a record $1.3 billion

in criminal forfeiture to resolve and not just because they agree to pay $1 billion to result serious fraud allegations including over $300 million paid to the state. this case is important because of what it says the but the u.s. government's cover meant recorded efforts to combat health care fraud and what that means to millions of americans who rely on the integrity of programs like medicare and medicaid for the health care they need. today's settlement demonstrate that health-care fraud is a priority for the civil division and this department of justice. when it comes to marketing drugs that so many of us rely on, we will expect companies to be honest about the claims they make about the drugs they sell. this settlement and plea agreement represents another

example of what penalties will be faced with a pharmaceutical company put profit ahead of patients' health. the legal conduct in this case puts the public health -- corrupts decisions and cost the government billions of dollars. it is not just the government pays more. when health-care fraud occurs, that tries the cost of healthcare up for all of this. consumers pay higher premiums. companies pay more to cover their employees. every medicare and medicaid dollar lost means that your children will see doctors for preventable shot the diseases. more seniors will be faced with the choice between food or medicine. your people will get the health care they need to dramatically improve the quality of their life.

that is life sediments are so important. @@@@ over $650 million to resolve allegations of the false claims act that the company illegally promoted for drugs using false and unsubstantiated claims

regarding their safety and effectiveness and cost federal health-care programs to pay millions of dollars for prescriptions that were non for medically said it uses. in addition, the investigation in addition, the investigation of pfizer began in 2007 -- three with a whistle-blower -- 2003 with a whistle-blower. we also used the anti kickback statute. it puts into pfizer's practice of kickbacks to health-care providers to induce them to prescribe many of their own drugs. patients must have confidence that their doctors are giving them the best medicine for the right reasons. and the criminal side, the civil division use the food and drug and cosmetic act, which requires that companies specified and hit the use of their drug

applications to the fda. once a drug is intended for a use, and may not be marketed or promoted for off label uses. that is a use that is not specified in the application and provide the fda. in this case, pfizer asked the fda ithaca promote the sale salevexstra for certain other uses and in doses higher than the approved maximum. the fda said no. is a marketed -- pfizer marketed those underproduces anywhere. when this happens, patients live separate address and those who cause the rest must be held accountable. teamwork -- without working together across agencies, the partnership that has developed

among the various agencies and local law-enforcement officials has recently led to several substantial health-care fraud enforcement actions, prosecutions, and recoveries. i want to thank our partners for their continued commitment to ensuring the integrity of our program. i am proud to be here today. it is my pleasure to introduce you to the attorney for the district of massachusetts. michael? >> thank you. i want to thank mr. pirelli for coming here. today's resolution addresses criminal activity within pfizer's pharmacea division. like every drug, fda approval had to be attained. there is no such thing as a general approval for a trip. fda approval as indications of

is indication specific prada any indication not on the table is a violation of the law. the fda approved it in 2001. if the justices were for three things -- treatment of a ride this and it built rheumatoid operettas of for the treatment of primary dysrhythmia. the fda often not approve other indications. why not? the fda told pfizer it to a pretty fair concerned about the safety. they had noted that a cause an excess of serious career gaskell -- cardiovascular of answering one clinical trial. despite the decision, pfizer's marketing machine used for all

manners of acute pain. the marketing machine pushed this from 2002-2005. they also pushed it for other uses. among other things, but abided doctors to consult the many reasons -- invited doctors to consult and many resort acacias. they were entertained with many activities. their job was to help pfizer how to figure out best to promote it for the indications. [unintelligible] they have no clinical evidence that it was superior.

pfizer utilize medical education and then to permipromote off lal and vince . them attract articles to touted for and used -- [inaudible] among the factors we considered -- this is the fourth advisor settlement. in 2002, pfizer paid $49 million to resolve allegations that it had failed to report the best prices for its drug lipitor. in 2004, they paid for and a $30 million, including a two and a $40 million criminal fine for the offer will promotion of another drug. in 2007, pfizer pled guilty for

payment of kickband kickbacks of other drugs. my office handled the last two matters. jury the 2003-2004 negotiations, management asserted that the company understood the rules and had taken steps to ensure corporate compliance. many of us involved with today's resolution were involved in those negotiations. we remember these promises. little did we know the woman struck are bargain with pfizer in 2004, that other parts of pfizer were violating those very same laws on other drugs and continued their efforts to do so. they are not the other drug company that has participated in health care fraud.

a dozen years ago, and boston and philadelphia were also in t. the first settlement in was in 2001. there has since been 42 other possible resolutions against the drug companies. today's settlement means that in this decade, the drug industry has paid its government $11.7 billion. $2.9 billion of that is for criminal fines. i want to make a work on the team. these cases require enormous commitment above and beyond the call of duty. they are incredibly -- they worked incredibly hard. sometimes you think you'll never see the light at the end of the tunnel. vote on the other side have more of everything, up resources,

money, and lawyers. i cannot praise and thank everyone here. much of the team is here. a gives you a sense of the scope with the involvement. today's result is a testament to the hard work and dedication of the two lead prosecutors in my office, sarah bloom, who picked up the case in 2004. this case cannot be done without collaboration. this includes the commercial litigation branch and the officer -- the office of consumer litigation. the team is assisted by an energetic team of prosecutors.

we worked seamlessly with the night the state attorney office in pennsylvania and kentucky. their assistance was crucial. we have collaborated closely in the past with those offices. we did so here. we share a common goal that is shared with everyone who is word on this. that is to assure that the rules are followed and the public's money is protected. i would do well to take notice of our close collaboration. while this case represents an extraordinary accomplishment to protect citizens, we continue. thank you. >> thank you. i and the assistant director of the criminal investigative division of the fbi. as you have heard, today

settlement is monumental. it was much more than the largest fraud settlement in history. it sends a clear message that the fbi and our partners will not stand by and let any manufacturer peddle their prescriptions or products for uses beyond their intended federal government approved focus. under the provisions of the cosmetic act, a company must testified the intended uses of this project -- project. once approved, the drug may not be marketed or promoted for any of label uses. -- off label uses. pfizer intended to circumvent specific fda directives concerning their drugs by using it sells force to promote off label uses. we have interviewed numerous physicians and representatives who have collaborated these assertions.

we would not be where we are today if it were not for the epic professionalism and courage of a few company employees they were willing to step up and speak out against a corporate giant that was obliquely violating the law and misleading the public through false marketing claims of providing incentives to help care providers to prescribe certain drugs. i also want to thank the hard work and dedication of the fbi investigators that worked tirelessly leading up to this landmark civil and criminal resolution. although these types of investigations are often long and complicated and require resources to achieve positive results, the fbi cannot be deterred from protecting the american public or continuing to ensure that pharmaceutical companies conduct in a lawful manner. thank you very much.

>> we will take a few questions. >> you make clear how pfizer violated the law. did you additionally find any evidence that pfizer's conduct actually harmed in the patience? >> whether or not it harmed patient was on a bogus. it was not something that was part of our inquiry. >> why is pfizer not making the guilty plea in the criminal matter? is there a concern [inaudible] >> it may have to do a particular history. the pharmacy division is the one that had the drug. they had struck a marketing arrangement with pfizer before the acquired the division.

in many respects, the pharmacy division was the logical choice. there is the exclusion issue that comes up. i'm sure that is what you are addressing. we look at it this way, if we excluded an entity. it is dumb. it has to sell it. those assets include assets like the drugs and employees to market them. there is no opportunity in that event for a continuing corporate integrity agreement. as you heard, this is a phenomenal agreement. we think that the better choice here is to have a plea that allows us to have a strong integrity agreement behalf >> can you explain -- to talk about

them being@@ p n,y can you talk about why there were no charges for the senior managers that you have identified? >> we have identified four managers -- >> can you talk a little bit more about the marketing machine and the doctors? it seems like they have certain prescriptions in effect, with the orders and the position requests. so they can have the doctor at the same time of the marketing? >> the secretary -- she had to catch an airplane. i think dan levinson will be able to answer a lot of questions. i would not say they played a

doctor. i think the sales force at pfizer was affectively -- effective in getting doctors to adopt things that were beneficial to the drug. i would not say that the refs were playing doctors. >> any other executives that you guys are talking to about possible criminal charges or is this investigation done? >> this investigation is brought to a close. >> does the co know? but this investigation is closed. >> there is discussion about whether pfizer should be suspended or barred from -- for a certain time to send a message? >> dan, if you like to talk about the results. >> i am dan levinson, the inspector general.

i would like to thank the secretary for her tremendous support and leadership and with these last few months as we have successfully concluded what is a four year investigation. i want to single out our boston regional office. our agents did an extraordinary job over the course of more than four years in bringing this case to a successful conclusion. the corporate integrity agreement that is part of the settlement that goes forward five years is unprecedented in terms of the provisions and reach and scope. the secretary outlined some of the broad features at the cia. i want to underscore that for the first time -- and we have been doing agreements at the department for a number of years -- this is really reaching into new territory. pfizer will be under an

obligation to proactively identify the potential risks associated with the promotion of individual products. if they can implement claims to mitigate risks. we have internal and external compliance as wall as a robust plan going forward to prevent this conduct from happening again. >> could that be employed if they violate the cia? >> it could be employed. it is important to understand that this settlement is for the benefit of certainly american taxpayers to return significant dollars that are spent under the programs. it is also, for the protection of beneficiaries, who count on drug pipelines from a variety of manufacturers. it is important to understand as we proceed on putting together a

cia agreement that is strong, that will avoid the kind of bad behavior that we have seen in the past, and that serves the benefit of the taxpayers and been of the sierras. >> it included -- >> they are. >> the penalties are not compliant? >> there will be a range from cheese to fines from removal from the program. >> can you comment on the $102 million? >> there are $102 million to be divided among the whistle- blowers. we will be an affirmation on how it is to be divided up. -- we will give you more information on how it is to be divided up. >> like many of the health care fraud cases that we do, this began with an action.

here there are several relay years who will be getting a recovery from the federal share of the settlement. depending upon -- i think there were 11 actions which are implicated by today's settlement in various parts of the country. >> there have been complaints that they are not hearing from justice and months and months are passing prepar. i am hearing from keith hamm lawyerthat it was put into the r a long time. the majority of the cases that we care began with these

actions. that is a very important commissioneresource. >> were all the employees whistleblowers? >> i do not know the answer. >> were they all company employees? >> we will try to get an answer for you. >> how are american supposed to trust this company moving forward? >> as the inspector general discussed, we have a path breaking agreements which will be a foundation for insuring that we can have confidence in the future. it will require an enormous amount of monitoring by the government. we will be spending a lot of time working to make sure that they comply.

we will continue to rely on the statute and other federal statutes. health care fraud is a very big priority. we are cutting significant resources to ensure that we can recover funds and health care and others. >> pfizer is not the only farcical -- its spies to the only financial -- pharmaceutical co. -- is pfizer the only pharmaceutical company being investigated? >> we are not want to comment on that at this time. >> this settlement was largely done during the bush administration. explain to me why you guys are having such a high-level announcement, which never happened during the budget

ministration. >> there is no question that there is a significant part of a commitment. it is not surprising that the department would have -- would want to use this opportunity to emphasize our commitment. $2.3 billion is huge. this is a very significant day in our efforts. it is part of a longer effort where we have tried to reinvigorate the efforts. we've talked about over the last four years. it is part of our broader commitment. >> you have talked about how difficult this case was to build. can he give us a little idea how you build is it? mr. perkins, you said your agents interviewed the physicians who went to these promotional meetings. one thing you do to build this

case -- what type of work did you do? b>> it was a basic investigator review, accounting records, interviews. it did not differ from any other type of health-care fraud investigation we do other than the scope. we worked very close to the folks at hhs. we interviewed physicians. we interviewed health-care providers. we interviewed people who collaborated that the allegations were being made. the gathered the evidence needed and financial records we needed. it was a slow stretch through the process. we are willing to continue with that have a commitment because of the outcomes that we receive and that the chief. not only in the convictions, but

also in the protection of the american public some of the behavior they described such as paying doctors to appear training seminars happen all the time i that is happening this weekend. -- happens all the time. i bet it is happening this weekend. are you setting a new standard of the papers that you think your crossing the line, such as paying doctors to show up at the training seminar, which is routine? >> i do not think we have set a new standard on that. i will defer to the inspector general. i think what we are doing is the we are looking at each and every one of these. we know when they cross a line when they do not those of these a picnic -- and when they do not. those of the specifics matters. >> one reason why this is a very

significant recovery if you have a combination of several things coming together. that includes whether it is a payment of doctors to actually work together to prescribe things off label for a use that was at 5 at the time -- identified as something the fda would not approve. the drug has been off the market since 2005. >> thank you everybody. thank you very much. thank you. [captioning performed by national captioning institute] [captions copyright national cable satellite corp. 2009] >> in a few moments, and look at how the japanese elections may

affect the united states. speaker nancy pelosi will say the house version of the house -- of the health-care bill will include a public auction. -- option. today, vincent keane on providing health services. we will take your questions on japan's recent elections with michael green. then erin arvedlund, on "too good to be true, the rise and fall of bernie madoff." "washington journal" is live each day at 7:00. joe biden will speak on the economy at the brookings institution at 10:00 eastern on

c-span. and the center for strategic studies analyzes the afghani elections from an observation team. >> we will review the health care debate in congress with house committee hearings. on friday night, where the issue stands in the senate. the comparison of the health care systems from around the world. with t.r. reild on q and a. >> the ruling party was ousted after 50 years in power in japan. the center for asian national -- international studies at a forum on what this means for the u.s. relations with japan. >> i am sorry to interrupt your

conversations, but we want to get going. i would just like to say that they could time the election and this event. but luck wins out over brill iance. we are happy to talk about the election in japan, one of the most monumental political developments of the last 130 years in asia. political developments in the last 20 or 30 years in asia, and what does that mean? that is what we are going to export to night and we have got some fabulous people to help us do that. this is the third of our series that we do jointly with tc-99 youth's schaefer school of journalism. we are really proud to have that opportunity in thank you so very much. i like you probably get a little tired with kind of shouting angry journalism in america and what i always admire about bob

schieffer is his tough as nails but cybil, a fair and honest spirit that he brings to his journalism but also brings to us in this forum. we are really grateful to have all of them. i would just like to say a special word of thanks to where friends at upc. this is a company that has a deep commitment to moving-- improving the quality of public policy in america. they have given us a chance to partner with them on this. the wall know them and you wrote down on one of their elevators and it is part of the products they have made possible for us. thank you for all of that. we are really grateful. but, we will turn over to. let me just say one last thing. i want to welcome back my very good friend kurt campbell. encourages over the state department and i was lucky enough to be his colleague for almost seven years and he went over to treat the center for american security and has done a fabulous job and of course he is

now on the hill. were so grateful and thanks for coming back. >> thank you very much dr. hamre and welcome once again. as they like to say in baseball, the partnership between csis and tcu, those of us at tcu hope it is good for both teams because it is certainly good for our team and we really enjoyed the opportunity to be here to join with csis into we have, the people who know most about japan with us today. i would also like two of knowledge the japanese ambassador, ambassador welcome and we will be calling on you when we go to questions here. but come here and the stage with us today, i have all of this written down. i don't need to write it down, but kurt campbell of course to is the assistant secretary now for east asian and pacific affairs. he has been in that job since june of this year.

he was previously ceo and cofounder of the center for new american security and has said several positions errett csis. as dr. hammer said over the years including senior vice president and director of international security program. they henry h. solutions your charen national security policy and was also an associate ofessor of public policy and international relations at the kennedy school at harvard. michael green is senior adviser and holds the deppan chair here ed csis. also an associate professor of georgetown and served as special assistant to the president for an national security force, senior director for asian affairs from january of 2004 to december of 2005. he joined the nsc in april of 2001. as director of asian affairs and worked at the council on foreign relations at the institute for

defense analysis, speaks fluent japanese and spent over five years in japan working as a staff member and the national diaz as a journalist for japanese american newspapers and is a consultant for u.s. business. steve clemons, senior fellow and director of the american strategy program at the new america foundation. he also served as publisher of a very popular blog, the washington note. he has been an executive vice president at the economic strategy institute, a senior policy adviser for center jeff and i got to know him through the years, when he was on capitol hill. he was there for seven years and -- as part of the japanese american group in southern california and was the co- founder with charles johnson, so let's get to it.

let me start with you, what does this mean for u.s. and japanese relations? >> it is great to be here, these are wonderful forms, and we are very grateful for the opportunity to explore something as significant as the selection. -- this election. election. it is important just basically to take a few minutes to appreciate something that the united states and japan share, which is this tremendous commitment to democracy so what we have seen is an enormously important election that took place peaceably, in which there a new generation of leaders have come to power in japan, so at a

very basic level we recognize that we celebrate it and we appreciate it, and i would like to just say today, earlier today president obama reached-- at a very good conversation. key thanked cam for some statements of late of importance to japan u.s. relationship and he congratulated him on his victory. he told the japanese leadership that the united states stands ready to work with japan. over the course of the next several weeks and months to ensure that our relationship is important going forward. this is a very early time. we have to take great care during the initial steps. we are trying to send a very consistent message of our determination to work closely and to consult with japanese

friends. we have a schedule for fairly deep engagements over the course of the next several months to ensure the highest possible level of consultation, and i am confident that in terms of the basics, the fundamental issues that unite the united states in japan, that those will remain in place. will there be some challenges along the way? undoubtedly there will be but the truth is we have faced challenges over decades. we have surmounted them. we have worked closely together and i think we have the lot of confidence that we will be able to do that over the course of the next several months. the watch word from our perspective right now is patience, commitment and solidarity so we feel very, we are excited about the election, we are excited about the path and the way forward. we take nothing for granted in terms of expectations, associated with issues beyond

our alliance but we do think that the foundation is there for a very strong relationship going forward. >> michael green, you and many other analysts really nailed it, everyone saw this coming but it is still almost a shock that one party has held power since what come in 1955, and then they lose it just a total-- they not only lose but they lose big. 300 out of 485 seats are something like that. why did it happen? >> well, the japanese voters, it wasn't because of mr. on the. it wasn't because of the dpj policy. it was because they were sick and tired of the liberal democratic style of governance and the inability of the government to provide the japanese economy has grown at

about 1.9% a year for a decade. there is the sense that just can't go on and things have changed, so this was a massive, massive victory for the opposition. japanese elections lately have been massive. there was a massive victory just a few years ago, so there's a lot of swing with the japanese voters and they were ready to throw the bums out and give the new crew a trying that is mainly what this is about. it is not so clear that the japanese public knows what the new government will do or has complete confidence in what they will do but they are ready to throw the dice in. >> in other words this was not so much a vote for the new party as it was a vote against the old party. >> that's right, that is pretty clear. there are some things the democratic party promised come to cut taxes and fees, stimulate the economy in empowers civil society more. they are going to the centralized government.

in terms of how to restore long-term growth, there wasn't a clear affirmative vote for anything. it was just time to get rid of the old crew and i talked to friends in japan right to live who voted for the-- but they weren't sure what came next. >> steve, when something like this happens, there is always, america always becomes an issue it seems like. it was and that you heard anti-american statements from the new party as they were coming to this election, but you heard them talk about, we need more independence from america, we need is to separate. is this going to make a difference in japan american alliance? >> i was writing a piece today that hatoyama is going to find his inner obama and what i meant by that is that a lot of things

that on the campaign trail are going to be softened, delayed and priorities are going to be set. the great ariel sharon line, we were sitting behind the prime minister's desk and he was responding insane things look differently behind his desk and things will look differently behind hatoyama desk in what he puts forth. i think this is an exciting election in part because to be blunt many people feel the ldp's sort of lost its ability to be flexible in a lot of key areas. in the past the lpd was able to reinvent itself and that sort of banded but you also have the impression rightly or wrongly, that many japanese felt that the u.s.-japan relationship and a whole variety of fronts was just stuck too much in the past and i have been one to sort of suggest as well that there was a kind of brewing nationalism that i would consider sort of nasty right-wing nationalism. i am very happy that now we are going to see a negotiated nationalism and part of that

will involve the relationship with the united states and where they take it. recently hatoyama published in "huffington post" in all places, ps complaining about the negative consequences of the american-led minnick neal liberalism if you will and they made a comment that a lot of americans felt what hatoyama was saying and we have had the shift to some degree on these issues, but i think that when the real strong man behind this wrote his book on a blueprint for a normal nation coming in it he did not destroy or dismantled the u.s.-japan relationship. he talked about the importance of becoming a greater stakeholder, sorting out japan's interests while in their own in changing the image to the degree it still exists of japan just being a puppet or a satellite of american interest exclusively and having a greater role to play. i think this is part of the japanese narrative which has been growing and we should look at this as a healthy thing.

i predicted a much healthier come a lively and so much reinvented u.s.-japan relationship in part because of hatoyama talking about the need to create some distance. i think it's a good thing as opposed to what some people see in some sense that it will cost this influence. i don't believe that at all. >> go ahead. >> i like both of what steven mic is dead. i actually think for the alliance to maintain its relevance, and its influence over the course of the first part of this century, a degree of independence, of confidence is actually-- absolutely essential so i actually think these are not, it is just and reaffirmed the. [inaudible] in contrast with one another, they are actually is essential. it is important that japan feel confident and independent and in fact the united states supports that. we don't see any contradiction in terms of a close alliance and

a greater independence in terms of doing business. i think we will find that even in an independent mind said we will find ourselves taking very similar positions. i also think that one of the things we have heard from dpj is a desire to have a closer in deeper relationship in asia with both south korea and china and that has sometimes been positive as something the united states either against orth written by. nothing could be further from the case. weep like to see japan play a stronger leadership rules partners with friends in asia and we will support that. we also believe that the process they will come to appreciate and understand the significance, so in terms of the basics were very comfortable. i would also suggest to you, we see this in the united states. i wrote a book on transitions with my friend, nav deputies secretary jim steinberg, transitions of democracies are difficult.

this will be different from transitions that we have seen in the past. this is going to take a period of time. we are going to have to be patient. is probably going to play out not just over a couple of weeks but months. new means and mechanisms of making decisions will be put in place. if i had one caution, i would say by own personal experience and some of the finest professional phi have worked with in japan are bureaucrats. i would hate to see a period whereby somehow they are positive as the enemy and somehow to be gone after. i think over time many of our new friends that have just arrived in power will come to appreciate how strong these men and women are, how much they serve japan's interests over the course of the last several decades. of course there can be changes, but overall, there has been a lot of very good work done and

we hope to continue our professional relationships. >> from the united states standpoint, what what means the most to us on this side? >> i will answer that, briefly, if i could. let me go back to what he said. there is this narrative that has come out, about the distance from the united states closer to asia. it is hard to understand where the japanese people are. there are a parent -- very recent polls, where they said yes and they were asking about a closer relationship with china and they said, they would not do this. in some ways this has never been better. much of this comes out of a narrative, that they're trying to use to attack the liberal democratic party. c party in japan

use to try to attack the ldp because the government corps raided very closely. and we are seeing that frederick still. i think is going to start dying have is these guys come into office and start looking at what they do about north korea, what do they do about rising china? they are very few issues where we disagree about japan. added strategic level, from the middle of the second world war, long-term strategic plan-- planners knew we had to have a strong relationship with japan and their foreign policy on a bipartisan basis has been based on that for 60 years. we especially need it now with the rise of china, not that japan or the united states wants to contain china but to provide a stable and environment or we can engage china from a position of confidence. japan is the second-largest contributor to the united nations and most of the international restitution so organizations to work we have to be with japan and we are.

we are close to japan in the g7 in g-20 discussions. we need to ban on the north korean nuclear problem and for ford presents across the hemisphere are bases in japan are absolutely critical. the dpj has made some noises about changing the status of our forces, but looking-- blocking okinawa. i think the japanese public and the rest of the reason-- regioned understand alimport ceasar and that is a long list of critical interest. >> do you see any of those changes coming nor any of those things changing in any hard way? >> not the major things but i think there will be down the road, not on the front end of the hatoyama and streets and but changes on the edges, things that will make kurt campbell a bit crazy about one to renegotiate for the rights of military service men on base is in discussions about sovereignty and decision-making. i think there will be some of

the. i think kurds will be in genius that getting the japanese to move beyond the abductee issue as the bee all when they think about regional security and began to look there and i think we are going to see and what i hope happens comes into reify something like just laid out, japan has some of the best international bureaucrats in the system and one of the things that i feel working against it, you have lots sarah come clean up unesco wehr jesse helms supported going back. you had in the high commission for refugees in peacekeeping, him iaea. you have got in the bretton woods institutions in japan used to combine a kind of commitment to security three notion of independence of the system in ways that took the pressure off the united states for being the player and i think there has been some muting of that. i would love to see a return to that because i actually think it

helped us and help the relationship and reminded people of the vitality of japan. i think japan, if i can be blunt, despite the interest of this dormancies ben is taken for granted. i think japan during the second gulf war, during the iraq war decided to stop challenging the united states gun keach rate issues and become our power into subordinate with a lot of the tensions. if you don't have points of tension with another country, you are not taken seriously and i think somewhat the u.s.-japan relationship has a lot less visibility than it should have given its weight. that is why excited about this democracy 2.0 moment and i think we are going to see japan rise in relevance and significance in consequence in the eyes of congress, which i think has been on attending this relationship and underwear that, so when you look at this combined portfolio and asking, going along with what mike said, i think you are going to see renewed interest

and hopefully to be in come back to some of these international institutions in which it is very useful for us and i think it will return them back to prominence internationally. >> are we on this same page with japan and korea, on the curry as? >> on north korea? pn south korea. >> in both respects, yes. even before the outreach problem, president obama, there have already been conversations between hatoyama and his korean counterpart in they have underscored their desire to work more closely together. i think one of the things we have seen over several years is a tendency to in certain circumstances for a of reasons to suddenly see south korean japanese, the japanese self korean relations taken a nosedive and ultimately that is not in our interest. we want to see our two closest allies working more closely

together. if i may say, focusing more on the future than the pests and i think we see their real prospects going forward so that is our basic issue and i think we are going to see very good work in this area going forward. and north korea, it is still early. i think, i think at a general level the united states in japan sherer basic beliefs. we will not accept a nuclear north korea. we are committed to a diplomatic process, whereby during the six-party framework we try in some future. not to sit down with north korea at they accept the commitments that they have taken in 2005, so i think you will see that the united states and japan will work closely together on north korea. i hate to say this but we are pretty much in violent agreement

about areas where i think we can work together. it is the real challenge, i don't think we fully appreciate how difficult it is, how wholesale a change this is likely to be in terms of the whole group of people. remember this is not just the new group of people coming into the executive branch. this is a new group of people many of whom have never been of power, not only in the legislative branch but will be serving in some capacity in the executive branch. there is a tremendous discipline and rigor associated with power and can be brutal, it can be very challenging and we see that lane at natalene united states intransigents but we see it playing out in other places. this is a whole new generation of people who are experiencing this together for the first time so i think one of the things we have to be careful about is not to have unrealistic expectations in the short term about clear and coherent policy statement. it may take time for them to be

able to fully enunciate and i think we have to be patient and also understand that they are going to be some straight flares and some comments made that perhaps make people anxious and recognize that we have to be much more focused on the balanced in the votes which are these larger issues that really unite the united states in japan. >> i just want to add one point to a firm something that kurtz said that hasn't been getting a lot of press but this party with 300 plus members it's going to have to hire staff people, trained step people, educate them about the legislative process. when you get beyond the sexy topic seaware fighting over, 99% of the work doesn't get the headlines. there is a whole infrastructure within the ldp that it's been there in place for decades that essentially much of the internal organs of policy and legislative work don't exist in any mature

way within the dpj, not to the same level so there is another sort of back shop question which i think even more disconcerting and can handicap the government and actually i think what you will have a few public hangings of bureaucrats ultimately those bureaucrats in up becoming a vital part of its so i just want to throw that out there, that their going to have a lot of handicaps. >> also the dpj is have the luxury of not having to come to a conclusion on key economic and foreign policy issues because they rode this way but the guy's currently in power. there are a variety of views. there's of a clear consensus on whether they should continue refueling operations in the indian ocean to help afghanistan, what to do about the okinawan agreement. i suspect what will happen as the politicians will learn how to learn with the bureaucracy will be the ones that have the inside and the power to actually governance survive so the dpj

has said there quintuplets citizens on everything. the smart politicians are the ones who will marry themselves to the right bureaucracy and get things done. i also think curt as articulated exactly the right policy. be patient, help work through a strategy together, focus on the relationship between hatoyama and president obama. there are issues. they will have to decide which do about the indian ocean. they will have to make decisions on the north korean policy. what worries me will is, this is not at all, what kurd said i think it's right, what worries me as having not resolve some of these convictions. this government may not be able to come up with the aid decision and will sort of punt and pass on key decisions. the last thing i would say is, steve is right, they are people like ambassadors hatoyama and others who were international organizations. we should be actively supporting war japanese leadership ken

personnel in the u.n. and elsewhere. what i would disagree think it finders did you steve, the idea that japan been to the cult in becoming interesting is good for u.s.-japan relations or japan's position in the world. a lot of the narrative has been nearly focused on the u.s.. were sending to people and i would-- to iraq and afghanistan because of the u.s.. what i hope will happen is the new government will come in, step back and stop pouring about the u.s. and think about whether their policies on afghanistan, on economic reconstruction in iraq, on revitalizing their own economy, think about whether these are credible internationally because what is credible to us is going to be credible to india, britain, to candidate, to korea and so i'm hoping they will step out of this u.s.-japan prism and step back and think through what will make japan influential incredible globally. if they do that i think it will

move in the right direction. >> can i say one other thing? the of the thing is, let's reflect that our japanese friends and government are not just talking to us, they are talking with a range of other countries. it is gratifying how many other countries have gone to the japanese and said look, job number one, yes we want good bilateral relationships that make sure they europe japan relationship is strong. they are hearing that from a whole range of countries, not just the nation. >> i want to go to questions in the audience center than we normally do because actually have so many experts here today and first i would like to call on the japanese ambassador. mr. ambassador would you like to make some comments here or would you like to even ask the question? and would you go to the microphone? we would love for you to go to the microphone.

it is a lot of cameras. >> in my country, they are saying that if the free people get together produce food as wisdom. there's not much to add to what they have said, and especially it has not started yet and i'm not in a position to projected. but, i would like to just make a couple of points. on the economy, i think what he is saying is that he is not denying market forces and globalism but if we leave everything to market alone, we not-- may not produce the best result for wholesale and the guiding principle in adjustment

is to care about others. and i think as steve said, it is also here in the united states as well that government is having a bigger role in adjusting economy. the second point is about u.s.-japan relations. mr. hatoyama says he is seeking future oriented relations between japan and and i think that is true that there are differences between the incumbent government and the incoming government, on these issues. however, what is most important is that they are saying, tha