and if this happens, this not only lowers the bar in the senate in terms of needing 50 votes, but this may restrict the kind of legislation that we may pass, with doing the kinds of things -- to reform the delivery system because as most of you know, the rules about what can be included in the bill, as this goes to the reconciliation, this is more narrow and therefore some of the health-care delivery may be under this. i do not know if -- this is clearly a big challenge, whether or not they are going to be able to find a bill that will attract several republicans, but where the more conservative democrats are going to be on this issue, with the blue dogs in the house, and the six or eight

conservative senators, democratic senators, in the senate. . is what i expect. i am hopeful we will see health care reform package of some sort. these issues at expanding coverage and slowing spending and improving quality of care are not going to be helped by just kicking the can down the road for five years. we have seen over the last 15 years that these are issues that will only be addressed by direct policy changes. we need to start making these changes in the course of several bills over the next few years. >> right here. >> thank you very much. my name is rita and iran for asian pacific audiences.

-- i write for asian-pacific audiences. there has been an assertion that illegal, undocumented people in the united states contributes in large measure to the health costs. other than eight being perpetrated in at talk radio but -- been perpetrated in the talk radio, but it has also been asserted by advocacy groups with data. would you be able to address the serious side of this question on how the health cost is being gobbled up by illegal people who are not supposed to be here?

>> that is a very hard question. about 30 years ago my activity in washington was focused on helping to put together the first of the large expenditure surveys called the national medical expenditures survey. it is now an ongoing survey that the department of health and human services collects. i have been curious about some of the numbers i had been seeing reported as to how many of the people either currently who are uninsured are people who are illegal immigrants and how many people who would remain uninsured are likely to be illegal immigrants. i have had some e-mails with some people i worked with who continue doing a survey research because my question had been how would we ever know that? the answer is it is almost

impossible to know then. the way we make estimates is to use annual current population survey, which is done by the census and every 10 years we have the full census. in the populations, they're blown up to the known number is 80 estimates based on 50,000 household population surveys are used to try to get estimates who does not have insurance. it is difficult to get estimates about the numbers of people who are here illegally. when you think about it, it is so much more difficult to imagine getting information

about the insurance status of people who don't want to have any discussions with people who are from the census. i think that there are parts of the country along the borders who face stress because when people are in acute illness, hospitals may not turn them away. it is one of the serious charges that a certain law that requires hospitals with medicare services to not turn anyone away if they are in an emergency situation. they will come get you if you are charged with pushing people away for what ever reason, including that they did not have coverage. it is not that there is not care in the communities along the

borders or where there may be unusual congregations, but there is very little that is known accurately about the impact of illegal immigrants. there has been some work that has been done looking at the impact of immigrants who are illegal, and i had thought that the use of services was more or less offset by the tax contributions and the employment these individuals were providing, but i don't recall the steady very well. -- i don't recall the study very well. illegal immigrants are having on cost or insurance estimates with a large grain of salt, because we do not have good

information. >> i stress gails'point on the senses. the numbers are out next week so you are likely to see some attention to this next week because of the numbers. the census does not ask people whether or not you are a u.s. citizen. studies we have done had looked at the border states specifically on this issue of. what the census clearly shows is in the border states the percentage of the uninsured of hispanic origin is exceedingly high, but it does not tell you legal or illegal status. that is one of the primary drivers for texas have been the highest percentage of uninsured and the state. to gail's his point, there is no

way to make the division because my understanding from hospitals is when they do provide this service they do not ascii there. -- they do not ask either. >> let me raise a broader point on this. it goes back to the discussion on healthcare reform. i agree with both, nobody knows the answer to that question. if they say that they do, i don't know where they're getting it from because we don't have the data. we do know that there are roughly 46 million people without health insurance. that is a mix of legal residence and illegal residents. if you look at total spending in the population, they encourage spending of about $60 billion a year. a lot of that spending is not explicitly pay for, which means two things.

we are spending a lot of money on the uninsured. we are not spending it wisely or doing preventive care. we could do a much better job. but if you look at how we pay for this, we are spending $20 billion a year in federal spending today to provide assistance to hospitals and other institutions to provide health care services for the uninsured. we already have $20 billion a year we are spending. what is not fully paid for gets bumped into the cost of private health insurance. we are paying for it one way or another. we either pay it from our health insurance premiums, federal funding. one hospital in atlanta, the local taxpayers pay for it. a chip in about $110 million a

year to offset these costs. i like the point because it brings us back full circle to what we are trying to do. there is a lot of money spent on the uninsured the not too late in terms of when they get their health care. -- money spent on the uninsured, too late in terms of when they get their health care. >> the uninsured use about half the health care of the insured population even when you adjust for health status. while it is true that the uninsured receive some health care now, usually fragmented, when they receive coverage they will use a lot more care and hopefully care that will allow them to lead healthier lives.

maybe over the long term to receive that care in better environments. >> let's go here and then i have been ignoring this side of the room. >> i am a finance writer. on the question of -- i think he said there was $100 billion in savings for better care coordination. he said there was money to be had by reduced hospital in missions. in the current political environment these are perceived as medicare cuts and we don't want the government on our medicare. what do you think will be in the final bill in terms of administrative changes that will improve the efficiency of the system? how can that be pitched so people don't perceive these as medicare tcuts?

you have to take 25 year time horizons. why do we have the entire economics profession raid against the idea that prevention will pay? >> i want to take on the second one first. the prevention one is a curious discussion, because there are a bunch of things we can do on the prevention side. 99% of the attention to this discussion has been on detecting disease. the primary goal of doing disease detection is not to save money. the primary goal is to intervene earlier to make sure people have healthier lives and hopefully live longer. there are other forms of prevention averting disease in the first place, i talked about this in terms of making sure people who are pre-diabetic

don't become diabetic. we have random trials that show that these work. we now do that in community- based settings that show that they save money. those interventions save money and work. there is another type for people with multiple chronic health care conditions to make sure we can manage their conditions so we don't have complications resulting from them. we have programs that are well- designed, and they save money and improve outcomes. there are three dimensions to it. detecting disease, which is not designed to save money, can work if you target people appropriately to intervene earlier.

on the medicare side, we have some good reforms build and after moving in the right direction, changing how we pay. doing something on the delivery system side. we need to build those out so that they are available nationally so we can make a dent in the growth and spending. if you think about care coordination, that adds to the benefits. that improves their benefit package. you have people working with you at home. you have a nurse working with you in the hospital to do it-a charge planning -- to do discharge planning. if you do it right, they state money. the combination of kaine it changes -- the combination of

payment changes enhances the value of the package. those are the things we should be building on in this discussion. >> the comments and studies you have seen with regard to prevention typically are focused on screening and narrowly- focused activities. whatever the purpose of using additional screening, even if it is a good thing because it provides a strategy for early intervention doesn't mean it will save money. you ought to make the arguments correctly. if you are doing it because it is a way to avoid a human cost and medical costs down the road, it may or may not save money

depending on how well you can target who is at risk. you may choose to do in any way and regard that as money well spent, but you should not make the argument that it saves mone#

demonstrations that are ongoing or included in the legislation. we need to make sure there is an ability scale up and impose them as they show themselves will not give you a lot of credit and they should not because we don't know which ones will work in terms of changing away from a system that rewards more complex to one that attempts to provide incentives for chronic care. we know what we would like to have it look like. we are not sure how to get there. what we do know is the kind of spending we are talking about for expanding coverage is quick and certain. if you don't plan to spend unfunded money, you need to have quick and certain funding. that is the dilemma that is being faced.

most of the quick money is either lacking at reimbursements, which is antithetical to the changes we have talked about that will take it down the rhetoric, or if it is increasing rabbinate and additional taxes. that has their own issues, but that is the dilemma. can you tell a beneficiary on medicare not to worry, they will slow down spending by $5 billion? i don't think you can do that. i think there are a lot of things you could do to slow medicare spending that will cause money up front, the kinds of changes with regard to lowering remissions which would give you savings on spending down the road. if you are using reconciliation,

that is irrelevant window. and how much -- that is the relevant window. if a good change like lowering readmission by having people be able to have interventions for their medication fulfillment and their scheduling with their physician and nurse practitioner, you need to watch out about how much of that cost you up front and how much will you save in the second year? this will require some careful crafting, because if you want sure scoring by sbo, just whack at reimbursement. when government is pressed for money it usually goes after the benefit the population served or it just wax -- it just whacks

reimbursement. unfortunately it is antithetical to the changes we're talking about that would allow us savings in the long term. that is the attention that will have to get solved by congress. >> let me make three quick points because gail and ken have addressed this early. when someone speaks about prevention, my question is what kind of prevention are we talking about? whether you are talking about screening tests for community- based prevention, it gives you a different answer. we know that investments in making the community healthier yield a positive return on investment. studies have shown $5.60 for every dollar invested in five years. the second is what is the outcome you are looking for? if you're looking for saving

money, i would say you are asking the wrong question because what we're trying to do with prevention is prevent disability and allow people to have more productive lives, which will produce more benefit for the country. the third point is we have to think about prevention is where there were nine -- whether or not we are using the right time frame for understanding what the impact will be. if you look at how long it takes to get the negative impact of obesity, date is 10 or 15 years. yet cbo is scoring things within a 10-year horizon. in order to see the benefit of the investments we make you have to look out beyond what we typically do.

those are the three things that we have to ask ourselves when we are trying to assess whether prevention saves money, which is often the wrong question to ask. >> we have a couple more moments. i know there were some people trying to get a question in. we will go further left. >> i in with -- we have several health newsletters. i hate insurance companies. the thing i am interested in is what would the panelists say is their absolute bottom line on a bill being passed that could truly be called health care reform? >> for me, it has to deal with these two issues. it has to do health reform, so

it has to have things that improve the health of our population focusing on preventing disease, focusing on people who have chronic illness, improving their health to keep them from progressing in ways that are preventable. those are things we can do. we need to invest in them just like we invested in health information technology. we invested $19 billion to put into place in permission technology which we know is a critical infrastructure investment. we need to make the same investment in care coordination nationally. i think the bill also has to have a clear path to move to universal coverage. we need to have a track that we are doing both of these.

i think it is more important to get there in the not hold hostage the better goal of universal coverage to the approach of how we get there. >> i am hopeful that we will revert back to what had started as a discussion on health care reform and has morphed into a discussion on health insurance reform. i am hoping that was because of polling decisions and not because of intent to focus on health insurance reform. it is important, we need to reform the health insurance market, but sustainability and approving -- improving quality is even more important because they affect the 85% of us with coverage as well as the 15% without coverage. a bill that is worthy of the

name healthcare reform needs to have a lot of attention focused on how we are going to begin changing our delivery system so we reward the kind of changes we want to see and we don't move in the opposite direction. it better have a lot of authority given to the hhs secretary so that successful pilots that show that they can help move acute-care-focused health-care into more integrated corrugated chronic disease focused. we need to acknowledge that we don't actually know how to get from here to there, so we will stumble along the way. it is why you probably won't see a lot of credit from the budget office in terms of savings that

could be provided if we do it right. it is because there is so much uncertainty about how to do it right and how long it will take to see savings. >> if i take your question more narrowly which is an assessment of will there be a bill? my response will be yes, i think there will be. largely because of what i mentioned on the front end which is most all of the interest groups involved in this business, labor, insurance, farma are still sticking to we have a plan where we need health reform. driven by the factor that has been most readily stressed at this table, which is dealing with cost, dealing with quality, in dealing with chronic disease.

driven by a recognition of necessity to a highly-performing well work force, that they have health coverage, they have health treatment. employers are absolutely committed to the knowledge that in the absence of reform of any type, they have to continue to provide it. the cost curve is unsustainable, so they are in this conundrum. whether it is bipartisan or a single party bill, but i think all of that is going to come together and you will not see what you saw that killed it last time. that is a whole lot of those interests relatively early in the process moving to plan b, which is kill it.

back then there was nowhere near a consensus across surveys, back then there was not the absolute belief that it was unsustainable. today there is a belief that kids just repeated -- there is a belief that is just repeated a. there is lots of disagreement on the details, but even if it ends up having to be the interest groups just with the democratic party, i think you will see something that is relatively comprehensive because of this absolute recognized the necessity that you cannot accept the provision and sponsorship of health-insurance even if you want to and at any hope of attracting he and retaining people you need to run your enterprises. -- attracting and retaining

people you need. that is the belief behind the necessity of reform compared to prior points in history. >> let me _ that by saying the belief is backed up -- let me underscore that by saying this is backed up by important studies. whether you look at five years or 10 years, there is likely to be more people uninsured by 30% to 40%. the costs for employers for premiums will go up. cost of individual's premiums will go up, and that doesn't address the issues we talked about in terms of reforming the delivery system so is more efficient. at this point there is consensus that we need to have change. it is probably going to require

some evolution of policy in order to get it to where we will hit two big, but there is no question that doing nothing as not an option. >> that is the bottom line of the bottom lines. i don't want to hold you beyond our time, we have already done that a little bit. i know there are a lot of you that have questions. i know you will appreciate that, but let me take this chance to thank you for some lively discussions. i think the folks at the foundation for the support and participation -- i thank the folks for the foundation. we will convene on december 12 on the 100th day to see how far we have gotten. thanks for a much. [applause]

c-span[captioning performed by national captioning institute] [captions copyright national cable satellite corp. 2009] 1 >> in a few moments, house democrats on healthcare for seniors and "washington journal" live at 7 eastern with the global recession, the war in afghanistan and the supreme court case on campaign finance.

>> on "washington journal" this morning, economics professor, carmen reinhart, examines financial crisis since world war ii and how the current global recession compares to others since 1945. ne next, foreign relations will take your call about general stanley mcchrystal's decisioning in the war on afghanistan. and talk to adam liptak from the "new york times." "washington journal" is live on c-span everyday at 7:00 a.m. eastern. >> house democratic chairman xavier becerra hosted a talk yesterday. this is less than a half-hour.

>> my name is xavier becerra, i am a member of congress from los angeles, california, also vice chairman of the democratic caucus here in the house of representatives and today we are going to release something that we think will help americans make good choices about healthcare reform and know the truth as opposed to the myths about healthcare reform. today we are releasing a study and a report that talks about quality affordable healthcare for seniors. and what this healthcare reform means for america's senior population under medicare, some 48 million americans. we think it is very important

that we get this right. with me today, we have several individuals who will speak, richard fiesta is with the alliance for retired americans. we have mrs. carla cohen, a member of raising women's voices for the healthcare we need. we also have patricia nemore with the center for medicare advocacy and as a resource pierceon is the director of the national women's health network. we've heard stories, panels, euthanasia, we've heard any number of things, seniors will pay for the healthcare of younger americans. the myths abound, but what we are here to tell america and america's seniors is healthcare reform will be good for their health. first, for seniors who are right now receiving prescription drug coverage under medicare, prescription drug coverage under

medicare part d, guess what? that ugly donut hole that you encounter about halfway through the year where all of a sudden your support and help paying for prescription drugs goes away this, legislation finally begins to close that loophole. secondly, for those who are saying, i'm going to need medicare for quite sometime and i keep hearing stories it's going under f. we pass this legislation today hr-3200, we will extend the life of medicare by five years, simply by going after the abuse and overuse of our medical care system under medicare. this legislation will also extend preventative care benefits at no cost, zero cost to seniors, something critically important to make sure our costs goes down because we give services to seniors early, not later in life. we also do something important for doctors and hospitals. doctors have been saying, i

don't know if i will be able to treat that senior who receives medicare services from me because we'll receive a cut in our reimbursement. this legislation would prevent those cuts. in some cases up to 21% on physicians from taking place, which means american seniors will be able to continue to go to the doctor or hospital they choose. finally, i think it is important to remember that we need to reduce the overall spending in medicare. you have a system of healthcare generally which spends 2-1/2 trillion dollars and hundred of millions comes out of the medicare system. we need to do something to remove the waste, the fraud and the abuse. this legislation enacts reform that will require more accountability on the part of all providers and we believe that is good for america's seniors because that means more of what they pay for will go into services that they need. this document we hope will help dispel many of the myths. this is not socialized medicine.

there is nothing that will stand between you and your doctor. this document spells that out. we believe it it is important for people to know that. i like to have rich come forward and be our first presenter and give some information about this reform we are undertakeing and more importantly help seniors understand really what they stand to gain if we reform this healthcare system for them and for all americans. rich. >> it will make it easier for seniors to see a doctor of their choice, it will make it cheaper to have a prescription drug filled when they need it and it it also will begin to provide a

system for long-term care and long-term care insurance in our country, as well. as we know recently there have been many media accounts about how many seniors have been skeptical about death panels, euthanasia and the like there. a lot of this stirred up by the folks who are already winning in our healthcare system, the insurance industry and oftentimes allie necessary congress because they are the winners right now in a system that is broken. what is in some states mere monopoly strangle-hold on the healthcare system. it is time to put the public interest in charge and not the special interests. it is important that seniors and all americans know what is at stake in this healthcare reform bill. retirees need to know how we have an opportunity to close the donut hole in part d, to lower drug costs and help early retirees get affordable healthcare coverage. seniors need to know how we can

control out of cost premiums and drug prices and even high quality public option will help bring prices down nationwide. in addition, seniors support healthcare reform because they see their children and their grandchildren struggling everyday, as well, in access, coverage and cost, too. they would worry about what would happen if a job loss also creates health insurance loss at times. so on behalf of our organization, alliance for retired americans, hr-3200 helps seniors, helps them get preve preventative care and bring premiums down and also helps bring most importantly prescription drug costs down. they are the group that use and need prescription drugs more than any other group in the country. thank you. >> carla cohen to talk from real-world insurance. >> hi, i'm a senior in case you can't tell. i own politics and post

bookstore in washington, d.c. we have about 60 employees, most of them full time. we insure them, but we also assure them if there are costs that they cannot pay that co-payments, that we will help them if there's a need to. we, as a woman, my responsibility extends to not only my employees, but my family. i still am very lucky and have a mother living. i have aunts and uncles living. i have many friends who are most of of them who are collecting medicare, some of whom are single and need support. some of us also worry as the previous speaker said about our

own children, whether they'll have -- whether their healthcare will follow them in their jobs and we worry about some catastrophic illness happening to them and maxing out in their payments and being tossed out of the system. the -- we need to be assured in this country that we will be able to -- everybody will have a chance to pay for his or her healthcare. it's something that preys upon a lot of people and it's just a very important -- it's an important asset going forth as a country to be assured that our country is providing what people actually need. it's not -- to hear people say,

if i get -- i might have my benefits cut in order to give other people benefits. that's not america. america is a country where it's not a "i win, you lose." it is a country where we want everyone to have some basic equality in their ability to meet their family needs and healthcare is one of the most important family needs. thank you. >> patricia, with center for medicare advocacy. >> i became a new medicare beneficiary this summer, so i'm -- my employers own client in one sense. i'm also the mother of a 27-year-old who has no health insurance. i have a great deal of personal interest in this legislation, but i've been asked to speak about the medicare aspects and i

will do that. the center for medicare advocacy is a national non-profit, non-partisan organization that works to advance fair access to comprehensive medicare coverage and excellent healthcare for older people and people with disabilities. we represent thousands of beneficiaries each year. we also do policy analysis of proposed changes to medicare. we believe that the house bill is a very important and strongly beneficial piece of legislation for medicare beneficiaries. the bill does not cut benefits for individual beneficiaries. it does not reduce healthcare or services covered by medicare for anyone. what is covered now under medicare will continue to be covered under the reform legislation. the cuts to medicare that have been subject of a lot of

confusion mostly have to do with the subsidy of private insurance which on average are 14% above the same cost in the traditional medicare program. these payments have resulted in higher part b premiums for all medicare beneficiaries. secretary sebelius just released a report that says $90 per beneficiary per year in extra cost just for the subsidies. they also cost taxpayers money since part b is partially funded from general revenues. they have professional soundness of the medicare program. besides that, they are fundamentally unfair and burden the entire program and all beneficiaries, but provide benefit to only some beneficiaries. the change in payments that are part of the bill will slow the increase in part b premiums, will help extend the life of of medicare trust fund and will help eliminate waste in the

medicare program. reducing overpayments to the private plans freeze up money for program improvements to all medicare beneficiaries. one such improvement as has been aleeded toex eliminate scheduled payments and cuts to doctors. that will protect medicare beneficiary abilities to see their own doctor and not have doctors leaving the program. the bill actually provides bonuses for certain kinds of services, one of which is care coordination, which will promote and assist people with complex medical needs, which have of course many medicare beneficiaries have. my organization has been a long proponent of having a care coordination benefit in the medicare program and we're very pleased with this particular provision in the bill. other improvements in the bill some have been eluded to.

there will be no require toment pay for preventative services, any out of pocket cost for preventative services. congressman becerra have helped improve the bill to substantially improve coverage for low-income beneficiaries, helping them pay their bills, as well as helping us identify who the people are entitled to the extra help. as i mentioned, there is a new care coordination benefit that is important and we've heard several references to closing the part d donut hole there is a provision in this bill that is near and dear to my heart that creates an office in the medicare agency, cms, that will help coordinate care for the poorest, sickest and most vulnerable beneficiarys and have coverage from medicaid and coordinating care between the two programs has proved a very difficult thing.

as i stated, the goal for the center for medicare advocacy is to protect and promote access to comprehensive benefits for older people and people with disabilities. we are very pleased with the house legislation and support it enthusiastically. >> thank you, trish, cindy pierson is available for a resource, as well. we will take question necessary just a moment. what this reform will mean for medicare and for all of our seniors is available by contacting any member of congress. you can go to the websites for the house and get information on this, but we are more than willing to make this available. if i could say quickly in spanish because we have journalists and media from spanish language stations... [speaking in spanish]

[speaking in spanish] >> thanks very much and we'll take any questions you might have. >> question: why is it it that seniors seem to be most susceptible to the distortions you have been talking about than other portions of the population. and is it too late? do they already believe these things? >> guest: everybody has heard the "keep government out of healthcare, don't touch my

medicare." that has been commonly stated for years now and we've heard more of it. we know that people like medicare. older people like medicare and their families like medicare because it helps the whole family by providing coverage for the older people in the family. and i think it's a matter of helping people understand that providing coverage for other people will not reduce the coverage you have and no, i don't think it it is too late. >> guest: very similar, we this august have been doing with our membership a number of member meetings and making presentations to other senior groups. what we're finding, when you explain what is in the bill, simple things like you no longer have a co-pay for a lot of preventative services, dotnut will over time become closed and the medicare trust fund gets

better. we find people are much more willing to not believe what may be on television or see there are good positive changes. i think a lot of it is education product to actually help seniors understand that healthcare reform for them as individuals makes it better, not worse. >> yes, polling is an issue and i think today in this guide is a very important step on winning that battle. [un [question inaudible] -- >> i think when the president next week addresses a joint session of the congress, we'll have a good idea of the direction this country can go in

on healthcare reform. when the president gives us a good outline and a clear path on where to go, i think all members of congress, senators and house members alike, will try to work within that framework. so i think every one of us has our goals, every one of us has our bottom line. at the end of of the day, what the president would like tous do becomes influential comment. we have to get something done and the president is the most powerful voice in getting us somewhere. he will ask us to move in an ambitious way to deal with the broken healthcare system. putting our broken healthcare system on steroid system not good reform. i believe we will have an opportunity to be ambitious, bold and provide change for america to make sure everyone, whether insured or not, will have access and choices to quality healthcare. the president, i think, will give us a good direction to go with. >> no proposal is in the

conversation? >> the president always said nothing is off the table. everything is on the table for conversation. whenever you are trying to do large meaningful reform, everything has to stay on the table. that's why some of us are concerned some would take things off the table before americans have a chance to make choices. why would you take something off the table that would otherwise be a choice for that american to select? if senior or american decides not to go with a particular insurance plan, that is his or her choice, but for congress, some bureaucrat or should insurance company bureaucrat to limit healthcare is the wrong way to go. >> significance of having the speech the obama administration has tried to avoid pages in the playbook that president clinton had done 16 years ago in his speech and what that means under state healthcare bill.

i was here 16 years ago when we tried to do healthcare reform under president clinton. there is a big difference. the speech president obama delivers comes under a different circumstance than the speech that president clinton delivered. president obama said from the very beginning, i'm going to give you general outlines of what i would like to see, but i'm going to let you put the meat on the bone. this next week when the president comes and speaks to the american people, quite honestly, not just to the congress, what i believe he's going to say is this is my selection of meat and i think it is very important that we listen because we had a chance over these last eight months to try to shape a good bill for america. now i believe the president is going to weigh in and tell us this is how we get this across the finish line and that is so important and different from 16 years ago and why i think this

year, 2009 will not be like 1993. yes? >> could you support the idea of a trigger for the public option after being home and hearing people's concerns about it and do you think it it could be some great compromise where you get more moderate democratos board, but you are not eliminating the idea of a public option? >> guest: i still have a difficult time as a vote, one of those crucial votes. 306 americans and 535 of us get to vote. i have a difficult time from the beginning limiting america's choices on what they can do with healthcare and how they can get it, whom they can get it from. i think it is better to give americans as many choices as possible. when the president said at the beginning of the debate, if you like what you have, you should get to keep it. he made it clear, we will start from the choice of what you

think is best. if there is something that could be better, then good for you, you get to select it. but for policymakers, politicians to be telling americans, we'll limit your choice before you get to see it, i can't accept that. i have a difficult time believing that is good reform. when people talk about triggers, unless they apply across the board, why would we limit america's choice for some options, but not others tochlt me that sounds more like a play out of the playbook of those who are very happy with this current bloated broken system versus those who want to see real reform. i'm open. i'll listen to anything. everything is on the table, but before i decide to cast a vote to limit an american's vote on healthcare, i better be given a very good reason. >> what is your analysis of how the democrats and president obama lost control over this debate in the last five weeks? >> i wouldn't say there was loss of control.

what happened was americans started speaking. some spoke, not to be heard, some spoke to drown out, some spoke to distort and some spoke to delay, but americans spoke. i heard from a lot of voices, most of them were very constructive in their comments, most of them were very interested in what we were planning to do to reform the system. now i think the members of congress come back. we are better armed with the information we need from our constituents what we can do. i think with the president's help, we will move forward with the reform of our broken healthcare system so it is more efficient. it offers people more choices and guess what, we'll finally break that cycle of being the only industrialized country that can't figure out how to provide millions of americans healthcare while we spend as twice as much as any other industrialized country.

we gallon in a good direction and it is important to hear america's voices. one last question. >> democratic members of the caucus are undecided and voters are undecided. could you talk about what the leadership is doing to secure those votes and how do you reach out to them and ensure them that they will not pay a price later for supporting this bill? >> we have held almost weekly telephone conference calls and had great participation on the calls. we provided information through hotlines, through internet sites so member consist get the latest information and they can also share information. quite honestly, this month has been a month where democrats, while we've not been together in washington, d.c., we've been together talking about healthcare reform because of the ability through the internet and through new technology to stay in touch. when members come back, we'll be

sharing stories and i think we'll be ready to go forward and with the president's remarks next week, early next week, i think it is a great roadmap to move us forward and i believe most democrats are prepared to take that leap. as i keep saying to my colleagues, you are packing my parachute, i'm packing yours. americans need to know we are doing it it the right way. we had august to tell people how to pack the parchute. now it it is time to get ready and take the jump. thanks all very much.

>> as debate over healthcare continues, c-span's healthcare hub is a key resource g. online, follow the latest tweets, video ads and links. watch the latest events, including town hall meetings and share your thoughts on the issue with your own citizen video, including video from any town halls you have gone to and there is more. at c-span.org/healthcare. >> in a half-hour, economic professor carmen reinhart examines financial crisis and recovery since world war ii and how current global recession compares to others since 1945. at 8:30 eastern, max boot of the counsel on foesh relations will take calls about general stanley mcchrystal's report on the war in afghanistan. we'll discuss upcoming supre