about $1.10 trillion over 10 years. . .

hopefully we can kind of steady that a little bit more in the months ahead because i think the biggest enemy to this bill or a bill passing is people not understanding what it is. the last people understand, the greater the opportunities to demonize it. honestly, we bear a large responsibility for conveying to people as clear and concise a way as we can what this is all

about. >> we appreciate you coming in to explain it all to us. you can reach -- you can watch this as well as other c-span programming focusing on the health care discussing -- health-care discussion by visiting our web site. we have set up a health care hub where you can -- is that c- span.org/healthcare. >> coming up next on c-span, a look at the u.s. economy and how it has recovered from recessions since world war ii. after that, highlights of house committee debates on health care legislation that took place earlier this summer until later this afternoon, a briefing on the h1n1 swine flu virus. all this week on c-span2.

at 8:00 p.m. eastern, it is book tv. tonight, author bill ayers joins us to talk about his latest book. he joins us at the chicago tribune. also in the anti-war movement at the vietnam war. see bill ayers tonight at 8:00 eastern on c-span2. >> we will continue our review of the health-care debate in congress tonight with highlights from senate committee hearings and analysis by shailagh mary. also, t. r. reid sunday on q&a bajad. >> watch the latest events, including town hall meetings, and share your thoughts on the issue with your own citizens video, including video from any town halls you have gone too. and there is more.

at c-span.org/healthcare. now a look at financial crises and recoveries since world war ii, from today cost's "washingtn journal." guest host: for the series of studies living economic downturns a historical perspective. thank you for being with us this morning. guest: thank you. host: in reading some of the papers that you have produced a new look back at global economic slowdown as far back as 1800. what got you started on this path? guest: we started first looking several years ago at the imf that debt crises. crises are not your everyday occurrence, so to get a real

flavor of what a crises hot -- what a crisis looks like, you have to have enough of them and live through enough of them. since we do not live through enough of them, we have to look further back into the past? i that has been particularly useful for looking at current crisis because this is the first global crisis that we have had since world war ii. host: how often on average two major economic crises occur? guest: major as in global? well, it has been since the 1930's. some countries have had crises every 10 years. but as a general rule they are quite rare events. host: are the roots similar? guest: the rates are generally to be found in great

availability of credit, so that borrowing, households can borrow a lot, business can borrow a lot. when there is a lot of credit to be had, you typically have bubbles, be it in the stock market, the real-estate market, or both. but ample credit bubbles are usually side-by-side very good economic growth and the title of the book is this time it is different because we humans are what we are, and we think that each time the old rules do not apply and prices will continue to go up. that dominance psychology has been there for time immemorial. host: so the title will lead some to believe this is different, but in fact it is not. guest: it is meant to be ironic, yes.

host: part of the conversation on the table is how to unwind the major stimulus packages that various governments put into play. how dangerous is this time right now when people are beginning to see signs of economic recovery and they are looking for ways to back out of what they have put in place? guest: it is a very dangerous time, and by that specifically i mean that some of the mistakes that we should be learning from during policy management in the great depression are calling victory 27. -- calling victory too soon. still unwinding should be a of very -- should be a gradual process rather than a stop/go. that is one of the lessons that in my view we should be taking from the great depression, which we provided -- wheat, the united states -- provided great fiscal stimulus. but it was done in a very haphazard way with stop/ago.

that should be, i think, a lesson that should be in the policy makers' mind going forward. host: we invite your participation in our discussion with carol lynn reinhardt -- with carolyn reinhardt from the university of maryland our line for republicans, 202-737-0001. our line for democrats, 202-737- 0002. and for independents 202-628- 0205 where are we in the process right now by comparison to other global meltdowns? guest: one is the contraction part and then there is the recovery part. we are touching bottom. how quickly their recovery is, if you look at the average post

war, how long does it take to get back to where you were before the crisis? on average, two years. so it means that from around where we are, by historic benchmarks, it is another two years before we get back to the income levels we had before the crisis. host: since this crisis had added 3 to a housing bubble, it is interesting to learn that some of these -- since this crisis had added to it a housing bubble, it is interesting to learn that some of the past crises -- what is the national -- what has history taught us about the recovery of the housing market? guest: housing prices in the united states peaked at the end of 2005, so they have been declining for a while. so we are well into the housing cycle. and i am not expecting a 60%

drop. each crisis has its own features, but the correction that we have seen in the state's, over 30% correction depending on what index you look at, you get a slightly -- it is certainly not a typical at all -- not atypical of all. one of the messages from the study is that recovering from financial crises takes time. it is a protracted process. it will be a while before we see a return to a normal housing sector host: the banking industry has been of course connected to every one of the crises that you have strutted. i recall language that you suggest that -- that you have steadied. i recall language that the countries think they have solved

the problem with that. i want to share a headline leading into the g-20 conversation. "europe's leaders called for binding rules to rein in bankers' bonuses." "a joint call issued for binding rules for reining in bankers bonuses." "the three leaders cannot in a different awards. the move comes at a time when anti-bankers sentiment is running high and designed to put pressure on the u.s. and other big nations to -- guest: none of this is surprising after a friend at a crisis on the order of this magnitude of the tendency is to reregulate. so i would not be surprised if this turns out to be a -- more broadly, what concerns me as a

true solution to avoid future crises is for the supervisory and regulatory framework to be very nimble on its feet so that we do not regulate the last crisis rather than the next one, which has been a problem in most cases. host: picking up on that, could a lay person take the lesson a way that no matter what the regulators will do, the finance and banking industry will find a way around it? because there have been subsequent crisis -- crises, even though the regulators have come in and tried to fix the problems. guest: i think it is safe to say that -- that human nature can and does find ways of, creative ways of circumventing regulation through innovation, for instance. the subprime itself was a financial innovation. one of the things that the

potential for future profits, which rewards are so great. that does not mean we should turn a blind eye and say we can i do it, therefore we should not try. i think it does mean -- it does highlight that, and i am repeating myself, but we have to be nimble and take stock of new instruments as they rise in new markets, and new markets as they rise. host: the core of your message seems to be that the fiscal crisis that could occur with the mounting government debts, not just here in the united states but also with other major economies -- this will be my last question, and we will go to calls. this morning, pete domenici has a piece in local the washington times, the chairman of the

senior republican u.s. budget committee on any in history. he writes of " tim geithner -- has peeked behind the curtain. mr. geithner acknowledged he knows what is coming when he said the administration would do whatever necessary to get the deficit under control. their appearance is revealed that they know what is going on, they just do not know what can be done politically about it." he goes on to worry about what could happen. deficits could rise, not decline, total federal indebtedness could continue to surpass any previous estimates if we do not get control of this, and the united states was nearing a level of indebtedness that could undermine the of the nation's economy and its security. america will be spending more on education, the environment, infrastructure and less

scientific research, and all the other things our founding fathers thought were important to the nation. our debt is on an unsustainable path." guest: we have been writing about the issue of debt is quickly accumulated after a crisis. that is irrespective of we have a fiscal stimulus in place so not because the largest source of the debt accumulation and the deficits are coming from the fact that our revenues suffered deeply through the recession that follows a financial crisis. having said that, part of it is inevitable and associated with the crisis. i think we are well poised to be looking forward and see what we can do both on the expenditure and revenue size. to ensure that debt remains sustainable. having said that, i think my earlier note of caution that we

cannot be too quick to jump the gun in calling it an early victory and focusing on the debt situation imminently should be at the forefront of our policy decisions. host: a person has been studying general of the history of the economic crises globally and regionally and we would like to hear your comments and questions by phone, email and beit twitter. let's go to jane on the republican line. e one time a month call so i want to quickly mention on healthcare in russia, what they ended up doing is put protesters into insane asylums because they didn't agree with the government under socialism. but anyway, getting back to the problem. we started with the community

reinvestment act and then under president clinton, clinton rewrote fannie mae and freddie mac rules and so then the people in the bank his to loan money to people who had no money. so we have the same people for example lots of money was given to the democrats in fannie mae and freddy and we have the same people running our country now and it seems to me nothing will change. there are still trillions of dollars owed out there because the democrats repackaged all the loans and sold them abroad as bonds. so i just don't know how this is going to be cleared up that quickly and and i just fear for my country because i see our people protesting and the government nopt wanting them to say anything. please let me know where you see us going with this kind of an

administration, with democrats in control and thank you. >> guest: i think the issue of managing the debt, which over -- if we look forward, what should be the cause of concern for u.s. policymakers, democrat or republican, how do you manage the debt? that is critical and that basically means you have to look at rather unpleasant alternatives down the road, meaning tax increases, meaning not having the kind of expenditure programs one would like to see and cannot afford at this going forward. i think the issue of civil libertys that we have seen clamp downs, you are right, in many countries after financial crisis and civil libertys is hopefully

one that we will not see here. i think the concrete major problem that either party faces is dealing with a soaring u.s. government debt that shows the u.s. in financial markets is an undermined by a huge debt burden. >> host: we have linked a couple of the economic papers to our website at cspanwashington journal. tell people how they can get to your book, eight centuries of financial folly. >> guest: well, our book is due to be available on all bookstores within the next two weeks. >> host: it is available. next telephone call for carmen reinhart is john in hamppton, virginia. what is your question or comment? >> caller: from georgia. >> host: thank you.

>> caller: ms. reinhart, when you say we haven't experienced recession, i mean, who are you talking about hasn't? what specific grum aoup are you talking about? i'm 66 years old and i've seen recession all my life. have you ever heard of dr dr. claude anderson? >> host: why do you ask, caller? >> caller: well, he explains what has happened as far as different groups of people in america and how they have been living since this country has been here and there's a group of people here that has been in recession forever and i mean i think that's a statement that, you know, we haven't experienced. there's a group of people that has experienced it and i'm not talking about no racial thing.

i mean there is people here that have been in recession since they have been in this world because i have seen it with my own eyes. >> host: thanks, caller. >> guest: sir, let me be clear, i said we haven't experienced a recession of this magnitude, of this magnitude in the first world war ii period. we've had plenty of recession, your typical recession in the united states since world war ii has lasted the rest of the year. we're here in our two-year mark. that was the nature of my remark, not to imply that we had had no recession or different groups are more particularly damaged or hit by the upturns and downturns in the business conditions. >> host: have you taken a

position on the proposal to extend the powers of of the fed? >> guest: no, i have not. i have not. >> host: why not? >> guest: i really -- i really have had my hands full trying to think about other regulatory issues and i have at this stage seen that the fed hasn't been particularly curtailed in what it can and has been able to do during this crisis to start thinking about revamping its scope of activities. the fed has been -- has acted in an unprecedented manner in terms of aggressiveness in dealing with the crisis and its had a lot of variety of of resources,

new facilities. so expanding certain activities, that is not something i've been thinking a great deal about. north kor >> host: nancy in new hampshire wants to hear about the crash of the '20s. she says it was the housing market collapse, as well. >> guest: well, i would like to reiterate that the theme of the book, "this time is different," dwells very much on the example she has pointed out and indeed you did have stock market booms, you did have housing booms, you did have easy credit and living beyond your means, but that isn't only the roaring '20s in the runuph of up to the '29

crash. it actually characterizes most of the major financial crisis, not just in the united states, but in europe and in emerging markets, as well. >> host: birmingham, alabama, glen on the democrats line. good morning. thanks for the call. >> caller: i was calling to say, first of all, it is refreshing to see someone that is not bias on this situation on c-span this morning. because we are sick and tired of republicans and democrats, i'm a democrat, playing politics with this issue. ms. reinhart, i would like to ask you, first of all, when did this recession start and also, we have the fair and equal housing act and i'm so sick of republicans and some people saying, they don't have money, they lend it it to people that

didn't have enough credit. we have equal housing act in this country and some people asked americans that had good credit watch the housing because of certain issues. i would also like to ask you another question. please explain to the american public that are being very ignorant what socialism is because president obama is not socialist. he's for america and we need to start respecting that. i am sick and tired of all this, this ignorance and this hate going around in america. i was born in alabama. this is hurting to african americans to see this type going on in 2009. please, america, let's get beyond this and explain to me, ms. reinhart when did this recession start? are we seeing a little something showing light to us and explain to america what socialism is. thank you and you all be

blessed. >> your very important question, when did this recession start? well, without circumventing your question at all, the seeds of the crisis are during the feast years and we had feast years in the 2000s. we were borrowing from abroad from the rest of the world a great deal. and this fueled the boom in the housing market and the fuel in the housing market in different degrees hit every region in this country. so when did the recession start its origins were during the feast years. do we see -- the second part of your question, do we see light at the end of the tunnel? this goes back to my earlier remarks that it it is consistent with everything that i understand from past historical crisis and what we are seeing

the indicators that we are seeing in this one is that the economy is approaching a bottom. this is consistent with the economy going from a peak to a bottom in roughly almost two years, which is what the mark where we're at. however, i don't like the idea of providing a false basis for optimism and to reiterate my earlier remarks even though we are touching bottom, i think full recovery is still a ways off meaning we're looking at a couple years. >> host: this comes from twitter, wall street numbers keep going up, where is the money coming from, banks said we were broke five months ago.

>> guest: one question is are stock markets getting ahead of themselves? it certainly has happened before. as regards fundamental question you are asking, are the banks broke? well, the banks and more broadly the financial industry has received massive assistance in terms also of the stance of monetary policy. we have almost zero interest rates. there are interest rates and so conditions are very favorable for banks to be able to recover. have they recovered? are they broke? have they recovered fully? no. the answer is no. there are still a lot of problems in the banking industry. there's a lot of deadweight loans being carried around. so i wouldn't go as far as they're broke, but they're certainly not fixed yet and

hence my sense that the recovery process is not going to be very sharp and and from "washington times, " stability depends on more capital." he has a five. program and what the definition of a stronger is paducah you agree with him? guest: i would really have -- of a stronger is. do you agree with him? guest: i would have to see more productio. it cut capital requirements should be --

that was a tough one. banks should be subject to a liquidity standards designed to improve liquidity standards, and the buildup of liquidity risk in the financial system as a whole. finally, we need to improve the rules used to measure risks embedded in bank portfolios." guest: 8 is hard to disagree with any of that. the real proof of any of these things is in the implementation. on paper, our rules look a lot better, so it is hard to disagree with that. but the real challenge is in turning those into practice. host: next voice is walter, from indiana, republican line. caller: to your guest, i have a few comments. i believe the keynesian approach to spending our way out of the recession has failed every time. i believe, just like you said in your book, that this is quite different.

i think when you have trillions and trillions of dollars in debt, when you turn around and spend money you do not have, and america always used to be able to bail itself out because we had a tremendous infrastructure of making things, making clothes, making automobiles, making widgets. we were the kings of making widgets. we could rely on the basis of american productivity to rebound and get us out of trouble. this i do not see it happening. we are getting ourselves away into debt. the politicians and democrats in charge are doing things that are against getting us out of a recession by capt. and trade, by owning the banks, the automobile industry, and they are going to get into health care, where we are going to become a bankrupt country. what i try to teach my daughter now and my family is we stay tight, we do not spend much, and

instead of taking the money and investing in wall street, which will -- wall street is basing all of this on -- you know, you listen to them, well, we are not as bad as we work, but we are still losing jobs. we are not as bad as we were, but we are still losing pots at -- profits. when this hits, i believe we are going to go into a terrible spiral, a great recession, the ones that we have not seen since the 1920's, because our country is tilted the wrong way. we do not make the widgets' anymore. trade is ruining us. the question i want to ask the caller is do you believe we are going to hit a double dip? if so, what is america going to look like in 30 years? have a great day. guest: i hope that you are wrong about a double dip and a prolonged -- the last time we

had such an experience was the 1930's, and it took us 10 years, not four years, to recover the income that we have lost between -- from the crash in 1929 onwards. 10 years for full recovery. i hope that is not the situation here. let me say that the road to recovery is not going even if we don't have a double dip, the road to recovery is not likely to be a very swift one and that is i mentioned earlier because banks are still not -- banks are still in the red. i think as regards the debt, you are right to point out there are concerns. we have been very concerned highlighting the issue of debt

for a while. let me say, however, that some of that debt pileup is not a direct consequence of policy loan. we are facing the worst recession post-war, which means our revenues are down. we have to be realistic as to what kinds of deficit numbers, what kind of debt numbers we can expect in the face of a substantial decline in revenues. let me highlight that, everyone is very in which tune to the fact housing prices in the united states have come down in largest historical decline. this means lower property tax. so the hit on taxes has been hit from every angle and that is just a reality that we have to face when we look forward to what we can expect on fiscal policy and on debt. >> host: you probably saw yesterday vice president biden

made a major address on what the economy and the state of the effect of of the stimulus. here is historical reference the vice president made yesterday. >> we are at the nine mile marker of this marathon. the recovery act is not the course that is carrying the whole slate, but it is pulling its weight. where we are today is a much better place than we could have possibly been without it. even more exciting is where i think we are headed. the road ahead is going to remain very bumpy. there is going to be positive economic news and negative economic news, but i believe it is going to be the three steps forward, the one step back of that is the way recoveries work, particularly in the last four

decades. but we know, we are absolutely confident we are on the right road to recovery. ry. gl comments on how he sets the sta stage. i think it is very wise to hedge, first of all. i think that pointing to too rosy a picture would be a danger. it would also be fairly unrealistic. so, i do agree with the tone that there will be good news and there will be bad news. let us hope that the bad news doesn't outweigh the good news. host: we are talking with carmen reinhart ph.d. has been involved in multi-year multi-level study of history of global declines and we are learning what her work has produced and trying to

understand more about our situation. next is dan on the independent line from alexandria, virginia. caller: let me voice my pleasure with spc-span having someone wh seems to have the faculty and seems objective. i happen to believe a paradigm shift is necessary as in the 1901, right wing financiers shifted, the media coverage of the issue and the people who support certain things that might not be to their benefit, most revolutions in the past come from the bottom up. but i think we are in a special time and place now where we are at a level of being dumbed down as problems that are incredible. so i think what is needed is true journalism to combat this,

stop giving credit to people who have been discredited and from that point we can begin to learn from the issues and make proper policy decisions feel as it stands the politicians in place are merely just going to tread water and not upset big business interests, meanwhile having people believe their best interests are in mind and it just about maintaining a status level. but i like what you said about false hope because there have been no structural changes that will bring true progress. we will see these slight upticks then a drop, a slight george w. bush tick then a drop. i want to know, do you think -- what do you think of the economic policies of ronald reagan which then were just

repetitive in the h.w. administration and clinton and george w. bush and obama. they are pretty much all the same caliber. do you disagree with that? guest: well, you are covering a lot of ground and during all of those years, all of those administrations, we had -- we are covering a lot of ground, but i think what is very important is that you say here is that we have to be on our toes to be forward-looking in terms of the paradigm as you phrased it that we adopt. to go back to the earlier question on the g-20 is a very dangerous point in that not just in the u.s. but abroad we can

call too early a victory and what i want to reiterate and leave with all of you behind is that this is a global crisis and none of the policy makers in place -- none of them in the united states or abroad -- have dealt with a global crisis because we haven't had one since the 1930's. so, we do face a lot of challenges and i think -- let me leave it at that. host: next question is from thomas republican line from michigan. caller: good morning. mrs. reinhart, i think the basic problem that we face here is that we live in a fiat currency environment and we have established no limitations on congress's ability to either

incur additional debt or take down additional guarantees. federal reserve is doing the same thing. the debt to equity has gone from 26 to 1 to 50 to 1. the basic problem is that the politicians discovered that they could spend and borrow without any political penalties. they used to spend and tax. they learned they could spend and borrow without any political penalty and without any kind of limitation whatsoever. my own feeling is that we need to establish a value base for our fiat currency and debt. i think it ought to be the gross revenues of the federal government. but first of all we need to establish limitations on what amounts congress can borrow and amounts they can guarantee. until we do that, they will never stop.

they must pay a political penalty for the excesses or they will never stop. it is too easy. do you address this issue of establishing limits on congress in borrowing and the fed, borrowing and guaranteeing, which are absolutely astro knowledge confidential at this point? -- astro knowledge confidential at this point? guest: i think you are right on the mark that the level of guarantees has skyrocketed to use a mild term in the very recent past. i think, however, one thing i would like to address directly in your thought about setting limitations, what is critical is limitations have to be credible. you can set limitations on paper, but when circumstances ari arise those limitations are rethought or removed, re-april corresponded, whatever you -- reanchored, then setting the limitation won't solve the major

problem. in effect, a lot of the -- i make that point because a lot of the debts that governments assume -- and this is not just this government, around the world when you have a financial crisis guarantees go up right, left and center -- there is a real, always the real moral hazard problem. astro n ast you say i'm not guaranteeing this but when the bad occurrence arises you guarantee it. it do not do anything to curb borrowing. so the limits have to be credible, they have to have teeth. which i don't view it as likely. fwl next is from philadelphia, muhammad, independent line. caller: good morning, mrs. reinhart. thanks for everything you are

doing today. i have a comment actually and a question. my comment is this. why are we so worried when we are going through a recession and every month we have employment news and other news and everybody loses their mind like it is something new? and these are things we don't know what is going in the recession, the markets will be going through expireles up and -- spirals but every month the market does something crazy and news that just came out of -- and we are not expecting it. my question is, one way to avoid mother recession is how -- another recession is how the government regulates the banks or different financial sectors. and just like you said, they are

going to try to prevent the past crisis. what do you think they should do defendly to regular -- differently to regulate the financial institutions going forward? guest: that is a very tough questi question, because one of the key problems with regulation is markets always getting ahead of the regulators. and i have to say that it is not only the regular ration on paper that -- not only the regulation on paper but the ability of regulators to stay abreast of market developments. and i have to say that i'm not terror ibly optimistic that evef we revamp regulation that, yes, it will work for 10 years, 15

years, maybe 20 years. i am not confident that maybe 40 years down the road-i hate to sound so negative about this, but this is a truthful answer to your question. regulation could actually prevent all together something like this from happening again. host: manchester, new hampshire. steve, democrats line. caller: a pleasure to speak with you. in the 1980's i own a business, and with the s&l crisis, we were stuck in that. it caused us a lot of problems. when the regulated, a lot of banks took over, all over state lines, involving themselves in the risk businesses. i thought well, that is a good idea because we were stuck in the regional thing productio.

when i look at what they did now, it seems like the further you that the situation spread out, the for the crisis spreads and it makes it much more difficult. what i really wanted to discuss was, three callers ago, i believe it was michael from san francisco, how he gets through so often, i do not know. but michael savage has four hours a night to spread his misconceptions of what the world is going to do. i would like to say i wish you would screen these guys. it takes me years to get

through. michael salvage has his own hoe. gl do you have a question to close? caller: no, thank you. host: this is a question from a viewer by twitter. guest: well, i think looking at the problem in the eye and continuing to do so, not taking a very optimistic but a realistic view, i think, there are more problems in the banking industry than we are willing to adm admit. i think not forgetting that the problems originated in the financial industry an keeping our focus on the financial indust industry. stimulus paneckages anding else deal with symptoms but dealing with the cause and looking critically still at what

policies are doing for the ba s banks, with the banks, should remain our number one priority. we do not want to replicate japan in the 1990's in which it took 10 years to deal with the banks because the banks were sick and the economy never really recovered it full growth potential. that is a very important lesson. host: in two weeks you can go to bock stores and buy carmen reinhart's book called "this >> earlier today, the labor department announced a rise in the upon the rate for august, from 9.4% to 9.7% as employers eliminated 216,000 jobs. vice-president biden commented on the latest figures earlier today as he spoke via satellite to employees of a manufacturer

of solar panels in fremont, california. >> let me begin first by talking for a moment, if you do not mind, about the unemployment figures that came out today. when we took office in january, there were 741,000 jobs lost in january, 681,000 in february, 652,000 in march of this year. we knew we had to act, and within 200 days we passed -- 200 days ago we passed the recovery, the american recovery and reinvestment act, which we will talk a little bit about today. the recovery act is working, and you will see it work right on that site. we are making progress with substantially less job loss than we sell a few months ago. the numbers reported today show

216,000 people lost their jobs last month. much too high, but roughly 2/3 of the job loss we saw on a monthly basis from when we took office and the lowest it has been in a year. i want to be clear about something. less that it is not good. that is not how president obama and i measure success. we are not going to be satisfied any more than the governor is or anyone else until we start adding, not losing, thousands of jobs per month. one of the tools to get us to that point is the recovery act. experts from moody's to goldman and others have pointed out that we have created or saved 500,000 to 100 million jobs in the last several days. -- 500,000 to 1 million jobs in the last several days of doh.

>> still to come to a house committee on health care debate that took place earlier this summer. later, pentagon briefing on u.s. strategy in afghanistan. after that, more about afghanistan with remarks from british prime minister gordon brown on security in that country. >> as congress comes back and gets ready to debate health care once again, we thought we would take this opportunity to look at some of the issues around a chart-3200, the house version of the health care reform bill kentucky joining us to help put some context into this bill, and we will show you the debate that happened earlier this summer martin vaughn, when you looked

hr 3200, how radical it is it? >> it is a pretty far reaching proposal, and that is why there is so much controversy, people know that this is not incremental mips and tucks around the edges. this is an ambitious plan to cover -- the goal is to cover all americans, provide universal health insurance, and so that requires some radical changes in terms of the insurance market and the revenues needed to meet that goal. >> what are some of the more significant changes to the health care system as we know it now? >> i think one significant change of course is the one we have heard about in terms of democrats talking about a public plan to compete with private insurers. >> the public option?

>> the public option. the market is dominated by private insurers now. the u.s. is not completely alone, but it is an anomaly internationally among western nations in that sense. so the effort is to create a government-run plan to compete with private insurance, so that is one of the may be more far- reaching aspects of this. >> when you look at the entirety of the commerce committee house, i should say, 435 members, how are the mainstream, progressive, and blue dog democrats reacting? >> a lot of nervousness, not just among republicans but in the democratic caucus itself, both in the house and senate and the more moderate democrats are nervous about the plan. they are hearing from their constituents back home, as we have seen. not all of them are on board

with the idea of a public auction. the white house is attuned to that -- with a public auctic op. the white house is attuned to that. they are certainly attuned to the voter nervousness about that idea, so it is nervousness particularly for democrats. >> what about progressive democrats? >> it is an issue where you push the bill in one direction, and one group screams, and then you push it back in the other direction and another group screams. the process with any kind of legislation is often like that, and the extent to what we will see over the next several weeks, democratic leaders in the senate and the house as they move to the center, we are going to hear

a lot of yelling and screaming. i do not mean to be derogatory by saying that, but we will hear a lot of different points from the liberal factions who are now seeing their dream of universal health care, in their view, watered down. >> what about the republicans? have they offered any options? >> they have with the republicans have offered their own versions of health reform. not as ambitious or with the same types of goals that the democrats have of completely remaking the system, but they have offered plans. one thing that is really missing from the democratic plan that would certainly be an essential element of the republican plan is the whole issue of medical malpractice reform. it is sort of know where in the debate right now, and republicans are keen to point

that out. >> we have touched quite a bit in the initial conversation on the public' option part of the plant. we want to show you some wins and means committee options. >> the amendment is very simple and strikes the public's plan. it says no public-run plan. my question of mr. van hollen and his shorts -- and i wish they were still here -- and -- let me explain why the public plan is the case where they are the player and the referee in the same game. it is virtually impossible for a public plan to compete fairly on a level playing field with the private insurance markets. four big advantages the public plan has been to number one, it does not have to pay taxes. the privates do.

number two, they do not have to have large capital reserves. the privates do. number 3, the public plan does that have to account for its payroll and benefit costs -- does not have to account for its payroll and benefit costs. the public plan gets to dictate the prices it will pay for services, and so clearly the private plans do not until there is a debate about actuarial firms, what they say, what cbo says. let me tell you about what a couple of actuarial firms who are repeated, often cited by both sides of the aisle, who do it for a living. when group tells us in three years 122 million people will get pushed off their private health insurance. two out of every three americans will lose what they have and get pushed on the public plan because of all of these factors come because of the cost shifting that occurs. cbo does not think cost shifting is that big of a deal. they do not think it occurs.

if we are underpaying hospitals and doctors, where will they make up the difference? studies show that a combined family of four will have higher premiums of $3,620 right now because of medicare and medicaid underpayment. so we are going to exacerbate that underpayment. let me read a quick line from an editorial today in "investor's business daily." i think it gets it right. the public option will not be an option for many but rather a mandate for buying government care. a free people should be outraged at this advance of soft tierney. pretty harsh words. these are words -- of soft tyranny. pretty harsh words. why don't we say let's make private health insurance work? why don't we work together to make it affordable for everybody.

why don't we pass legislation to address the problems we have. people that do not have health insurance, people with pre- existing conditions that can i get it, and the fact that costs are rising so much. we could do that together if our agenda was not to have a government takeover of health care. which the public plan, no matter what actuarial model you look at, it goes in that direction. in this debate direction is destiny. the direction of this bill is to have the public plan crowd out the private sector. i am looking forward to a vibrant debate on this point, but i urge my colleagues to think twice about this moment. think twice about the moment where you are going to vote for this bill and think about what your constituents are going to say to you in three or four years when they have lost the health insurance that they have. 80% of americans like what they have got already. let's address those americans who do not like what they have got, and not take those things

away from those who like what they have. i yield. >> mr. chairman, i would oppose the amendment. i would like to correct four of the points that my friend from wisconsin brought up and admittedly, the public plan would be tax-free, but there will be many private plans that are not-for-profit companies, so they will not be the only tax- free. . that are not for profit, so they would not be the only tax-free. as far as capital reserves, they would be built into the premiums charged by the public plan, and will establish whatever reserves are required by the various insurance commissioners. s to payroll and benefits, they will be fully paid for by the premiums paid into the public plan, and there will not be any government subsidize station to the plan. there will be perhaps to some participants, but they could get

the same the subsidization for the same the subsidization for going into private s to dictating prices, in so far as i am aware -- as to dictating prices, plans to have limited panels dictate or negotiate prices. the public plan will be no difference, except that it will create a new choice. many areas of our country dominated by one or two private insurers today. it will operate on a level playing field. it will be subject to all the market reforms and consumer protections as the private plans. it will be self sustaining, and there is one other thing that has been a driver for innovative delivery reforms.

providers or counsel for productivity, payment in since for efficient areas, improved position quality of reporting. i could go down the list. eliminate cost sharing for preventive services. these are the results of a creative, flexible, quit moving plan which -- quick moving plan which should give the public plan the emphasis that will be followed by the private plans to make good changes for the delivery of medical services. so i would urge my colleagues to vote against the amendment and allow a plan to create the kind of competition that does not now exist in the private market, so that all americans will have the right to participate in a plan

of their choice, but that there will be a choice there that will drive innovation, creativity, perform, and cost savings. >> mr. chairman, i strongly support the amendment offered by my good friend mr. ryan. this amendment goes to the heart of what we believe is one of the most serious problems with the bill before us, the so- called public option, which is really a new government-run plan that will threaten the health coverage of more than 100 million americans and put our country on the path to a government single payer system. i recognize that this is a controversial statement. many supporters of government run plans insist they are not really trying to have a government takeover the entire

system, but you do not have to take my word for it. jacob hacker it is a political scientist who is credited with developing the idea for the government run option. here is what he said about it in a speech last year. "someone once said to me, this is a trojan horse for single payer, and i said, well, it is not a trojan horse, right? is just right there. i am telling you, we are going to get there over time." common sense should tell us the same thing. the majority says that the government run plan will compete with private insurance companies. how do you compete with the federal government, when the government is also setting the rules for the competition? there will never be a level playing field. there are any number of ways for the government plan to get an

unfair advantage. the bill before us says providers will not be mandated to participate, yet the government can make it very unpleasant for those who opt out. the bill says consumers will not be forced to enroll in the government plan, yet the commissioner of the exchange can also enroll them. that is without even talking about all of that hidden subsidies that come into play whenever the government is involved in private business. make no mistake about it. this government run plan will be the camel's nose under the tent for a complete government takeover of our healthcare system. it will mean government sets prices for physicians and hospitals well and government bureaucrats take the place of doctors in deciding what medical

treatments patients will receive. it will mean sacrificing much of the medical innovations in which america is so proud to lead the world. i urge my colleagues to reject this dangerous course and passed the bryant amendment. >> mr. levin. he has to be recognized. >> i am going to yield back. we have heard those scare words before. they have been echoed for decades about government, that government is the enemy, that it will take over, and this

proposal simply will not do that. it is not a trojan horse for any thing, except to provide care for all americans, and also to provide innovation. the major reason for a public option is to drive innovation, but to drive in -- to drive a change in the way we deliver systems. you all say you want that, and yet when it comes to actually supporting something that will help bring about, you oppose it. you like to quote cbo when you like what it may say, but you will not quote them when they say something that says you are wrong.

cbo's estimate says there will be about 9 million people in this plan. it will be a small percentage, less than 4% of the insured population at the time. that is what cbo has estimated carefully. so when you bring up this imagery to try to scare people, it simply will not work, and the public is already on to that tactic. if you ask the public did they want this kind of public option, they decisively say yes. there is such an urgent need for health-care reform in this country, and so much of a need for competition with the insurance carriers, i cannot believe anybody seriously says

that the public option dick takes all the private insurance companies do not. that is simply not true, and as providers -- ask providers if insurance companies do not dictate what they were received. if they are polite, they will not laugh. you cannot scare us away from taking steps that will truly began to change this system and provide affordable health care for all americans. i urged defeat of this amendment. >> let's be clear with the legislation is trying to accomplish. we are trying to accomplish a true national purchasing pool of exchange with a menu of health plan options for people to choose from. whether we like it or not, a

large number of people in this country would like the choice of a public option in this exchange. we have been trying to do our best under this legislation and make sure that if there is a public option that moves forward, that it competes on a level playing field. it has to be self sustaining. whoever would be running the public option cannot be the one in charge of running the national exchange. an area where my friend from wisconsin may have legitimate concern is whether it makes sense to pay the reimbursement under the public option with current medicare rates. this is especially tough in areas where there has been -- why would we like in a system? there's more work that has to be done in regard to the adequacy

of pegging reimbursement to current medicare rates. before this is ready for prime time, it is an issue that will have to be addressed. as far as competition is concerned, let's not fool ourselves. one of the reasons people want a public option is because there has been tremendous consolidation with the delivery of health insurance in this country. into many areas, there is not true competition right now. people would likeçó that choice, but some may not want to choose a public need a plan in the exchange that is run by private insurance companies who have different motivations, different business plans, profit motives that drive a lot of the decisions. ultimately, this is all about consumer choice. there is that recognition in the country today that there are a lot of people who would like the choice of a public option at the end of the day, instead of having to be forced to choose a private plan as their only

option in this exchange. >> i cannot believe mr. kind, that you can see charge that the organizations involved, that there can be anybody that can make it work. reform is needed in our healthcare system. some do not have access to quality, affordable health care. to many small businesses are deciding between hiring workers are paying health benefits. we need to find real solutions to these problems that hit every household and every business on main street across the country. however, i am convinced a government takeover of health care is not the solution our country wants, needs, or deserts. i have posted numerous health care listening sessions to hear what the constituents think. no matter what health care

problems that are facing, or what health care crisis they are struggling with, i heard over and over again that they do not believe more government is the answer. the problem our current health care system has is that we do not spend enough money -- we do not spend it wisely. we do not need more government interference. look at that chart. that thing is a mess. there must be nine people who tell us what kind of health care you are going to have, so what is a public plan? nobody knows. i cannot think of one instance in recent memory where the federal government getting involved in a problem make things better. once bureaucrats get involved in a situation, everything always gets worse. mr. chairman, i would like to ask unanimous consent and -- to insert in the record the chart you are looking at that shows how much government bureaucracy

is designed to make this thing work. >> mr. johnson, i want this in the record, too, but where did this chart come from? >> it comes from the joint economic committee. @@@@i e e there is a whole lot of yellow in here. this is a very, very attractive chart. >> thank you. i appreciate your support. >> mr. pomeroy is recognized. >> let me just say i support my companion's amendment here. >> you made that clear. >> thank you. [laughter] >> you made that clear. >> mr. kind covered what i wanted to discuss, essentially. i want to oppose this amendment,

even though i have very serious problems with the public plan as contained in the bill. the reason i do is because it does not paid fairly. pays on medicare rates, and there are portions of the country that are underpaid by medicare presently. you do not move forward constructive plea by building on a flawed foundation -- constructively. that needs to be changed. i am completely confident that this bill is not going to be the bill that ultimately goes to the president at the end of the enactment process. it is inconceivable to think that we would ultimately pass health reform rely on medicare rates for the public plan option. that is not to say that the public plan option does not have a role if this constructed to compete fairly and effectively. to suggest that the american

people are locked into the existing health and st. -- existing structure that we have would be completely at odds with the constituents i represent. they think insurance shortchanges them at every turn, and more of a competitive presence would be a good thing. whatever ends up in the final legislation needs to play fairly, and it cannot be based on insufficient medicare rates. this leaves us with the same old health-care insurance coverage we now know so well, and that is why i say we should defeat it. >> mr. davis from kentucky is recognized. >> mr. ryan amendment to strike the government run plan from the underlying bill -- a government- run plan is simply unworkable.

it does not get to the root problem of affordability or costs. it is called america's affordable health choices act. i do not know who came up with the name, but well over one trillion dollars is not considered affordable in kentucky. tens of millions of people -- he in my district, if you cannot find a provider who will see, it is worthless. the reason this bill must -- does nothing to address the core issue that some of us have been talking about for years. i not fixing the process at the core, we are going to increase costs, limit reimbursements, and reduce them. you cannot end up with anything but a rationed care system. reform and reengineered medicare and medicare services which are not in this bill.

second, true reform of the private insurance system to allow competitiveness and increase access for small business and individuals, and the thing that has not been addressed here is meaningful, medical liability reform which is necessary to free our provider so they can function and do their job. one doctor in my district said who is going to sue me now? is the government going to sue me? without all three of the things i mentioned, we fail in our shared goal. this is not about politics and partisanship. it is about human lives. we are talking about spending well over a trillion dollars to get the bill and the public plan started, and we do not know what we are going to get in the long term. we do not have the details or the facts in front of us today because the process is being hurried along by artificially imposed timetables by people who have never worked in a

professional health care world in their lives. this legislation will have generational impact. we have to take the time to consider the bill. we need to slow it down and get these practitioners from the field in here. i want to close with a quotation from an e-mail i received. we absolutely cannot reform health care in this country if we do not get a better grasp of what drives the health care costs. i am so frustrated because too many of the decision makers have little real knowledge of what needs to be addressed. is not as simple as cutting payments to hospitals or doctors. who will peel away the layers that find so much of the cost of operating a hospital? things like hidden energy costs, malpractice costs, that create defensive medicine, and on and on. i fear for the medicare patient,

as more and more doctors speak of closing their practice. other than more, in my lifetime, i do not believe there has been such an important task at hand. it is imperative that the voices of many are heard. a government-run plan will not live up to the promises made by its proponents. it will reverse -- reduce quality at a gargantuan cost. i urgyou back. -- i yield back. >> i share your enthusiasm for putting the chart in the official record. the chart was not from the joint economic committee. it is the joint economic committee republican staff. i think this is a modest glim

pse of what some of the elements are to try and rationalize a system that, if we locked this committee in this room with some of the smartest bill drafters and experts of our choosing, in a week we could not come up with a chart that would reflect the byzantine non system that faces american consumers today, a hodgepodge of costs, confusion, gaps, and inequality. what we have done here is make an initial, critical, first step to try and provide choices to people who do not have meaningful choice. i do not think this bill is done, by any stretch of the imagination. i think it is an important step moving forward, but to pretend

that somehow throwing a lot of boxes and colors on a piece of paper is somehow significant and confusing and determinative of whether or not we should have a public option, particularly for the one half of american states that have no meaningful insurance competition, where one company has speedy% or more of the market, is laughable -- has 50% or more of the market. i am pleased that the staff walked through the elements, and i hope that everybody does go ahead and correlate in pieces that are in there, because it gives you a sense of what is going to have to happen to achieve much of what there is a consensus amongst people on the committee on both sides of the aisle. i think the bill we have before us is a start in that direction, but it would be unfortunately handicapped if we were to adopt

this amendment. i strongly urge its rejection. >> i support the ryan amendment to strike the government from the plan. i am intrigued by all the conversations we have heard about choices and options for the american people. the american people do not make these choices, their employer does. that me tell you what some of the employers are going to do. this government run plan was priced at 8% of your payroll. if you are not providing coverage for employees, you pay 8% of your payroll. the typical small business pays 11% to 14% per payroll. between two companies, they employ about 500,000 people. i ask the ceo's what percentage of the payroll went to health care costs. they both said between 15% and 16%. i said if you could pay the

government 8% and they would pick up, we do in your program and turn it over to the government program? they said in a heartbeat. this is designed to drive business owners, employers come into making economic decisions for their shareholders that wind up with employees in the government run plan. it will succeed. thank you, mr. chairman. >> why would the government possibly have a conspiracy to remove the obligation of employers to insure their employees? why would they want to do this in a heartbeat? >> is the same question i keep asking, and i do not have an answer for, but the assumption is this. most of the people writing these bills want a single payer plan. this is the way to get it. >> ok, ok. the chair is ready to take a

vote. mr. davis is recognized. >> let me be brief. let me also say that i oppose this amendment strongly. as a matter of fact, the most important part of the legislation we arkin considering -- i want to protect all of the -- we are considering. i want to bring in those individuals who are currently out. i do not think we can have the balance we need unless we do have a public option, so i am opposed to the ryan amendment. i yield back the balance of my time. >> i support the ryan amendment, for reasons i outlined in my question. i think the government option is

poorly conceived and is a recipe for financial disaster. with that, i will yield the remainder of my time to mr. ryan. >> let me make it clear that mr. ryan can take your time and his time. >> and try and address some of the things that have been said here. i wish my friend from wisconsin were still here. he is concerned with concentration of health insurance options in america. does anybody believe that after this bill passes and becomes law, we will have more options, in addition to the public plan? we are federalizing the regulation of health insurance. let me make my case. [laughter] we are adding new costly mandates, making health

insurance more expensive. do you think the 1300 insurers out there will be able to compete in this environment? employers will be looking at a situation where the insurance they have will become more and more expensive. one study says that right now with medicare and medicaid cost shifting, is $88.8 billion a year. another study says that if this passes, the cost shifting will increase private insurance for a family plan by an average of $3,628. employers will be faced with a situation where a more people go on the public plan. the public plan under pays providers, and they make it up by overcharging private payers. cbo does not think there is much cost shifting. everybody else to talk to does. just think about it. ask any doctor or hospital in

your district, and they will tell you cost shifting occurs. employers will see their insurance going up and up at unpredictable rates. they make a choice. i can keep paying this high-cost insurance that the government tells me what i have to buy, or i can just pay and 8% payroll tax and down my employees in the same kind of help richards i have to buy them anyway. -- health insurance i have to buy them anyway. what employer is not going to dump their employee on the public plan as soon as the price of the insurance exceeds 8% of payroll, where it already does? the problem is this, mr. chairman -- it is impossible for the private sector to be able to compete fairly with of the government with all of its muscle and all of its tools.

at the end of that process, we will see a situation where people will have lost their choices. employers will not be offering insurance to their employees. they will say, "i am paying the payroll tax and you are going into the public plan." you know what the payroll tax rate will be? 23%. 23% of our wages going into payroll taxes to pay for the public plan. this is not a good idea. if you come from places like where i come from, where medicare under pays hospitals and doctors substantially, who is going to want to continue to offer these services? i would just urge my colleagues, get rid of the public plan and let's work on fixing the private health insurance market so that it works better and let's not take away all of these insurance products that people currently enjoy.

i yield. >> as we close this argument, i have the deepest amount of respect for you, and it is abundantly clear what you are against, and you are one of the few people that have a plan on the other side but i do hope that before we conclude this markup, you might be able to share with us who you persuaded on your side that you have a better way. who you persuaded on your side that you have a better way. i do not care what legislation we have. it is so easy to take a shot saying this does not work, this has to happen in 2023. at my age, i am concerned that what is going to happen at the end of this week. it seems to me that somewhere between now and the conclusion of this legislation, the chair is open to any positive thoughts that collectively might come together so that we might talk

about it. it is a long way between here and the president's desk. i would like to get a vote on this, so all in favor of the bryant amendment indicate by saying aye. all opposed say no. clearly the noes have it. the clerk will call the roll. >> that was the ways and means committee debate. it was a portion of it. at the end of that, the chairman says he is open to alternatives to the public option. what are the alternatives that may be under serious consideration? >> there is one alternative that has gotten a lot of discussion in the senate. that is to have non-profit co- ops that would be an

alternative to private insurance, but would not involve a federally run plan. it is an idea that has gained a lot of currency among rural centers, in particular senator conrad of north dakota and senator grassley of iowa. it is not an idea that has followed support in the house, however. it is not really tested. there are not a lot of examples of a co-op that would work in this sort of context, and the proponents point to rural electric co-ops and that type of thing. the biggest objection is that we do not know how it would work. there are questions of whether it would attract enough people to really function as we wanted to. >> are there any other alternatives that chairman

rangel might be open to? >> aside from the co-op plan, that is the main alternative that has been discussed. >> another one of the concerns that has been raised during the debate has been the doctor- patient relationship and how that would change. in your reading of hr-3200, what do you see it would be the major changes? >> this is an issue that is very controversial. to hear republicans describe the bill and to hear democrats describe the bill, you think you are talking about two completely different bills. much of the controversy stems from new bureaucracies that the bill is creating to investigate things like how do we innovate in madison, and how we bring more quality to treatment so that we ensure we are getting the best bang for the buck, so to speak, in terms of the

treatments that are delivered. when you start talking about that, that is when republicans make the argument or get concerned that are these bureaucracies setting standards are putting forth mandates that will dictate to the doctor what kind of treatments they can prescribe and what they cannot? that is what they mean when they talk about interfering with the doctor-patient relationship. there are a number of provisions in the bill. there are new centers that are called for to study these things. for the democratic perspective, they are looking to control costs. that is what these new organizations are for, to investigate how we can deliver treatment for less cost. when your in the minority, you have the luxury to point out

things that are wrong and they could interfere with the doctor- patient relationship. a legitimately raise a question about that. >> is this where the death panels phrase comes into play? >> right, that is the catch phrase we have heard in the national media, based on a provision in the house bill on end of life counseling and what points folks in hospice care might get counseling about planning for that stage in their life. sarah palin used the term. some of the republicans that have used it sort of later backed off and said we are not claiming that some bureaucrat is actually going to dictate whether a child or an elderly person lives or dies. that one got caught up in a little bit of hyperbole. i think it really showed the

sensitivity in the electorate, the nature of how strongly people feel about being able to choose their doctor, and trusting their doctors' advice. in that sense, it is good that people are talking about that. it is certainly a legitimate concern. >> another phrase is comparative effectiveness research. what is that? >> comparative effectiveness deals with looking at different treatments and treatment outcomes, and whether one treatment consistently has a better outcome than a different treatment. to the extent that you can -- it is an area that most would agree needs more research. that is one of the things the house bill is doing, providing funding and new avenues for that kind of research to happen so

that that information will be available to doctors and to the insurance companies to say that treatment is really not effective. the idea is that you could get cost savings that way. >> the energy and commerce committee headed debate about federal employees and whether or not they should be in the middle of a doctor-patient relationship. here is part of that debate. this is about an hour in 20 minutes. >> the clerk will report the without objection, that amendment will be considered as read. >> this amendment would prevent any federal employee or political appointee to dictate

how a medical provider practices medicine as a result of the development of best practices by that center for quality improvement. mr. chairman, doctors and their patiencts are really sacrosanct, and the doctor-patient relationship is extremely important. the center for quality improvement is similar to the nice organization in the u.k. system, the national institute for health and clinical excellence that makes decisions under their system that basically denies certain coverage. i would reference particularly in cancer therapy, chemotherapy, wherein the results that the

five-year survivability of prostate cancer and breast cancer is significantly less than it is in the united states under our current system. mr. chairman, that is simply because this so-called oversight group makes decisions based on costs, and not necessarily clinical effectiveness. i have no objection to the center for quality improvement to do research, hopefully scientific research, to come up with what appears to be best practices for each and every disease. but they have to take into consideration the fact that patients very, and who knows that better than the doctor that maybe has been treating the patient for 25 years, who specializes in a particular

disease, whether it is diabetes cancer, and knows that this patient is on medications that might conflict with a certain treatment that happens to be found to be the best practice by the center for quality improvement, or the least costly, but yet the doctor knows this patient should not take that drug, and that there is a better drug for him or her? when we heard last week on monday, the director of the congressional budget office talked about the fact that in looking at this bill and the bill that was passed by the health committee in the senate, there is a bending of the growth

curve in regard to the cost of health care, but is bending in the wrong direction. my fear, and the purpose of this amendment, is that when we signed up 97% of the people in this country for health insurance, universal coverage, we are not going to be able to meet those obligations. it will be like noah's ark, and you put too many people on the ark, and it may take a couple of years, but it begins to sink. so you decide you have to get rid of some of that baggage, and you began to throw people overboard. who gets thrown overboard first? it is the sickest, those suffering from illness. i think it is very important

that we do not let that happen. doctors are smart enough to understand that the center for quality improvement says what works best -- they are going to take that into consideration, but they cannot be forced, or should not be forced to practice under the dictates of some federal employees for political appointee who really has no medical background. they may be good it business -- good at business, or maybe even a former governor, but they do not practice medicine. mr. chairman, i would hope that everybody would agree with me that this amendment needs to protect these patients so that doctors can continue to practice medicine as they see best, taking into consideration the

recommendations of best practices, but not be dictated in regard to how the country. >> the gentleman yield back his time. >> thank you, mr. chairman. i would like to speak against this amendment, and here is why -- this amendment says that this would not allow any "federal employee or political appointee" at the center for quality improvement to dictate how medical providers practice medicine. this is very, very broad language. consider a checklist for health care associated infections as written up by atul gawande in "to the new yorker," and innovation that both sides of the aisle hailed as a major

advance in care. certain types of health care associated infections can be nearly eliminated, saving tens of thousands of lives and millions of dollars if implemented nationwide. if the center were to try to assist in the implementation of the checklist, this could easily be construed as "dictating the practice of medicine." the checklist is exactly the prototype for what we want the center for quality improvement to develop. this language could prevent at the center for quality improvement from carrying out its essential task to develop new and innovative best practices to improve the quality of health care in the united states. scientific advances, if done properly, should change the practice of medicine. we would never pass a law that said to the national institutes of health that if they develop a new lifesaving therapy, doctors should not use it, or could not use it. that is exactly what this

amendment says. i urge my colleagues to vote against this. >> with a gentle lady yield? >> yes, i would yield. >> just to add to the broad as of this amendment -- broadness of this amendment, i would agree that we don't want to deal with how doctors practice specific medicine with the patient. -- we do not want to deal with how doctors practice specific madison with their patients, but this is so broad, -- how doctors practice medicine with their patients. this could go to the overuse of tests are too many of the provisions we are trying to get at with this bill to improve the quality of medical practice, while at the same time making it more cost-effective. while it looks appealing on the face, i think this is going to undermine whole legislation. i urge a no vote, and i yield

back. >> i rise in support of the amendment. it is simple. nothing in this section shall be construed to allow any federal it bought -- appointee to dictate how a medical provider practices medicine. it does not say bills for medicine, researchers, it says practices medicine. if the majority is right the congress women really do not want to prescribe help doctors practice medicine, we ought to accept it. all he is attempting to do is make sure that these new components in the legislation do not end up actually giving bureaucrats the power to tell

doctors how to practice medicine. if that is not the intent of the authors of the legislation, this ought to be accepted by unanimous consent. we are going to make this point over and over and over and over and over again in this markup. most of us on the minority side believe in the marketplace. we believe in transparency. we believe in choice. we believe in letting diversity -- we are not opposed, if you want to put out a check list for best practices. the next amendment we are going to offer is one by me on transparency. you want to put out results of surgery's, and if you want to put transparency into pricing, we are all for that. if you want to compile best practices and innovative research and make that available, you want to do

internet technology, we are all for that. what we are not for, and you create so many new bureaucracies, so many new positions of potential authority and mandate in washington, where people that are not trained doctors have the ability to dictate to the medical community how to practice medicine. it is not technical language. simply, we do not want the bureaucracy created under this provision, or the presidential appointees of either party, if this bill becomes law, having any hint of the ability to compel our medical professionals how to practice medicine.

>> what he is saying is exactly my intent. the argument about not following best practices as determined by the center for quality improvement, or whatever the committee is called an whatever country, i am not opposed. i think doctors should pay attention. they should fall best practices. if it is a five step process of protocol, or 812 step protocol, i think that most physicians would follow that suggested protocol. let's say a situation where a neurologist has found that in the last three cases where he has suspected that a patient may have a malignant brain tumor, that he ordered a cat scan, and the report was negative, there

was no evidence of a brain tumor, but his clinical acumen, his gut feeling, if you will, told him that there was something wrong with this patient. so he felt like a more expensive test, an mri, should be done, and these cancers were detected and these patients had an opportunity at a very early stage to get the appropriate chemotherapy. not just to improve their five- year survivability, but hopefully to cure them. i think a doctor in that situation would be willing, if the center for quality improvement wanted to slap him are on the wrist and say we are not going to reimburse you as much, they would gladly be an acceptance of that lesser payment if they had the continued right to make those

decisions which they knew were best for their patiencts. . . >> whatever innovations and practices this suggests or development, i'm not linked to a reimbursement mandated on physicians. the concern that i have this with the amendment and this language, you kind of a throw water on innovation. in other words, you suggest that somehow they should not develop these practices because they may somehow hinder a physician from practicing medicine, and that is not the case. there is nothing that they would develop that would be mandatory or say that a doctor would not get reimbursed if they didn't do it. the language is not necessary. the only thing the language

would do is that is going to hinder the development of these practices, because there is going to be some fear that somehow we are in differing with the practice of medicine. the practice of medicine. there is nothing in here that the mandate -- that is a mandate. i know there suggestion of that on the other side. >> i do not think any of us in opposing the amendment are suggesting that we think doctors should be told how to practice. i think the concern is, and it is ironic because the name of this construction, we are concerned that this provision could get country in a way that would end of discouraging the kind of best practices and implementation, which you agree ought to happen anyway. i think the language of this and the potential for it to get construed such that you then create barriers to the

encouragement of best practices, which is what we are trying to do. that is the problem. it is not that we want to stand in the way what the physician want to do. we are worried this could end up working against best practices. >> i with trauma point of order. -- i withdraw my point of order. >> and a lot of these -- i want to read this from the july 7 wall street journal. the british officials who is -- established a rigid position as a body that would insure the government-run national health system use best practices in medicine. as the guardian reported in 1998, health ministers are setting up nice designed to insure every treatment operation for medicine years is in the proven best. it will root out underperforming

doctors and useless treatments. that is exactly what i hear my colleague on the other side say. what has it become? nice has become in practice a rationing board. as health care costs have exploded, even in this bill, the cbo has predicted that it will float -- in britain, it has become the heavy debt reduces spending by limiting the treatment that 61 million citizens are allowed to receive three the nhs. march comedy ruled against the use of two drugs that prolonged the lives of those with certain forms of breast and some cancers. after last year's ruling, director noted that there is a limited pot of money that the drugs were a marginal of benefit and quite often an extreme cost

and the money might be spent elsewhere. the board restricted access to the two drugs for regeneration and blindness. if they allowed this drug -- he was going blind into eyes -- they said, we will pay for the drug in one eye, but you can go without the other eye. nice limited the use of alzheimer's drugs. it includes the rejection of a drug for rheumatoid arthritis. it is a subject of protest. they even have a mass formula for doing so based on quality adjusted life year. i am telling you, folks, if we move this direction to socialize medicine and the best intentions of the best practices, we are going to end up with a rash and health care system where people who need care will have to try

to find some other country to go to. guess what? they are not out there. if you want to set up this quality board and you want them to subvert doctors and the doctor/patient riel -- relationship -- as they did in england -- go ahead. we are not want to be any part of it. >> 5 thank the gentleman for yielding. this is really straightforward. it is very fundamental. read the words of the amendment by dr. degree. -- dr. gingrey. says they may not dictate how a medical provider practices medicine. if you oppose that, then you decided that a federal bureaucrat should be able to and can dictate how a medical provider practices medicine. if you are going to do that, then you are going to assume

medical liability for every decision that she meant it. this has nothing to do with suggesting best practices. this has nothing to do with informing doctors of what is the least expensive form of care or effective if a doctor were advised that the best practice was to do what was suggested and did not do it, that would be malpractice. they could seek a remedy for that. this is not a question of it innovation. innovation can from doctors as low as government boards. the question is, do you want to put the doctor between -- put in the federal government between a patient and his or her doctor? i would suggest to you that the practice of medicine is in part science. we can make suggestions to doctors as to what the shooter should not do. -- should or should not do.

if you think we should have federal employees telling doctors how to practice medicine, and then we are abandoning medicine as it is abandoning medicine as it is taught in you are embracing the notion that a bureaucrat is going to tell your doctor how to practice medicine. if that happens, we are giving up all form. pick up a dictionary and look up the word "dictate." it says "mandate, compel." should we give this power to government or leave it in the hands of doctors? >> gentlemen's time has expired. >> having worked on health care both in health insurance issues

in the legislature and on the committee, the amendment is so simple that it almost seems so easy, but it is probably the ultimate gotcha amendment. i have listened to my arguments -- the arguments about the united kingdom have been socialized medicine. this is not a socialized medicine at bill. no matter how much you say it is, it is not. we're taking advantage of its 60% of the folks who get insurance through their employer now and that will be continued. this will not be anything near the single payer like the united kingdom has. he bought a medical malpractice, that if you do not -- you brought up medical malpractice, that if you do not pass this, the federal government could get sued. nothing in this bill dictates medical practice any more so than since 1965, medicare has not told doctors how to practice. i bet you this amendment

probably could have been jermaine in 1965 when medicare was created. -- germane in 1965 when medicare was created. they tell you what you will be reimbursed for. blue cross does that right now with my insurance. blue cross does it with my insurance, it did it when i was a state employee, when i was managing the printing business. . if that is what is happening now. this bill does not allow any federal employee to do that. i would say that if you make an argument against this legislation, maybe you should have made it against medicare, which is probably the second most popular domestic issue in our country only compared to social security. this is not a national healthcare like the united kingdom. it has so many variations of it. i get as close as you could get would be the netherlands to have a national healthcare and backed away from it.

they have employer responsibility and individual responsibility. that is what is in this bill. this is such a simple amendment. it has no bearing on this bill, because it has been the to do the federal employee telling a doctor how to practice medicine. that is why the amendment should be voted down. we really do not have a federal employee provision in here or political appointee that can tell someone or a doctor how to practice medicine. i yield back my time. >> for the debate on the gringey amendment. >> this get to the heart of the debate. i take the gentlemen at his sincerity. if you read this bill, it is a bold face life. it is disingenuous to tell the it is disingenuous to tell the people if you want to your health insurance that you have and they will be able to keep a. there are perverse incentives in this bill. that is if your employer keeps

a. ask your employers if you can pay and a% payroll tax or pay 15% per employee for health care. what decision will you make? they will make -- a study shows 114 million people will be shoved off with their private land and on to the government plan. employers to not want this hassle to begin with. you set up a perverse incentive not to offer health care to their employees. that is dangerous. the one thing -- way the government controls cost in health care is by rationing care. -- and/or reimbursing at dave rate less than cost. welcome to medicare and medicaid. now you have 100 million people shoved into a planet does not reimburse at the right rate and you have a huge problem. we make up that difference by the number of people in private insurance. we are shoving 100 million

people of private insurance. where does the money come from? this notion that you can tell people and say, you will get to keep it if you wanted only if your employee offers it. there is every incentive -- do not take my word for it. talk to your employers. they cannot wait for this to happen. there one to show other people off of their private insurance. -- they are going to shove people off of their private insurance. i would not ask my mother or my daughter to go into a system that i know would not allow them to survive breast cancer at the same rate that we have the ability today. that happens. i will tell you why. let me give you an example. a 19 year old persons the doctor blood in the urine. a healthy 19 year-old playing football. they come to the conclusion that person has been charged and take

a few days off. thank become a doctor said, i have watched this patient for 15 years. something is not right. something does not seem right. i want to do further tests. everyone says, do not do it. it is crazy. frankly, that woman doctor wins and the patient find out they have bladder cancer. the statistics of that for almost impossible. had that dr. not been able to act on her hind and her medical science and history with that patient, the patient would have been dead at age 26. that patient was me. i take this very seriously. when you start talking about getting involved 20 doctor and patient and this bill will do it -- to not kid yourself -- it is the only way you can cut costs. they would have said specifically you cannot have

that bladder cancer. that person should not that is exactly what they doing kennedy. it is what they do in great britain. if you look at the cancer statistics, and that is the general population -- in bladder cancer survivability is pretty close to 99% in the united states with treatment burda and the other two countries, it the combined is 75%. it is fitting for breast cancer in cervical cancer and skin cancer burda an. they made the trade gap. we will expect that some are young women will die of breast cancer. we will accept that. that is the trade-off they made the. if we say we will not even draw the line in the stand, we will not allow a bureaucrat or a

politician to get in the middle between the doctor and patient so they can survive. >> what the gentleman is talking about -- he is talking about the art of medicine. medicine is not an exact science. those practitioners of the art here are really good at physical diagnosis and understands patients and what signs and symptoms mean, with this bill, with this ability for the center of improvement to mandate, you take away that art from the practitioner. even more serious than that is those people in our society with chronic illnesses are going to suffer because when the bureaucrats are in search of revenues, that is when they will deny coverage.

i appreciate the gentleman for yielding. this is a good common sense amendment that lets people and practitioners continue to make the final decision. >> thank you. i would like to direct some questions to the staff about this. there are a couple of interesting words here that concern me. first, nothing in this section shall be construed. let's take the word is section. what does the word section cover? >> it refers to section 931 of the public health service act. >> it covers the whole act? >> no, certification. it is 931 of its. >> what does that do?

>> no center for quality improvement. >> then it says shall allow any federal employee or political appointee -- who would those be? that would be anybody. it to the food and drug inspectors. it could be the secretary of hhs. it could be the director of the social security program. it could be cms. who else could it be? what's mr. dingell, the provision would be broadly construed as any federal employee. that could include the commissioner of food and drugs or the director of the senators for the center of disease control. >> anybody in the federal government dealing then with

federal law would not be able to do anything that would be construed to dictate how a medical provider practices medicine. is that right? y? es, ir. -- is that right? >> yes, sir. >> it could be a doctor commoners? >> yes. >> it could be a doctor on the floor in the hospital who is going to decide when a person will get a particular shot? would this rebate to the handling -- relate to handling of controlled substances? >> to the extent that it is otherwise covered in this section. >> could relate to food and drugs? you are saying you cannot give this particular drug because it is unsafe or it is out cited

the approval that has been given by the food and drug? >> to the extent that is otherwise covered in this section. yes, sir. >> can include a wide array of other people including nursing homes? >> yes, sir. >> hospitals? >> yes. >> could include laboratories? >> yes. >> could include anything in relation to billing practices? >> i am sorry. i do not know. it is about a medical provider practicing medicine. >> could it relate to who is

qualified to it ministry predicted ministry -- -- could relate to is qualified to administer this? could it be the anesthesiologists? could this relate to the making of decision in that matter? >> to the extent that it is otherwise covered by this section. yes, sir. >> what is the position? it virtually says that the administrator, the head of cms, cannot address questions like what kind of activities are permitted to be practiced. whether an individual is going to get a shot at a particular

time or not. whether or not steps are taken with regard to that seen a kid it -- seeing that a patient does not get bedsores because he or she is not routine enough. >> @ -- to the extent it is otherwise provided. >> it might also prevent food and drugs from saying that a particular 1c pharmaceutical cannot be used or has to be recalled? >> to the extent that it is otherwise provided for in this section. yes, sir. >> i think we have a dangerous amendment here. it probably needs some redrafting. i yield back the balance of my time. >> thank you. i do support the gingrey

amendment. over the years, whether i was a state senator in tennessee, be it had to deal with the funding of the funding. we have always looked it these issues. i said, how do we preserve access to affordable health care for tennesseans? i think that is at the crux of what we are deali >> some of us are very concerned that we have built that is going to put the bureaucrat in the exam room between the patient and doctor. of course, we have had some many people go through this -- the different provisions that have been bandied about, not the written legislation, because that made it to us late, but everyone says that the patient is left out of this equation, and certainly, when we hear our colleagues across the aisle talk about how is this on to be paid

for, how is it going to be funded, we are going to raise taxes and the wealthy are going to have to pay, small businesses are going to have to pay, and seniors, medicare, we're going to achieve savings from medicare, and that is going to be used to help offset the increased cost of this national health plan. and those seniors feel rationing, and they are talking about it a lot, and i am very grateful that they are talking to us about their fears. they are afraid of losing access. so our parents of children that have chronic diseases that need ongoing care. the are very concerned about the restrictions and the caps that are going to be placed on care, that are going to deny that those children access to those processes. and i am very grateful that mr. gingrey has brought this

amendment for to say, look, you cannot do that, you cannot let a bureaucrat practice medicine and make those decisions. they cannot interfere with the practice of medicine, and i am very pleased that he has brought this amendment forward. the amendment deals with section 931 of the public health service act, not the whole act. that section that deals with the center for quality improvements, and that is important for us to realize, that you cannot have a bureaucrat making those decisions. i am appreciative of the amendment and of his efforts to make certain that this legislation moves to being something that is patient centered, rather than something that is going to be more power to the government, and with that i yield the balance of my time to mr. gingrey.

>> i think the gentle lady for yielding, and i would like to address that the distinguished chairman ameritrust -- emeritus asked. as she points out, this is a very low -- very narrowly drawn amendment. it is applicable to section 931. let me repeat it. this amendment would prevent any federal employee or appointee to dictate how a medical provider practices medicine as a result of the development of best practices by the center for quality improvement. the bureaucrat could not use of best practices to dictate what a doctor could do. with that, i yield back. >> i yield back my time. >> mr. doyle?

>> thank you. it is always amusing when you hear this argument that we do not want to let bureaucrats make these decisions for patients. like the current system is somehow letting patients making a decision. i love to see a poll of americans and ask them whether they like to see someone in washington with no profit motive make a decision on what it paid for purses a bean counter at an insurance company. that is what we are comparing. they say parents ^ -- our word of the caps. but as counsel -- i want to ask counsel, what does the bill say about caps on coverage? >> i believe that other portions

of the bill, not division "c" do not allow for annual caps. >> does it not been lifetime caps -- the answer is that it banned them. does it not? the very thing that my friends are worried about is taking care of in this bill. heard someone here say that people are going to be forced into this plan. companies can just dump their employees. it'll be probably ellis' eight years before that can happen. it is up to the secretary of hhs to make that decision. once these decisions are made in the health exchange, there is going to be a whole list of private companies as well as one quality public plan. no one is going to be forced into this public plan. if people want -- the make the

decision. once the employer says we are going into the exchange, they make the decision on plan they pick. they can pick anyone of any dozen private plans and same private insurance. no one forces them into the public insurance. but at least get the terms of this debate street. no one is being forced into anything. >> would the gentleman yield? >> i appreciate your yielding. i want to point out that the american medical association sent a letter in support of this legislation. it is hard --the american medical association. they support this legislation, because it is key to an

effective reform. >> i will be glad to yield to my colleague from the virgin islands. >> thank you as a family physician, i am and averse to being dictated to as to how to practice medicine. i have read this section 931 over and over. i see nothing in their that suggests that anyone in the federal government would have any authority to dictate to a provider how to practice medicine. there is certainly nothing in there that would even suggest that there would be any support for any kind of rationing of care. in the implementation, it sounds involuntary arrangement withand some incentivizing of those entities that are entered into the agreement.

i oppose the amendment. i think that a lot of the concerns that are being raised are not even relevant to this particular section. there is nothing in here that would even suggest that someone would get in between the federal employee would get in between the patient and their doctor. >> i wish to yield time to another colleague. you have time. i like to yield. >> we does have an investigation on insurance recision. there are 60 million americans to buy policies and when they get sick the interim -- and the insurance companies has to wonder code which reject the policy because it may cause them to much money.

-- them too much money. they say $300 million by rejecting an depose market review. when you get sick or have blood in your during -- when you get sick or have lead in the your urine, and they rejected. we need to stop the practice of rescinding policies what people get sick. they told us we will continue. we will continue. the only way to solve it is to have national health insurance. we should reject this amendment and move on with this debate on more meaningful things. >> who seeks recognition? the gentlemen. >> thank you. i want to make a point about

the report, independent and non- partisan. its in the [unintelligible] c-span.i was a small business or for 22 years. i understand the cost of health insurance and providing i have evaluated the penalty here on small employers. i cannot run a calculation where it makes financial sense for a small employer to continue to provide health care the way this is crafted. if your payroll is $300,000 a year, your penalty is 2% if i'm reading this right. health-insurance costs are probably 12%. i have been trying to figure out all weekend -- this is a perverse incentive that will encourage those who are providing health insurance today to stop providing it is

because it is multiple times cheaper to pay the penalty than to continue to provide and operate under this government's mandate. i think we may not believe that will happen and that economics does not work in the real world, but i think they do. i think economic principles continue. employers will make tough choices, especially in a down economy. they are faced with a mandate or if they go along, it requires them to provide health insurance to the family and the employee and a 72.5% for the employee. if they are not doing family coverage now, that is a huge additional costs under this bill. it is even more of an incentive. you are destroying the healthcare opportunity that is out there today for people who have it. that is going to go away. everyone is going to be put in the exchange.

i want to yield the gentleman from michigan. >> i wanted to clarify that the health care did pay for it them. it would not have fit the profile under what the government around here has to do a checklist of things that are approved as a best practice for comparative effectiveness. by statistics, it would not have met their threshold. that is the danger. i'm going to read all of the cancers -- and which read them all. double digit, less survivability rate than those countries because they make the choice of not covering certain things. they say they are willing to have people have a higher mortality rate when you get these cancers because they are going to provide government ran care. i'm going to read them. prostate, scan, breast, bladder, cervical, lymphoma, leukemia,

overeat, melanoma, brain, stomach, long, and pancreas. they decided in those countries they are willing to have more people die from these cancers in order to cover other people. what we are saying is the we are trying to cover 15% of the people. this amendment is to the heart of this bill. stay out of the patient/doctor relationship. the only way have shown to do it in the civilized government run systems is by rationing care. and is the only way they can contain costs. when you take 100 million people, if they go off of their health care and are put on to this government's plan, guess what? they are going to have to ration care. how do they do that? with your best practices checklist and your comparative effectiveness checklist. that is how they do it. that is what this is proposing

to do. that is why we have to set a clear tone of front that we will not put up with that in the night the state of america. but with the gentleman yield to me? >> a one-council some questions. and did i want to ask some questions. this is an amendment that relates to section 931. is there anything in section 931 that would take away the authority of the fda to regulate drugs or devices? >> is there anything under this that would change the regulatory scheme for dangerous drugs or schedule drugs? >> no, certification. >> is there anything in this section that deals with changing the scope of practices to what a

nurse or doctor can do? >> under other existing statutes, and no. >> not under this one. >> if there are authorities under existing statutes, they would remain unchanged by this. >> this amendment the when not change to the law -- would not change a lot? >> the main of the current law on these topics. -- there may not be current law on these topics. this amendment would not change those other statues. >> thank you. >> time is expired. >> i move to strike the last word. on the issue of caps, if you read the bill, a lifetime limit on caps has been lifted, and this is a very important provision in the bill.

in 1996, and the interest legislation and called christopher reeve and asked if he would allow his name to be placed on the bill. he was a very good example of someone who incurred something that was catastrophic. most people do not realize what is in their insurance policies. where this is acutely experience and felt is in the disabled community. and i think it is important to note that that has been cured in this bill. members have made reference to the report. it was written months before this provision became part of the underlying legislation. it is important for members who do not know this -- you will find it interesting -- if you do, it is a refresher -- and

that is that the lewin organization is won't -- owned by united healthcare. they said they are not changing their practices for rescissions. , on, let's get our facts straight. i know we have philosophical differences. they should be debated, and debated really well, but we need to deal with facts. when you are talking about caps, the caps are no longer going to be in existence, and the american people are going to be 1000% better off as a result of that. thank you, and i yield back. thank you. i gave some thought to debating the amendment here. since no one appeared to want to do that, maybe that will be out of character.

this amendment, if i read it right, just deals with federal employees directing medical professionals. i heard someone say like that in the most americans would not like to detect aircraft that had a bad day the day before to make that decision and said their doctors. that is all this is about. there are other sections that deal with insurance companies. i think you'd find substantial interest in making the air insurance system more competitive, making it more responsive. competition has impact on price. the current system grew up to where you do not really have the kind of marketplace we could easily achieve. our concern is different than this concern. it is great. many of us believe that government cannot compete fairly. the loewen group has been around over four decades. it is always described as a left

of center healthcare group. it is never been described as conservative or right of center. it is well respected. there have been two studies. the first one said 160 million people will leave their insurance. on this bill they said 114-125. it was pretty close to this bill. it is hard to score this bill when you do not see it. to have that they are not that no one has for this bill yet, they scored two years ago. everybody believes that if you have a public competitor that is at near medicare, that the private competitors will get smaller and they will eventually go out of existence. that is another debate. this is a debate about whether a federal power gra power can intt

is about a federal bureaucrat and medical practitioners. we have all the debate on the other part of the bill we want to. that is not what dr. been reposal bill deals with. -- dr. gingrey's bill deals with. i support the amendment. >> i wheel to the chairmen. >> i want to reiterate what he just said. this is about practice of medicine. that is what it is about. i would use the word " innocuous." but as -- if i ask for a show of hands, how many people think somebody washington to tell your doctor how to practice medicine on the year? i do not think anyone would raise their hand. i would not raise my hand.

i do not want my doctor to be told how to practice medicine on me or my family. that is all he is trying to do. >> will yield? -- will yield? >> the difference in the argument here is who is standing between patients and their doctors. >> we do not want anybody to. >> we believe undecided the ideal that insurers due time and time again. i have not met over the phone a really bubbly, pleasant, welcoming helpful bureaucrats from an insurance company. i have to tell you that. i dealt with a lot of them when i had my mother and father. this idea then there are bad guys in the government and good guys everywhere else, i think that is overly positive i appreciate you giving me time.

>> i have had health problems. i have been in several hot examination rooms and even a few hospitals with various ailments. i have never had an insurance agent in the examination room or hospital room when the doctors were in near trying to discern what was wrong with me and what to do about it and implementing their strategy. if we want to have a debate about insurance companies, i have a feeling some of us on this side -- in fact i know, this is about doctors, patients, drand doctors practicing medicine. if you think doctors to practice the best medicine on you and your family, vote for dr. gingrey.

he think they should not be allowed to come of vote against him. >> >> is it not true that the harm you are trying to prevent with your amendment is already prohibited by the 10th amendment to the constitution? >> if you can explain to me what you mean by that, explain to me what you think the 10th amendment says in regard to preventing harm. >> the 10th amendment reserves all rights that are not specifically spelled out or are not prohibited to the states, and we all know that right now the practice of medicine is regulated in all 50 states. so, in your amendment, you're

trying to prohibit the practice that already is prohibited by the 10th amendment. is that not correct? >> i thank you for the question, and i guess the gentleman was for the first amendment that was offered by my colleague from georgia, the ranking member of the health subcommittee. the fact that the states have that right as protected by the 10th amendment. but we heard the general counsel said that absolutely under this bill the states could be pre- empted by the center for quality improvement. it said all plans for state employees have to cover certain mandates, maybe including abortion coverage. i am glad you asked me the question and i will be glad to

ask any other. >> the bottom line is that the purpose of the amendment is already protected under the constitution because nothing that we do in a federal statute can interfere with the constitutionally protected rights of states to control the practice of medicine. that is with the constitution applies. i also want to talk about comparative effectiveness research. i want to share with you a situation that conveys what comparative effectiveness research is important. in 1981, a well-known doctor who was working as a fellow at the cancer institute developed an experimental breast cancer therapy involving chemotherapy. he presented a presentation to the members of this committee, and he said if they did not pass

approval for this experimental but expensive treatment, the 70 breast cancer patients in the audience, half of them would be dead within a year. he told members of congress, as you look at a woman across the table from you, ask is the price of this woman's life worth the price of a luxury car? here is the rest of the story. he worked with another physician at the institute, and he warned dr. peters against accepting high dose chemotherapy with out and in delegation. he was ostracized by his warning. dr. peters, the one who invented the street, became concerned that in 1991 he convinced the national cancer institute to fund a clinical trial to make sure that his treatment was safe. safe. five different clinical t those five clinical trials found

no advantages and out comes between conventional treatment and high dose chemotherapy with bone marrow transplant. what was the price? roughly 42,000 women, 30,000 in the 1990's alone were subjected to the risk of this entirely experimental treatment. 34 $4 billion was spent. they later determined that 9000 patients died not from their cancer but from the treatment that they hope to be their cure. that is why comparative effectiveness research is important. that is why it is important to make sure that we have in this bill in the unbiased language. >> we've had a lot of debate on this. >> who seeks recognition? >> i do. i would ask you to yield two others who are seeking recognition on your site.

>> what do you telling me to do? >> you are recognized. you had your five minutes. >> we talked about the 10th amendment and of that. the [unintelligible] this amendment is so simple there is not a high school kid that cannot understand here are we have taught almost an hour and a half on it. it simply says nothing in this section shall be construed to allow any federal employee for a political appointee to dictate how medical providers practices medicine. you have read that. that is simple.

is there anybody anywhere that does not understand that? you have to consider this act based on the most simple medical practice like delivering a baby. for the most severe medical practice, a coronary bypass. i just wonder who would be the most capable federal employee of health care? crawly the architects of the capital. -- probably the architect of the capital. he would be the greatest political appointee. i do not know if it is the guy that has control of the trade for all the other nations in the world. i do not think you want him telling your doctor. would you want any federal employee to tell a doctor [unintelligible] would you want the architects of the capital telling him how to

deliver a baby? i do not think you will. would you want any political appointee -- any of these that obama has appointed -- any of them to tell the late dr. how a coronary bypass ought to be run? that is of certification. nothing in this section shall be construed to allow any federal employee or political appointee to dictate how medical providers -- is that simple. i do not know why we have all this problem with all this. of course insurance companies try not to pay losses. the medical doctor that testifies for the insurance companies will testify if you had a leg off it might grow

back. that is -- hear it is so simple that anybody in the world should read this and vote aye. i yield back to you, doctor. >> when i was a state senator in pennsylvania, i wrote a patient's bill of rights, and that has to do with issues with managed care because companies were making decisions. they were having people who did not practice medicine take over the decisions. the government is going to get into the insurance business. we have to understand that which is not specifically forbidden is permitted. this forbids it, otherwise it would be permitted. if the government wants to get into the insurance business, we should make sure we did not repeat the mistake that occurred before with managed care. >> i yield back my time.

>> why don't you yield to mr. boyer. >> if we are trying to figure out consequences of this, if we are going to have the center for quality improvement that will set best practices, will be setting standards and thereby having an impact upon medical liability that uses community standards? >> the provision in this section is to identify best practices. it does not have in the -- an ability to set enforceable standards for any practitioner. nor does it have the authority to set community standards for reliability concerns. there are no enforcement provisions within the section. it is to develop research to

identify best practices and to, get -- and to promulgate those. >> none of us want anything to come between our dr and ourselves. we do not want a government board that is gone to mandate these standards. not in this long? >> then everybody should support the amendment. >> i'm not want to yell back to anybody else. i want to simply close with three reading this. nothing in this section shall be construed to allow any architect for any political appointment to secretary of treasury to dictate how a medical provider practices medicine. breed of then vote. -- read it then vote. >> i want to enter into the

record that this report from the louisiana medical society opposes this legislation be entered into the record. they say "the most radical of the bill's provisions, the public plan option, is against louisiana state medical society policy which is an opposition to a national single payer system. it represented a way to a vast expansion of government control of the nation's health-care system and is a stalking horse of a thriving market place o." the biggest concern many of us have expressed every government- run plan is looking at the history the other countries that have it. it to the canada and england and you will have the experience, the first thing they have done is rationed health care for the people in their countries.

>> you do not think we have rationing in this country? they are people that cannot access to any medical care because the insurance companies will not cover them. they have nowhere to go. >> you are reclaiming my time. you actually taxed those people that are uninsured. you impose $29 billion in new taxes on people who are currently uninsured. that is on page 167. we actually taxed people at $29 billion who are uninsured. i support the amendment because it shines a light on the fact that it will ration care. this bill interferes with the relationship between the doctor and patient. if anybody can show and look at this organizational chart is a government is not interfering but the doctor and patient, then you have not seen it.

this is the patient and doctor. these are all the bureaucracy's better being set up ticket between the doctor and patient. it is in the bill. what dr. gingrey is doing is saying remove all these federal bureaucrats away from their relationship so that the doctors and the patient can choose what is best for the patient. instead of what canada or england does. we have seen what they do. i'll be happy to yield to my friend. >> i'm thank the gentleman from louisiana. i want to bring up a point in regard to his idea of louisiana medical society. i will tell you that my state of georgia feels the same way. they are leading a coalition of about 16 other states that are all part of the american medical association that do not support this bill because of the government option.

as the chairman mentioned, the support of the ama. it is a great organization. it represents about one/for the physicians in the united states. i do not think that speaks to all of the practicing doctors. the me say this as we come to a conclusion of this debate. the arguments that i have heard in the last 35 minutes -- it is nothing but an attack on the insurance industry. we can agree with a lot of things in this legislation, certainly ending this practice of rescission. because those of the technical language on their application there deny coverage. we agree with that. we agree with most of the insurance industry reform that is in the bill.

denial of coverage for pre- existing conditions, community ratings, we agree with the need for electronic medical record and transparency. we agree for equalized taxes on the purchase of health insurance. . . i yield back. >> will the gentleman yield to me for question? >> yes, mr. chairman.

>> since we have had medicare in operation for a long time, as medicare told a doctor how to practice medicine, dictate how providers practice medicine? has that been your experience? >> mr. chairman, no question about it, they do that by forcing the doctors to either accept medicare, accept the assignment, or have their reimbursement cut significantly. >> that is not the practice of medicine. that is the practice of reimbursement. we have a government run health program for seniors called medicare. it has been in operation since 1965. this medicare tell doctors how to practice medicine?

>> absolutely. >> the gentleman's time has expired. let's proceed to the vote. all those in favor of the gingrey eminence sayin aye. all those opposed say no. the nos have it. of representatives -- at hr3200. it will be subject to a lot of debate this fall when the house returns. we are joined by martin varon of news wires. we have talked about some of the doctor/patient relationship and the politics a little bit of this bill. but i also wanted

in order to fund -- this bill has a lot of new costs. it is the way they chose to fund universal health care to tax the wealthy. it would kick in, the way it is currently written, incomes above $350,000. that is for a married couple. for individuals it is lower than that, $280,000 is for the surtax would start. the democratic leadership got some bloop back on that. members felt it might be affecting the middle-class, and so nancy pelosi has said she does not want it to take in under $500,000. that is what the next -- we can expect on the house floor, a surtax that expects -- that begins at $500,000. it is raising around close to $500 billion in the house-past

ways and means committee. that will be reduced once they make the change to bump it up. >> the change will be made? >> mica understanding is the change will be made. she is comfortable with a higher level. >> what is the relationship between pelosi and the three chairmen of the committee's? of ways and means it? >> she has had her hands full bringing these three chairmaen, who for obvious reasons come from different backgrounds, constituencies themselves, different jurisdictional interests. and randall for the tax committee obviously has his own ideas about how to raise money for things. and it would be different from the ideas of chairman miller of the education and labor committee.

from the get go on this, a locy -- nancy pelosi has put a lot of commitment in to bring those three forward and moving them forward in lockstep on this. she did not want to create a situation where the chairman are squabbling on -- among themselves. that has worked out pretty well without too many problems. that is the house of representatives with the way that the house rules are structured. the majority party has a bit easier road to get things through. >> all three committees have passed the exact same version of age -- of hr3200, is that correct? >> nou, there are differences in these bills that will have to be resolved. that is the bulk of the work coming back from recess, for the committees to sit down and get together and resolve those. >> what are the significant the

vatican -- differences? -- the significant differences? >> let me think about this. one difference is in the energy and commerce committee, chairman waxman had to, in order to bring some of the blue dog democrats on board, the moderate democrats, he had to make some concessions. that resulted in a bill that looks different than what came out of ways and means. the waxman bill exempts more small businesses from the employer-mandate requirement. it also has a bit of a different spin on the public option. it is based on doctors and hospitals being reimbursed on a negotiated rate that the secretary of health and negotiate. and the ways and means bill, for instance, it is pegged to medicare rates. the energy and commerce bill is a bit more favorable to the doctors and hospital providers.

those are two examples of things that ought to be reconciled. >> we talked a bit about the surtax on high incomes. the energy and commerce had that debate earlier this summer. debate earlier this summer. >> let me recognize mr. rangel, since this amendment relates to the jurisdiction of his committee. it is good he would be in attendance when i discuss it. mr. chairman, under the pending bill, there is a tax on americans, depending on their income status. if this bill goes into effect, there would be an immediate surtax on incomes of citizens who make between $350,000.500000 dollars per year. there would be a 1% tax between

citizens who make $500,000 and $1 million. there would be a 5.4% surtax on others. those taxes on the lower two in complexes -- in, practi -- income brackets. what the barton amendment does is direct the study to find that regardless of the savings that the taxes on the lower to income brackets, the increases did not go into the effect. the effect of the amendment if adopted be the beginning in 2013, only those citizens who make over $1 million would have

their taxes increased by the surtax. the reason we do not repealed the tax increase, and that is what the chairman of the ways in committee is here, is we do not have jurisdiction to repeal in this committee that tax increase, but we have jurisdiction over studies. we use the study as a hook to at least say those citizens who make war -- less than $1 million to try to save them some money beginning in the year 2013. this is the million dollar taxpayer protection amendment, those that make less than 1 million of dollars. . to mr. waldron. >> i have to speak on this in support of it. if you look at the chart up here, my home state of oregon would have the second highest income tax rate in the world.

we already have the second -- i think highest marginal tax rate in the u.s. of any state. in the u.s. of any state. which is a g benefit for mr. and sleaze state because we are having to build a whole new bridge so that -- for mr. tensleensley's state, because we having to build a new bridge to the people can move to washington -- two or injured -- two or yen. i will be supporting the domenick amendment. -- i will be supporting the gentleman's amendment. >> i yield back i am not sure -- i yield back. >> i am not sure how mr. darden is trying to create jurisdiction over this issue -- mr. boorstin is trying to create jurisdiction over this issue.

but the basic problem i see is that he is doing some kind of gimmick to undercut the revenue committee, and is sort of interesting that the chairman, mr. rangel, is here. the reason i oppose this amendment is that from the very beginning of this debate when president obama talked about the need for health care reform, he pointed out that a good part of the cost, the paygo, if you will, was going to be from cuts and -- in existing programs, medicare in particular. but at the same time, there was going to be a new revenue need. the reason there was going to be a need for new revenue is that in order to cover more people and provide assistance to middle income families through a subsidy, at least up front in the beginning, a certain amount of money was going to have to be available down road as -- available. down the road, as more and more

health care kids income on we save money. -- more health care kicks in, we save money. part of it would be paid for through program cuts and part of it through new revenue. i think that we would be kidding ourselves if we did not realize or acknowledge that some revenue sources is needed. if you look at a revenue source, i think that what the mint -- the ways and means committee came up with is probably the most responsible way of doing this that i can imagine. if you look at this surcharge, it only applies to the top 1.2% of all households in the united states. it would have no affect on 98.8% of all households in the u.s. those are families making between $350,000 and $1 million. they would contribute less than 1% of annual income in order to provide access to affordable

help care for all americans. i do not think that as much of a contribution when you are going to cover all of these people who have no insurance, plus a number of people who would get a subsidy to help make their insurance affordable to them. we are a community. everyone should help to a certain extent. i think this is the least offensive way of doing it. i know it is not before our committee and maybe we should not even be talking about it today. but of all the proposals out there, this is the least offensive. if you think we're going to be able to do this without some new source of income, you're kidding yourself. i do not represent a poor district. i have a lot of people who would be impacted by this, but i still think it is important to recognize that this is a good way of doing it and something has to be done. this is not all going to be paid for through program cuts. i yield to the gentleman. >> i want to point out one thing. american citizens, taxes are going to go down as a result of this bill.

[laughter] that may explainç why. because right now, your state are paying too much for health care because there is no containment. >> of the republicans are acting like british parliamentarians. [laughter] ration your mirth. >> as long as they do not act like south korean won's, i will be fine. [laughter] the cost to citizens will go down because it will not have inflated health care costs built in. the amount of uninsured that are walking into emergency rooms are going to go down, so more efficient care will be provided. the amount for cities like mine and states that have shares of medicaid are going to go down. overall, tax expenditures are going to go down, down, down and osorno on tax expenditures. the way everyone should look at this effort is that while -- is that will the overall cost of life be reduced or go up? health care will double in the next five years. if we do not fix that,

everything we have is going to go up in cost. the question is not, what part of it is going to go up. everything is good to go up a little, but everything is going to go down appreciably a lot. i welcome the study that says what the conclusion of the study will be. the fact is that health care costs are driving everything in this country to be too expensive. when you are buying a car, you're paying a tax. when you buy food, you are paying a tax. when you go to the office, you are paying a tax. we say, no, that is not a good policy and we are trying to take -- to change it. >> will the gentleman yield? >> i do not control the time, but bring it on. >> i thank the gentleman for yielding. >> the difference time has expired. -- the gentleman's time has expired. maybe you could go to mr. blanton. >> i would like to make a couple of comments.

one is that there is no study that i am aware of that indicates that there is anything that saves money or bends the cost curve. we heard the cbo testify with conclusively -- conclusively that the cost is not go down. the gentleman's guarantee that this is to contain cost is not supported by any information that i am aware of. the tax that we are talking about is a tax that absolutely false on most of the small businesses in america and that gets beyond the $200,000, $300,000 level and their tax would be impacted by this dramatically. the former chairman's amendment, the ranking members amendment, simply if it is going to be this tax, it tries to move it in an area where it does not impact job-creating aspects of small businesses that do have income that might have saved $250,000

or $300,000. we had a meeting with a number of people this week about the 8% surcharge if you did not provide insurance. all of these saudis as job costing measures at a time when they would like to be -- all of them saw these as job kostis measure-- job costing measures a time when they would like to be hiring. >> if this surtax, particularly on those making less than $1 million per year, many of whom -- maybe one-third -- are small businessmen and women, if it is found by a steady in 2012 that more than enough taxes have been raised for paying for this health care reform act, then we should not continue to tax these individuals. the speaker was asked the same question on a sunday morning

talk show about a week ago and her response, mr. chairman, was, you know, we would use that excess money to pay down the deficit. goodness gracious, it would seem to me that we would leave that money in the pockets of the small-business men and women so they could continue to create jobs and we have more and more revenue coming in. >> will the gentleman yield? >> it is my time. >> you have got these same people, the democratic majority are going to go after these same people to pay for other things. you better save some for later. >> i yield to the gentleman from florida. >> i thank my colleague. mr. wiener says we're going to lower health-care costs with this bill. this is a study by the joint economic committee, senator brown back is the ranking member. it is bipartisan.

we should probably look at this graph. it is a small grass,ç but it shows that under this health care bill, health care costs are going up almost exponentially. you are welcome to get a copy, mr. wiener. i do not think there is any evidence to support your idea that this bill will bring down health-care costs. in fact, is going to increase it dramatically. when you look at what the president said, that he would not support any health care bill that did not bring health care costs down, i do not know how he could support this bill based on what the joint economic committee has published in this very thorough analysis showing health care costs going up. >> i yield to the gentleman from louisiana and if there is time, the gentleman from illinois. >> if anyone suggests that if this bill passes that taxes will go down, i suggest they go and read the bill. if you look at this section right here, 4-1, there is a tax

on anything that is unacceptable. they can actually impose a 2.5% tax on your income. it is so large that the congressional budget office sat here in this room -- unfortunately, it was not a meeting that was open to the public, but i was there. the congressional budget office said that one section alone is going to add $29 billion in new taxes onto the backs of people who are uninsured today. most of those people are making a board of $50,000 per year. it is not just some radical blog that is going to tell you that your gwenn to pay more taxes. the congressional budget office is saying that it will be so. >> i yield to the gentleman from illinois. >> cbo said that obama is cost

savings are an illusion. -- obama's cost savings are an illusion. >> the gentleman's time has expired. the chair recognizes himself for the last five minutes of debate on this amendment. this is a very confusion -- confusing amendment. this should not even be in this committee, but we checked with the parliamentarians and he said it was crafted in a way that allowed it to be germane. i do not know if that is why the chairman of the ways and means committee is here or not, but this is strange. the bill says that if we do not achieve the savings that we need to achieve, then we would look to revenues. this amendment says that if we do a study, we are going to determine that if the savings --

if we do achieve the savings, then we will reduce the revenues. the whole bill that we have is paid for out of programmatic savings, cuts in medicare, medicaid -- and if that is not enough, new revenues. this amendment would reduce the revenues. if we make a reduction in the revenue side, then we have to look to see whether we are going to get the savings. if we do not get the savings, this amendment could cost us several hundred billion dollars, if it worked. and there is a lot of comedic -- confusion on whether it works. i think this is a message amendment and i do not even understand the message. but the impact of this amendment would be very destructive to the bill that we have before us. and if the study showed that we and if the study showed that we did not achieve the savings

we would delegate this decision as to how much money would be available and then we would have to make additional cuts to medicare and medicaid which may not be possible. i urge members to oppose this amendment. it is what we call gimmicky. it says is doing something. it says the omb would find savings generated and if they did we would change the the surtax and individuals making less than $1 million would never face a tax. i don't know what the revenue provisions will be when we get to the house floor. no one wants to raise revenues. we would rather get program cuts but we are not going to get enough program cuts. this amendment says if we do not

get the program cuts, reduced revenues, and if that is inaccurate we have to reduce revenues even more. who is asking me to yield? >> thank you. the majority committee provided members with a description of what this bill does for the district including talking about the surtax. i would suggest your side to the same thing. i have a whole bunch of them here. the number of small businesses that would receive tax credits, every one of these that i am holding is about $12,000 or more for small businesses. , small businesses that help. how many seniors would avoid the doughnut hole in medicare part c? that is thousands. how many families would escape bankruptcy? that is in the hundreds. how many people in the district would get covered? in all cases it is over 100,000.

and every single case, 99% plus people in the district will not pay the surcharge. we're talking about a tiny number compared to the hundreds of thousands of people that will help because finally they will get insurance. you ought to look at this description so you can take a good look at how your district will be helped by this bill. >> i would just say that under this amendment, after you get some analysis, the first priority will be to reduce taxes rather than make sure we keep those promises. and if we cannot keep those promises, we have to look at further reductions in medicare and medicaid. this is going to cost us hundreds of billions of dollars and not make the plan work. i suppose that is the goal. >> i just want to point out one tax that the minority side refuses to point out. we have $2.2 trillion for health

care. that is going to go up unless we do something to $3 trillion by 2012. i said to my colleague from louisiana, yes, you can find charges in this bill, but you have to balance it against the close to $3 trillion in taxes for all americans. >> we have completed the debate time. we will now proceed to vote. mr. barton informs me he would like a roll-call vote. >> martin vaughn, that was a little bit about the surtax in the house bill. the senate does not have a surtax, correct? >> correct. the senate has chosen a different option to fund its plan. the details are still up in the air because the finance committee senators are still trying to negotiate this and

they have not released their legislation publicly yet. the way that is going is that they are talking about a tax on insurance companies, which would affect only what is called " gold-plated plans" or the most expensive plans. those plans that are above $24,000 in annual coverage. it would place a surtax on those with a couple of goals. it would generate revenue in the same way that the house what the surtax does, but also, it would havhelp control costs by steering people away from those very expensive plans and making them more thoughtful about their choices and economizing more. >> back to hr3200.

employer-provided insurance and individual-purchased insurance, what are the provisions in the house bill with regard to individual-purchased insurance? >> there is a mandate in the bill that is integral to how this works. that is, the house bill would require that every person be covered. you know, that every american purchase a health insurance either through dara employer or through this exchange -- either through their employer or through this exchange. the penalty would be 2.5% penalty assessed on your tax return if you do not have coverage. on your employer side, they want to keep employers providing coverage for people. çthey want to prevent a situatn where with the new public plan,

new options available through the exchange, the people who now have coverage through their employer migrate to those new alternatives. there's also a penalty in there for employers that do not provide, do not offer affordable coverage to their employees. >> and that penalty is 8%. >> correct, it starts out at 2% for smaller firms and it rises to 8% for the largest firms. >> and that is 8% of payroll. every dollar that you spent to pay employees, if you do not provide coverage, you could be taxed up to 8 cents on the dollar. >> my impression, though, is that large employers spend more on health care than just a% of health -- of a health care -- of payroll. what about just dropping

insurance and paying the 8%? >> you are right, the typical employer spends more than that on health care benefits. the argument would be that they want to set it high enough that it is a deterrent for people to dump their employee plans and send people to the exchange. however, they do not want it to be a burden. they do not want to be burdensome on employers. the argument is that employers have lots of reasons to offer their employees in good health care coverage. it has become part of a benefits package of how we think about our jobs as americans. you've got a good job. you have got good health coverage. you're probably got a good dental benefits, could benefit for vision. it has to do with the employer- employee relationship. the idea is that just because there is this new exchange, employers are not just going to suddenly drop that. they want employees to feel taking care of.

in addition, there is a tax subsidy that is associated with employer-provided health insurance and that does not go away under this bill. if the employer can provide health insurance, there is a building in subsidy that the government is chipping in -- there is a built in subsidy that the government is checking into the worker. that has to be taken into account. >> could you once again, before we show a little bit more ways and means committee debate on health care reform, explain what the exchanges are? >> sherkure, this is a central feature of this new plan and it is meant to help people that do not have insurance through their employer -- in other words, they are in an individual market or the work for small business and are in a small group market -- have more ways to get insurance. currently, in many states there are not a lot of options for these people on the individual market and is very expensive. what the bill would create is a

national exchange that is regulated, run by a commissioner appointed by the federal government and it would include both private health-care plans and also could include non- profit plants and under the houe bill as it is written now, would also include the government plan. >> is there a penalty for individuals who do not have employer-sponsored health care or do not purchase health care in the exchange? >> there is. >> what is it? >> the penalty is, a person would vote to point represents nine of their income -- would of 2.5-- would 0we 2.5% of their

income on their tax return. the idea is to get healthier, younger people buying insurance, whereas in today's market in my hobby -- might not be so inclined. -- they might not be so inclined. >> here is about 10 minutes of the debate about individuals who do not have insurance. >> #34. >> thank you. mr. berchtold, you have been hanging out with us all day long and you have had one chance to respond to a question. i figured i would for one that you. >> 34. >> this is the amendment that helps make good on president obama's promise not to tax people making less than

$250,000. looking at the spreadsheets that we do have from jct and cbo, is it not the case that some of the people that have to pay the 2.5% tax will be making less than $250,000? and is it not also the case that the employer payroll tax will be paid on payroll for people making less than $250,000? mr. ryan, you did ask me a couple of questions i number of hours ago. >> ok, not since dinner. [laughter] >> you asked about the proposal for the tax on individuals without acceptable health care coverage. it is a tax on the individuals' wages over an agi threshold.

the threshold in 2009 would be $18,700, on a joint return -- 18,007 of dollars on a joint return, and a little over $9,000 on an individual return. yes, i would have to say there is a surtax on individuals making less than $250,000 in that circumstance. you also asked about the% payroll tax that would be applied to non--- the 8% payroll tax that would be applied to non-electing employers. as mr. elmendorf said this morning when we discussed a similar issue, both the congressional but ought -- congressional budget office and joint committee when we estimate the effects, when we do distribution analysis, we see the economics of payroll taxes

as generally ultimately falling on the employee. >> wateville, thank you very much. -- wonderful, thank you very much. let me quote from mr. obama during the campaign. "middle-class families will see their taxes cut and no family making less than 2 under $50,000 will see their taxes increase -- making less than $250,000 will see their taxes increase." this bill violates that promise and we want to help the majority, help the president make good on his promise. pass this amendment and we will make sure that families making less than 2 wondered $50,000 do not see their taxes -- $250,000 do not see their taxes increase. it is just that easy, it is that simple. these taxes increase over 10 years. they're not the major pay force in this bill. they are the punitive penalties

designed to force people into the mandate. obviously, we have a policy problem with that. but more to the point, this bill violates the kind of change most people thought they were getting when they went to the polls in november. i bet if you ran a poll, most people believe that if they make less than 2 under $50,000 they will not get their taxes -- $250,000 it will not get their taxes increase because the man they voted for told them they would not. we make this bill law, they get their taxes increase. if we get this amendment, that will not happen. it is that simple. >> mr. blumenauer, u.r.l. -- you are recognized in order to respond. >> thank you, mr. chairman. would that work "that simple." my good friend, mr. ryan, and i occasionally have a chance to reminisce about the good old

days when he was in charge@@@@@l we had medicare part b airdropped and without any expectation of how we were going to pay for it. some of us voted against things of that nature. this is structured differently. first of all, his proposal would call for a significant increase in the deficit. he is not talking about adjusting the program. he is just talking about eliminating revenues and driving up the deficit. second, he is sort of blowing a hole in the whole concept of insurance. if we are going to have individuals who do not have a feed, not an increase in their -- who do not have a fee, not an increase, but a fee to make sure

that they do not answer -- that we do not destroy their insurance, what he's going to have is a person who will not get coverage until they get sick. under this provision cannot opt out, get coverage when you need it -- under this provision, opt out, get coverage when you need it. and suddenly make it impossible to talk the insurance reforms that are critical here. you just have people sit back and wait until they are sick. we already have provisions under this bill to help people avoid additional tax by obtaining health insurance coverage. if they have got problems, we have subsidization. if they are not eligible for subsidized coverage, there is a hardship waiver. but what he is talking about, increasing the deficit, destroying the principle of insurance, providing incentives

for people just to drop in when they need it and have extensive payouts. then in terms of having an employer fee to make sure that people be a part of the system, he would exempt people the payroll of $250,000 the latest information available, that is 2007, i do not know if it is up or down, but is probably that ballpark. there have been some choppy economic waters. he would exempt 99.1% of american taxpayers from dealing with the payroll tax. i think that is a little bizarre. it is a little expensive. it is not increasing the income tax. this is taking away some of the

principals, some of the fis and the regulating mechanisms -- some of the fees and regulating mechanisms to make the system work. if you want to cut the coverage, cut the coverage. or to reduce the revenues in one place, pay them somewhere else, but do not destroy the principle of insurance. do not drive of the cost of the deficit. that is what you did when you were in charge. we are trying to avoid that and i think we have done a reasonably good job. i would urge rejection of a misguided amendment that takes us back to the days when you were in charge. >> all of those arguments are fine and good, but they neglect the fact that the biggest promise of the last campaign is being violated with this piece of legislation. i do not want to do a rehash of the prior history, but when we were in this committee, when we were in charge, the majority

offered a prescription drug bill that cost $1 trillion. so, and paid for, i would say. you could easily fall back the $1 trillion in this bill to pay for this. the point is this, you are violating his pledge. this bill breaks the president promised to the people of this country. it's just that simple. roll-call vote, please. >> martin vaughn, we just heard about penalties that individuals could face. what about subsidies for individuals that may not be able to afford health insurance? >> the bill also includes subsidies for low to moderate income people that are going to be seeking coverage through the exchange. they would cover people of 2400% of the poverty level. -- people up to four under% of the poverty level is on a sliding scale, so -- up to 400%

of the party level. it is on a sliding scale. >> what are your requirements for employers to provide health insurance in hr3200? >> of 5-employers are required to offer affordable coverage -- employers are required to offer affordablç coverage to their employees and coverage that meet certain criteria. if they do not, they are subject to a certain percentage of surtax on the payroll. >> to the offer options, or just one plan? what does the bill say? what some of these details have yet to be flushed oufleshed oute key is that they are for an affordable plan. what does affordable mean? that might require some fleshing out. but there is not a requirement for more than one, but there is a requirement that they offer affordable insurance.

>> could offer the public option as the plan? >> if they did that, they would have to pay the penalty. >> the ways and means committee debate on penalties for employers also occurred this summer. we want to show you a little bit about that. it is about 30 minutes in length and then we will come back with martin vaughn. >> thank you, mr. chairman. what i am offering is to strike the employer mandate. mr. chairman, the bill we are debating today contains an 8% payroll tax if they do not offer benefits to their employees, but also, if they do not offer the right kinds oveof health benefi. it is not only those businesses that cannot afford to offer health insurance to their employees, but health care coverage that is offered that is insufficient by the federal

government. it also taxes those who offer sufficient coverage, but employees decide to enroll someone else. it also taxes businesses the federal government decides are not paying enough of the employee's premium. as the national unemployment rate climbs toward 10%, this is the wrong time to increase taxes on our nation's employers. that is why i am offering an amendment that strikes this ill- conceived employee mandates -- employer mandate. mr. chairman, i would like unanimous consent entered into the record, letters from the u.s. chamber, national federation of independent business, and 31 other organizations who have expressed their desire to see the employer mandate removed from the underlying legislation. the u.s. chamber of commerce has stated this employer mandate

will not increase health care coverage, but rather, lead to the outsourcing and offshore in of jobs, hiring independent contractors as well as reducing work force and wages. the national retail federation, which represents one in five american workers, has said "employer mandates of any kind amount to a tax on jobs. we can think of few more dangerous steps to take in the middle of our present recession. but the nonpartisan budget office has also weighed in saying, as employers required to pay insurance or a fee is likely to reduce employment. even the white house economic model confirms this is true. it projects that an employer mandate included in the bill will result in 4.7 million americans losing their jobs. i cannot think of anything worse

this congress could do right now in light of our current economic situation that would be as devastating as taxing businesses out of 4.7 million jobs. i urge my colleagues to join with me and support this amendment that would strike the act on american businesses. >> mr. levitt will respond. >> thank you, and to my friend, mr. johnson, i am very glad you have proposed this amendment. this very much across the lines -- draws the lines between those that want to sustain or maintain the status quo and to those who are determined to change it. we on this committee have been talking about this issue for

years and as washington has talked, the number of people without insurance have grown. i do not know what more could moveç people than 45 million people to 50 million people without insurance. i do not know what is going to take. but if you go into the issues of people without insurance, look them in the eye, i do not see how you can support this amendment. the status quo is not only untenable, but unconscionable. and for the first time, the president of the united states and a majority in this congress are determined to step up to the plate and no longer daud to this

issue. we have an employer mandate. we have been sensitive. and we have tried to balance this. we have exempted the smaller businesses with payrolls under $250,000 entirely. and what we have also done is to provide tax credits for businesses so that they can provide affordable, comprehensive coverage. what more do you ask? cbo says there will be 97% coverage. a dramatic increase in the coverage today, and my guess is that if you would replace all of us -- if you were to replace all of us with people who had no health insurance, that

republicans as well as democrats would vote against this amendment. you talk about offshoring. so many of these jobs could never be sent overseas. you have opposition from the retail establishment. those jobs are going to be of short -- offshored? no, the fact is that so many of the businesses have been providing insurance, but a lot of the companies that are not have failed to do so, relying on those who provide insurance to cover their dependents. there has not been a single plan that i know of from the minority, a single plan that would lift the coverage for people in this coverage anything close to 97%.

no proposal that would be scored as coming anything close. so, i say to you, if you want to pose this, come up with a plan that reaches 97%. come up with a plan. all of those -- all of us hold a town hall meetings and the hardest thing to do is to listen to a comment from people who have no coverage, who cannot afford coverage, who work hard and there is no health care coverage. there is no health reform without coverage. and let me just finish on this. the president has said, a mandate is that we get costs under corol. a mandate is that we also cover

virtually everybody. that is a double mandate. and this bill attempts to meet both mandates. maybe we can do more, and i think probably over time we will in terms of containment of costs, of rationalizing the delivery system. ok, but one thing that i think is untouchable for the president of the united states, and it should be for us, is covering essentially all americans with health care coverage. and if we leave here without anything less, we will not have done our job. done our job. we can we cannot continue to sit here and essentially sit on our hands. i oppose this amendment.

>> a quick fact check, 70 million people in america without health care. we are still waiting to see what the cost is. that is about the population of florida. republicans have an number of proposals to cover the uninsured in america out but we did not have 24 hours or less to respond. there is a distinction on both sides of the aisle between those who understand how jobs are created in america and those who have no clue. having run a small business and organization working with small businesses and struggling to pay health-care myself for our workers, i don't think this

committee fully understands what a struggle it is for small businesses to keep workers in tough economic times and to keep them with health care. to keep them with health care. i looked at this from a small business perspective of what this mandate would do and according to the national bureau of economic research, who study the impact of a mandate like this on businesses, they made three key points that i think ought to be of interest to this committee. first, who loses their job with a mandate like this? primarily, women, minority, and high-school dropouts. more than 60% of those at risk of losing their jobs are racial and ethnic minorities. who else? minimum wage workers, those earning within $3 of minimum wage would be next at the greatest risk of losing their jobs. and interestingly enough, those

currently without health care or seven times more likely to lose their jobs than workers presently injured. -- insured. a bill that is supposed to, that is claiming to cover the uninsured is a seemingly at odds with each other. i think you will see companies drop their coverage congressional budget office says requiring employers to cover employees or pay a fee if they do not is likely to cut jobs. in other research, small businesses are disproportionately affected by this mandate and will account for two-thirds of the job loss. that is the fear that our manufacturing companies and the workers in america reflect as well. with the national association manufacturers say is that this

scheme will, instead, force a calculated cost-benefit on employers that will cause some to reduce benefits for workers, or just drop coverage altogether. i think this provision will backfire on the economy. it will cost us jobs and ultimately drive people out of the coverage that they have. this is a common-sense amendment that deserves support. at least, if used -- if you care about workers in america. i yield. >> of the 17 million, about half of them are undocumented workers. would you cover them with health insurance? >> can you guarantee to me that they will remain on documented? -- undocumented? >> that they will remain undocumented? >> as you go through your immigration reform, a lot of proposals offer amnesty to them. can you guarantee that they will remain undocumented?

>> no, i do not think senator mccain and other sensible republicans would raise that issue. but do not throw in the 17 million. half of them are undocumented and we will be glad to talk to you about job loss. this side has been in the lead in terms of creating jobs in this country. >> [laughter] reclaiming my time, mr. chairman. i respect you a great deal, but you have lost 2 million jobs in the last five months. unemployment is higher and the economy is getting worse by the day. the president the other day just said that this stimulus failed. >> he did not say it failed. and your talk"a=uq jobs is the same as when we talk about minimum-wage. is the same old song. and the country wants a new tune. >> well, they are certainly getting it.

[laughter] [captioning performed by national captioning institute] [captions copyright national cable satellite corp. 2009] >> the chair recognizes mr. blumenauer. >> thank you, mr. chairman, and i think this is an important amendment for us to have on the table. it is clear that this provides advantages for a wide variety of businesses because it levels the playing field. now, everybody will be providing health insurance or they will be contributing to overall. it is going to help avoid the slow unraveling of employer- provided health care in this country. we're on a passed unless we do something like the legislation -- we are on a pass, unless we do something like the legislation before us, where we continue to shrink the pool of employer-provided health care. we are watching the numbers

decline as the premiums go up. this is an opportunity to stabilize and reversed it. this is not a huge burden on employers. we have had testified before us a number of examples where people point out that small business is all ready paying far more than 8% and there is an exemption under the bill for the smaller ones. but i would call people's attention to the information from the chamber of commerce. in the second paragraph they are saying in 2007, the employee benefits totaled about 18.6% of total compensation. health insurance is a significant portion of that and for virtually all employers that are providing health insurance now is higher.

i think with any analysis of the information that we have had presented before us, that this is not an unduly burdensome level. it is, in fact, a bargain for most of the smaller companies and it will level the playing field so that everybody provide it and we will be protecting employer provided health insurance. failing that, within the next two or three years we will watch a continued and accelerating decline as it becomes more and more affordable. . .

i think it is important to understand what makes up that number and if we can direct the precious resources that the american taxpayers give us to this 13 million to 16 million, then we can move forward. >> i appreciate the gentleman talking about the complexity of that number. i would point out that some of the higher income people do not have a choice. for the sum, -- for some, the problems in our legislation will

take care of that. the fact that there are people that they're finding that -- that is why we would want to of the assistance of two $80,000 as a minimal amount. you have seen it in your state the increasing burden on employer-provided insurance. the numbers are going down and the premiums are going up and the future is bleak unless we do something similar to the legislation we have before us. >> thank you, mr. chairman. i want to follow up on a statement -- an observation made by the gentleman from michigan. that somehow of this spring's added discussion that reflects the difference between those of us who defended the status quo

and want change. that is pretty hyperbolic. i will not touch that. but this amendment does separate those who want to place a priority on getting people back to work and those who do not. that is it. there is a lot of talk around this discussion about the number of uninsured. we all know that the number is fluid and the make up the number can change in any discussion. >> what is the breakdown? >> at the end of the day, we ought to be focused on the 14 million plus people in this country who are unemployed and the families that are reliant on the paychecks that are no longer coming. you can begin to look there and say that you have probably 30 million people that now have no hope of getting through the end of the month. that is where we need to focus first. that is what we should be doing. this amendment goes in

completely the opposite direction. . as it has been said, this amendment creates a payroll tax on small businesses. in fact, the new tax could be as high as 8% of payroll for an entire company. let's really think about why small businesses, if they do not offer health care, why they do not offer health care. they do not because, frankly, they cannot afford it. 49% of small businesses with three workers to nine workers, that is really small business, only 49% of those offered some kind of health care. rather than reduce the cost for them, what this bill does is says, we are going to raise the cost. we are going to start with small businesses that have a payroll of $250,000. somehow, that is going to get us

to have a more people insured. in response to the gentleman from oregon that this is the step to take toward preserving the employer-based health -- the employer-based health care system, this does not even begin to preserve the employer base. this goes in the opposite direction. even more, this bill says that, if a small business, if one of the 51% of small businesses with three workers to nine workers does provide insurance, the government in washington can say that that insurance is inadequate. let's look at the facts there. the bill says, in order to be adequate, first off, a small business must cover 72.5% of premium costs. in the case of a family, it must

be 65% of premium costs. 20% of small businesses cover less than 75%. a third of all businesses cover less than 50% of premium costs. right away, you're going to provide and impose this tax. even more, the bill says that, if your employee decides he or she wants to participate in a government exchange and they like a richer plan elsewhere, even though the employer has decided to provide health insurance and is adequate, that employer would have to provide more money toward providing health insurance. it does not make sense. at the end of the day, if you pay tax to a payroll, it is a direct assault on providing jobs in this country. we ought not be doing this.

an analysis that was performed by a model developed by the council of economic advisers demonstrated that this employee mandate, this tax on small businesses, would destroy -- could potentially destroy 4.7 million jobs. this is why we need to support mr. johnson's amendment. mr. johnson's amendment. >> mr. johnson is prepared to close. i have two speakers if you two would take that into consideration we can dispose one way or another to the amendment. >> in 2008, there were 65 million people unemployed. >> thank you, mr. chairman. i will be quick. the reason that we are against this mandate, it will put more

americans up to 114 americans on the government plan. the government plans that we have today, medicaid and medicare, are broke. but there are trillions and trillions of dollars in the red. as long as we send secretary tim geithner to grovel to the chinese to buy bonds, as long as the federal reserve is going to buy bonds from the treasury department, the gentlemen from oregon is correct. this plan will work as long as we continue to print money. how much money can we print before we destroy this economy? >> mr. johnson. >> thank you, mr. chairman. i would just like to quote from

nfib. they are saying instituting insurance market reforms that spur competition and choice for private insurance is where we ought to be going, and they do not think we are going there by taxing our businesses. it seems to me if you are taxing a business that does not provide insurance, something is wrong with that picture. higher taxes are not the answer to get ourselves out of the problems that we are facing. i yield back my time. . . . >> the question is on the amendment. the amendment is not successful. the clerk will call the roll. >> martin vaughn, we spent the day talking about h.r. 3200.

day talking about h.r. 3200. e next step this fall? what do you foresee happening first? >> as the house lawmakers come back, they have to integrate their bill into the committees. there will be some negotiating over that. we do expect to see a house floor vote probably within the october timeframe. the leadership will also have to respond to the concerns of their democrats, even back in their districts, from their constituents. there are a good deal positives and a good deal of negatives about the bill. the senate is really where the rubber hits the road. they need to either bring 60 senators on board. following senator kennedy's

death, that means they need to find at least one republican another way to go is that they could pass a bill with a simple majority with 50 votes through a budgetary parliamentary maneuver that is rarely used. to do that, they will have to shave its back and talk some of the provisions and have a more stripped-down bill than they have today. >> have the committees passed out a bill yet? >> yes. the house committee passed down a bill. it was one of the first committees to do so. that bill has been out there. the finance committee has not passed a bill. they are continuing to negotiate. the house committee bill did not get support from any republicans. the goal of the finance committee has been to do a bipartisan bill with the support of at least two republicans. there is a big question as to whether they can accomplish that

given some of the comments about the direction the democrats are heading from republicans involved in the negotiations. >> so the health committee and the finance committee, did they look at the same bill? or are they each starting from scratch? >> each pretty much started from scratch. they have their basic goals and objectives. president obama has laid out some of the things that he would like to see. but there would need to be some gearing up as things moving forward. they are not the same bill at all >> tomorrow night, we will be looking at the senate debate at 8:00 p.m. eastern time on c- span. by the way, you can see all of this act c-span.org. you can watch it on line as well as on television. what is the impact of the town halls have had in your view? >> i think the impact has been pretty big.

there is a lot of questions about how much of the concerns raised and the practices -- and the participation has been from activists and how much has been from legitimate constituents. i have questions about this bill. i think it has been a little bit of both. i think that what the town halls have done is to slow the process and ask more questions about what the effects are for these provisions. they brought to light a real trepidation in the electorate about turning over health care to the government, whether or not you think the bill does this. in other words, giving the government a much larger role in

what now is a market dominated by private companies. >> if you would like to read a charge 3200, it is available at c-span.org. -- if you like to read h.r. 3200, it is available at c- span.org. you have read it. >> it is worth getting into the details of this bill. there's no question. i have been impressed with the degree to which the voters, of people, are involved and are trying to find out what the bill does. it is a real positive sign for our democracy and whether or not you slava through -- you slog through the entire bill, it is a good idea to have the key provisions in mind. >> thank you for giving us a little

>> we will continue our coverage tonight, and this weekend, a comparison of health care systems around the world with t.r. reid. >> coming up next, a look at an upcoming supreme court case dealing with corporate spending that supports or opposes political candidates. after that, a briefing on the h1n1 swine flu virus, and later, an update from the pentagon with defense secretary robert gates on u.s. strategy in afghanistan.

>> the house returns 2:00 p.m. eastern from its august break. they plan to begin the week with a number of bills dealing with federal lands and historic sites. later, a measure to protect and restore the chesapeake bay. lighthouse coverage on c-span. the senate is also back next tuesday -- lighthouse coverage on c-span. that will turn to legislation to promote u.s. tourism to people and other countries. the bill also creates a nonprofit tourism corporation that would get its money from fees on foreign visitors. the senate is live on c-span2. >> september 1 marks the 70th anniversary of the start of world war ii. sunday, a commemoration including german chancellor angela merkle, russian prime minister of labour putin and the polish president, at 9:00 eastern and pacific on c-span.

now, a look at the upcoming supreme court oral argument that deals with corporate spending that supports or opposes political candidates. from this morning's "washington journal," this is close to half an hour. k from "the new york times." let's start with the investiture process for the supreme court. talk about the court that she is joining. guest: the process is a lovely formality. nothing of substance happens there. it is a way for her friends and colleagues to celebrate her joining. the court she is joining is closely divided. she is coming in to replace david souter. he was a liberal vote. she is expected to be the same. she does not fundamentally alter the court.

host: least something yesterday about the dynamic inside the court when a new justice comes in. i would like to show the clarence thomas clip if we have an available. it is ready. we will come back and discuss what you know about the dynamic in the supreme court. >> you are bringing in a family member. it changes the whole family. it is different today than what it was when i first got here. i have to a net, you wrote very fond of the court that you have spent a long time on. there was a time there with chief justice rehnquist and justice o'connor when we had a long run together. you get comfortable with that. then it changes. now, it is changing again.

the institution, the nine, it is different. you have to start all over. the chemistry is different. host: is the new justice just about the dynamics among the nine? is it larger than that? guest: it does not look like the voting will change fundamentally. many justices will tell you that anytime a new justice arrives, we have a new supreme court. they have to interact with each other every day and work closely together. what you have heard from justice thomas and what you will hear from other justices is that these are older folks were not happy to have changed. they like the way it was. it takes them a little while to integrate a new personality into the court. host: next week, there is every argument of the case. how often does it we hear a

case? -- how often does it rehear a case? guest: it is quite rare. it is usually for a procedural reason. in this case, it seems that they discovered a large issue in what seemed to be a small case. they want to your argument before they make what could be a really important decision. host: the genesis of this case was a video that was made for last year's election by a group called citizens united. we're going to show you a little bit from the trailer. then i will tell us what is at the heart of the case. >> she is driven by the power. she is driven to get the power. that is the driving force in her life. >> she is steeped in controversy and sleaze. that is why they do not want us to look to her record.

>> it is worth remembering that after her health care fiasco, the clinton team put it aside. >> you have to ask whether she has learned a lot from that experience. it was a failure. she knows it was a failure. it was an embarrassing failure for her. >> she is a person who is struggling with figuring out who she is or how she wants to present herself to the american public. >> she is deceitful. she will make up any store, lie about anything, as long as it answers her purpose at the moment. the american people are going to catch on to it. >> a cannot think of any other politician in history of that shown such a disrespect and contempt for the constitution and the rule of law as hillary. i represented the nixon-- richard nixon's best friend. i knew richard nixon.

she is much worse. host: that was a clip from "hillary: the movie." it is widely available on the internet. guest: question is whether this 90-minute documentary to be treated the same way as political advertising. there is a law that says during some campaign periods, certain broadcast communications cannot be shown if they were financed by corporations. you have a 90-minute movie, a documentary that is relentlessly negative about hillary clinton. at the same time, it is a kind of political speech that has been thought to be protected at the core of the first amendment. it can be banned from the airways under the federal law. the question before the court initially was whether it was really that kind of movie and whether we should treat a

documentary the same way as a documentary the same way as a there were little questions in the case, but the court, instead of deciding the case by june, said waite, we will set this down for argument next week and ask a bigger question. the bigger question is, should we overrule a 20 year old president called austin against michigan chamber of commerce which said you cannot regulate the speech appropriations. so now you have this quirky little movie turning into a big question, can the government regulate corporate speech, or can we allow corporations to flood the market place with all kinds of communications, adds, documentary's, whatever, that support or oppose political candidates?

by the sides of the case, there are briefs that people can file on one side or the other. you have reported that there are over 50 in this case. is that unusual? guest: it is a very large number. it may be a record or close to it. this really engages people. there are very strong views on both sides. people were usually allies managed to think about the case in very different ways. some people think it is up first amendment issue, the public should not be denied the opportunity to hear vigorous political debate, including the relentlessly nasty communication that this movie represents. other people think that allowing corporations to play will make the playing field so uneven that will drowned out real political discourse and represent a threat to democracy. host: another interesting thing about this case is that a brand

new solicitor general will be arguing the case against a former solicitor general. talk about that. guest: it is really a clash of titans. we have the former dean of harvard law school and a first- rate lawyer, but not known yet is a great appellate advocate making her debut at the supreme court. on the other side, you have olson who was the solicitor general in the bush administration. he defended the mccain-fine eingold law. -- he defended the mccain-fein gold law. host: what are you anticipating that the supreme court plaza will look like on wednesday? guest: there will be a long line of people waiting to get in. they like to take a summer

break. for them to come back almost a month early to hear this is interesting in itself. host: our telephones are lighting up. let's get to your calls. john is on the republican line. caller: this is john from palatine know, illinois. -- this is john from illinois. the supreme court is like any other body in the government. there basically it lobbyists -- they are basically lobbyists. i believe the supreme court will go the way that the lobbyists want them to go. that is not in the interest of the american people. that is all i have to say about it. guest: it is an interesting point, but i disagree in this way. lobbyists and a lot more power over people who have to seek reelection. the justices are appointed for life. it gives them a measure of independence.

i think they think of themselves that way as well. host: this is dan. caller: we just had max boot on who made all sorts of declarative statements as if he spoke with some sort of authority. it is the media that makes it that way. it gives people time to present their views. everything is so declare to. nothing is argued or discussed. -- everything is so declar ative. nothing is argued or discussed. the question with this ad is whether the artificial corp oration has the same speech rights as individuals. the basic problem is not with this program. it is an attack akin to the pro- afghan wars statement made.

it was a total exaggeration. the question is, is the real person? he had the right to speak. this is what he did. a bunch of people did the same thing. they put their money in as an artificial individual or corporation to practice free- speech. guest: make an interesting point of whether we should treat corporations differently. i think lots of organizations that we agreed should have free speech rights are organized as corporations. my employer, the "near times -- the "new york times,"is a corporation. maybe listeners should be allowed to exposed to all

points of view and decide for themselves what the right answer is. host: we have a viewer that has sent a twitter message. it has been widely available since last year. guest: has been on the internet. it is available for purchase on dvd. it was shown in some movie theaters. i do not think it did very well. i am not sure it is out of keeping with other documentary's across the political spectrum. it is a-look at political tenets of the sort that we've seen 200 years ago, 100 years ago, and now today. host: is at issue is not the availability but the availability as video-on-demand? guest: became law only applies to broadcast satellite and cable

transmissions. it does not include all technology like newspapers or new technology like the internet. in the first case, the lawyer asked whether congress could hypothetically ban books. he candidly said yes. if it was financed by corp. and distributed during a certain time. , it could be banned. -- if it was financed by a corporation and distributed during a certain time period, it could be banned. caller: nothing is more important than this issue. if we had real campaign finance reform, the rich and powerful could not control this country anymore. if democrats have lost momentum, it is because the insurance industry has spent

almost $1.5 million per day to brainwash the public's against health care reform. that is spent on advertising in the media and campaign money for the corporate blue dog democrats. it is bribery. the supreme court does not have the guts to do anything that would make a difference on this issue that affects all other issues and the future of our country. that is campaign finance reform. thank you. guest: a thing that is a vigorous articulation of one side of the debate. -- i think that is a vigorous articulation of one side of the debate. the other side of the debate is that free speech issues are very important as well and that people can be trusted to distinguish between good and bad ideas. host: how many reviews of the mccain-feingold laws has it

undertaken? guest: it was upheld in 2003. the roberts course seems to be hostile to campaign finance laws. there have been baby steps. this is the first kind of big one. host: david is on the republican line. caller: i think mr. liptak it away some of his thoughts on the issue. he said that people were assaulted by 30-second commercials. i have never been assaulted by a television show or commercial in my life. i come from the other side. i think there should be unlimited speech. one of the original readings of the first amendment was to protect political speech. i am amazed that we're coming up

on the third mccain-feingold case. i hope the reason they wanted to be argued again was to take a broader look at it and start down more of it. i think that is what they're looking at. i hope that is what they are looking at. unions can put their money into campaigns. corporations can put their money into campaigns. guys like george soros pour millions of dollars into the campaign finance systems. i feel that if they do look at this hard, they will strike down more of it than people thought the originally void. guest: i think you're quite right. i think they will take a look at it to do something broader. my comment about being assaulted was to draw this distinction.

there is the difference between an uninvited ad and a video on demand program. that does strike me as being different in kind. if i care enough to learn about "hillary: the movie,"that is a little bit different from watching a football game and getting political advertising it is a distinction that the supreme court might increase. host: someone has tweeted us. does this case deal with the question of whether corporations have the same speech rights as people? guest: it certainly does. that could be a ground on which the court decides. it will be a point that the liberals make. a lot of people think that when

they buy a share of general motors, they're hoping it makes good cars not that will make interesting political ads. media corp's speak all the time. a part of general electric, nbc news, can say anything it would like. another part of general electric cannot. it is hard to know where to draw the line between the two. caller: i tend to be an anti- marxist in thinking. i tend to think that way myself in politics these days. i think the infusion of money into politics ends up o influencing our government too

much. could you comment on the development in the court or subsequent challenges to restrictions on campaign contributions like davis v. fec. in britain, they have a much shorter campaign season. much shorter truncated amounts of money can be spent by the major parties. i am wondering about the sort of development. you can put this at both ends of the spectrum. it could be health care, military contractors, republicans. it seems to polarize things because we do not have

restrictions that limit us to individual contributions by individual voters. every time there is some reform, there are loopholes that go around. the first thing i can cite is buckley vs. vallejo. guest: you are right in saying other countries would not tolerate this. they have much stricter finance laws. on the other hand, britain has a much less robust commitment to free speech. we have different traditions. the history of the supreme court decisions in this area, even think about two ends of the even think about two ends of the corporations are allowed to put up campaign ads supporting

ballot initiatives, but has said so far at least that they can be stopped from putting up ads supporting individual candidates or not. so we do not regulate corporate speech in general about politics, but we do regulated as to particular candidates. on the other end of the spectrum, the supreme court said that contributions to candidates by individuals or corporations can be limited, but that individual expenditures of people, including rich people, cannot. so if george soros wants to put up millions of dollars in assets, he may, but so far at least, general motors may not. michael more wanted to advertise "fahrenheit 9/11" on television. there was no question he could show it in theaters. if he wanted to advertise it in

mission george bush by name, the legal advice he got was that he could not during the campaign season. there is a similarity that runs through this. some people have said that " hillary" is not inherently different in kind. host: akron, ohio, this is dan. caller: i am a first-time caller. i'm concerned that each person have an equal voice in the election. when it comes down to campaign finance, how does the supreme court looked at thassuring that all the people have an equal voice to speak and receive information?

guest: i think you put a nice way. there is tension between liberty and equality. in a democracy, everyone gets one vote. on the other hand, you want everyone to be able to say what they like. some people have more money, power, access to the airwaves, and might be able to say more. the question then arises about whether the government should step in and try to equalize the volume of these different voices or should we allow everyone to say whatever they like as loudly as possible and trust people to make distinctions among ideas they agree with and ideas they do not agree with. host: regarding the circumstances of this particular movie -- guest: i think that is a fairly powerful argument. that is a distinction that the

supreme court may still draw. it is that we do not have to decide the big question today because we can go off on this smaller ground. there is a difference between having to go look for something the you're already inclined to hear and having people provide you with information at times you may not want it. host: sarasota on the independent line. caller: i think it is true that if you go on-line to look for something, you can look at anything you want. when you go to a movie, you pretty much know what you're going to see. if you turn on the tv and our bond added -- and are bombarded by ads, that is different. i think we need to either eliminate private financing altogether, but that is a pipe dream. or we should get the fec involved in making sure that there is a balance.

all the money in the world can buy only an equal amount of time as limited resources could. there has to be some method or technique of doing that. i wonder what your expert feels about the prospects of such a thing. they do. i will take my answer off the air. -- thank you. i will take my answer off the air. guest: a thinking makes an interesting point. i think it happening through the fcc is unlikely. i think it could only reach broadcast communications. so much of what we see on tv these days is on cable. that is generally beyond the purview of the fcc. with the rise of the internet, some of these issues may be of the last century. in short order, all of this activity may be taking place on the internet. it should be.

>> the supreme court has a rare, special session next wednesday. also marks the first appearance on the bench of justice sonia sotomayor. formal investor takes place later. >> it is stressful for us because we so admire our colleagues. i have great admiration for the system. the system works. it gives us the opportunity to look at ourselves and make sure we are doing it the right way, so that the new justice will be able to take some instruction from our example, if we are doing it the right way, and i am sure a new justice can always ask the question, what are you doing this for? then we have to think about

whether or not we should continue to do it. >> hear from other justices during supreme court we, as supreme -- as c-span looks at home to america's highest court, starting october 4. >> next, a briefing on the h1n1 swine flu virus. later, an update from the pentagon with defense secretary robert gates on u.s. strategy in afghanistan. then, more about afghanistan with remarks from british prime minister gordon brown on security in that country. >> all2 this week on all at 8:00 p.m. eastern, but tv. bill ayers joins us and talked about his leadership in the

anti-war movement during the vietnam war. see him tonight at 8:00 eastern on c-span2. >> we will continue our review of the health-care debate in congress tonight, with highlights from senate committee hearings, analysis by sheila murray of the washington post, and this weekend, a comparison of health-care systems around the world with former post reporter t.r. reid. >> yesterday, the center's -- head of the centers for disease control and prevention said the age one in 1 swine flu has not yet mutated, meaning the virus has not become more dangerous since it appeared earlier this year. from atlanta, this briefing is half an hour. >> the first point to make is that h1n1 influenza is here. it is spreading in parts of the u.s., particularly in the southeast, and in fact, it never went away. we had it throughout the summer and summer camps, and now with

colleges and schools coming back in session, we are seeing more cases. the good news is that everything we have seen shows of the virus has not changed and become more deadly. though it may affect lots of people, most people will not be severely ill. however, the h1n1 influenza and influence that generally is unpredictable, and that means two thinks. first, we have to vigorously monitored to see whether it is changing, who it is affecting, and what is happening with it. second, we have to be ready and prepared to change our approach, depending on what the virus does. today, cdc is releasing conditional data on some tragic

pediatric vitale's that occurred in the spring. i will provide you with more information on that -- tragic pediatric fatalities that occurred in the spring. the experience in the five countries in the southern hemisphere is very similar to what happened in this country in the spring. large numbers of people, particularly school kids, became ill. in some locations, hospitals had challenges to keep up with a number of people coming in, but overall, no increase in the level of severity, no increase in the death rate. in these countries, some possibility that indigenous populations were more severely affected by h1n1 influenza. you had a greater likelihood of having severe illness from h1n1 if you were a member of a tribal or indigenous population. that is not proven, but it is a

possibility. this information, as well as the child information i will be presenting shortly, emphasizes what we should do to prepare and what are the groups that are at highest risk, and therefore we need to reach out to the most. the mmwr study being released today out lines 36 deaths that were among the first deaths among children in this country. in two-thirds of those, the child had at least one severe underlying illness or underlying disability in most of the cases. several polls, muscular dystrophy, longstanding respiratory or cardiac problems, so most of the children who had fatal h1n1 infections this past spring had an underlying condition. there were some children who did

not have an underlying condition and who did become severely ill, and they were generally infected also by bacteria. when you get the flu, your immune system can be weakened. you can be more susceptible to other infections. that is an important message for doctors, to know that if someone has the flu, they get better and then they get worse again with high fever. that is a clue that maybe they should be treated with antibiotics, things that will help them. most people with lou did not need treatment. i will discuss that more in a bit. -- most people with flute do not need treatment. the review of the several dozen children who died this past spring emphasizes that flu can be very severe, and it is important that we do everything we can to protect people from the flu. i will allied some of the things that we are doing.

it also identifies groups that are particularly important to address. we have been working closely with pediatric societies, with parent groups and others to assure that, for example, children with special needs, children with cerebral palsy, mel -- muscular disability -- muscular dystrophy or promptly treated if they develop flu that they are at the front of the line for vaccination when it becomes available. protecting health care workers is critically important. we want to ensure that health- care workers are and feel safe when they come to work. they are the first line of defense, and we need to ensure that we do everything we can to reduce, to the greatest extent

possible, their risk of becoming ill on the job. protecting health care workers involves many different factors, including held hospital or health care setting is organized, whether people who are not severely ill come in for care and overwhelm the system, and how many different health care workers have contact with people who may be infectious. what is particularly important are circumstances where we think the risk is highest, but in all cases, we want to ensure that health-care workers are safe. the institute of medicine was charged by the cdc and the occupational safety and health administration with looking at what kind of mask or respirator health care workers should use. they are -- their charge, consistent with the ocean mandate, required them not to look at the economic or logistical considerations, but just look at their view of the

most recent science on protecting health care workers. we have just received the report. we are studying it, and we will review it in the coming days and weeks. the next issue of like to discuss has to do with vaccination. there is a lot going on with vaccination. we continue to anticipate that a vaccine will be available by the middle of october. the vaccine itself will be free. the administration may be charged by individual providers, although in the public health system, all vaccinations will be free. it will not be easy to get back seen update -- vaccine updates. we have the possibility or likelihood that it will be a two-dose series for children and like it for others. we will try to reach out to children and parents to get kids vaccinated. so many kids can get the flu,

and the vaccine is likely to be quite effective. my kids will get the flu vaccine when it becomes available, and i would recommend that all school children get vaccinated. we also are recommending that all people with underlying conditions get vaccinated, people who have asthma, diabetes, lung disease, heart disease, neuromuscular conditions, neurological conditions that increase their risk factors, and women who were pregnant. vaccination programs will be run by the states and localities throughout the united states. we are working closely with all jurisdictions to help them identify the challenges they will face in that region in vaccinating the people in their area and in addressing those challenges. we are in the process of releasing $1.5 billion in vaccine planning, prepared as, an administration funding that will allow each jurisdiction to

identify what are the strengths there. some jurisdictions will work largely with the public sector. others will work largely with the private sector. each place will know what the strengths are in their area and will be able to reach out to the specialty clinics, for example, children with special needs are people with asthma or diabetes, to have the detailed planning available. we also are looking very closely at the possibility of reports of adverse events. we know that every year there are cases of paralysis, there are women who have miscarriages, there are people have sudden- death. in all those situations, we need to know very clearly how many we would expect if the vaccine does not cause any problems whatsoever, in an average preseason, around half a million

pregnant women get vaccinated. that is important, because pregnant women are more likely to get severely ill from flu. it is a way of protecting them and ensuring that they have a healthy pregnancy. among those, if they had not gotten vaccinated, we would have expected more than 1000 miscarriages within a week after the vaccine. if they are vaccinated, we expect about 1000 or 1500 among a half million women who are vaccinated. that is the kind of number we need to track and understand to see whether, when we do see adverse event reports, because we know there will be some, they are occurring at a higher rate than expected. in the coming weeks and months, with school resuming, we do expect to see more cases. we are seeing it now, and we expect that will continue. how long, no one can predict with certainty.

influenza is unpredictable. that means we need to monitor closely and be willing and ready to adapt to different approaches. one of the challenges is preparing our healthcare system for the likely increase in the number of people who will seek care. we know there are lots of things that can be done to reduce the spread of flu, and that needs to occur, but forced people with the flu, there is no reason to see a doctor or go to the emergency department unless you are severely ill, for example, you have trouble breathing, or you have an underlying conditions such as diabetes, pregnancy, heart disease, lung disease. for people who do have an underlying condition, is quite important to be seen promptly, if you get a fever. that can make a difference between being severely ill and recovering well.

treatment in the first 48 hours can make a big difference in hastening a recovery. we also know that as of now, not only has the virus not become more virulent or deadly, we have not seen a lot of drug resistant strains. the drugs we have available are still very effective against the virus at this time. the big picture is that there are two things we can do to reduce the impact of flu. one is to reduce the number of people get infected, and the second is reduce the proportion of those who get seriously ill. to do that, vaccination is our strongest tool. with the vaccine not get here, what we can do now is to reduce the number of people who get severely ill, stay home if you are sick. cover your cough and sneeze, and wash your hands frequently. that means that workplaces

should increase the availability of teleworking, to the extent possible. employers should not penalize workers for stay home if they are sick during flu season, nor should employers require a note from the doctor to return to work, because the doctors will be very busy taking care of people who are sick with flu. in or to reduce the number of people who become severely ill from flu, prompt treatment of people who have underlying conditions or severe illness is very important. flu is unpredictable. flu season is just beginning. it is very unusual to see flu continue through the summer as it did in the u.s. this year. it is unusual to see this many cases this early in the year, but only time will tell what this flu season brings. what we are doing is everything in our power to be as prepared as we can for the things that

may occur in coming weeks and months. i will now be happy to take questions. >> i was really interested in these bacterial infections, because most of the reports up until now have been about viral pneumonia. i just wondered if you can, and indeed if you can comment, is the upshot of this that more help the children may be at risk of serious disease? i also want to ask separately about how significant you think these findings are in china that one dose of vaccine may be sufficient. >> taking the last question first, we look forward to seeing the data from china and elsewhere about vaccine efficacy. it is very important, and as soon as we see, it will help us

inform the policies here. fundamentally, we need to look at the u.s. vaccine and how that vaccine does in the trials that are under way. bacterial pneumonia is a known complication of flu. this is one of the things that is often problematic. the findings we are releasing today are not unexpected. this is what we see with seasonal flu. it is quite similar with h1n1 influenza. it is of primary importance to doctors to know that if someone has had the flu and the comeback with a high fever later, it is important to think that it may be a bacterial pneumonia, and to treat for that. it also emphasizes the use of pneumonia vaccination for all people for whom it is indicated, including children and the elderly. >> thank you for taking my call.

looking at these pediatric deaths, since that is something people are very shocked by, what more can you tell us? i know you talked about bacterial infections, but what is the message you want to get out to the parents who are saying they need to go to the doctor, even though that is not what you are recommending? what is the most concerning data you found within the report? >> it is important to put a report in context. in new york city, where we have the big picture on how many people got infected, hundreds of thousands of people got infected, and the overwhelming majority of them had moderate illness and did not require testing. it did not require treatment, and they did fine. if children have underlying conditions, and two-thirds of the children in this report had conditions such as muscular dystrophy and several policy, is very important that they treated

promptly. if a child is severely ill, if they are having trouble breathing, if there fever comes back after it away, if they are having difficulty keeping fluids down, then it is very important to be treated promptly. the question is important. this is a real challenge. we need assistance from the media as well as the public to understand the balance between saying on the one hand, the overwhelming majority of people with h1n1 influenza are going to define, they did not need testing or treatment. on the other hand, if you either have an underlying condition or you have severe illness, it is really important that you get treated promptly. that is a complicated message, but getting it right is not only important for helping people stay healthy, it is very important for making sure that our hospitals and emergency departments are available to the community and to the people who really need the treatment.

>> could you please explain began what you said about the numbers of miscarriages that would be expected if people were vaccinated or not vaccinated? i cannot quite follow that. >> the basic point is that certain conditions occur whether or not vaccination happens. we need to anticipate that those conditions will occur after vaccination, even if they are not caused by vaccination. in 1976, for example, there was an increased rate of dionne array syndrome. that occurs in depending on the age of the population. we are looking at somewhere around one per 100,000 people as a routine work a norm, even if there is no vaccination. we need to recognize there are

baseline rates of things like neurological syndromes and miscarriage. in an average low season, around half a million pregnant women get vaccinated. in that group, there will be miscarriages. those miscarriages, even if you gave placebo vaccine, you would expect more than 1000 miscarriages in the one week following vaccination for those half million women. if we see that after a 21 vaccination, that does not imply there is a problem -- after h1n1 vaccination. " we need to see is whether the rates that occur are higher than would occur if no vaccine had been given. with that, only time will tell. the bottom line here is, we will look very carefully to see whether there is a problem with this vaccine in terms of safety. we do not anticipate that there will be. it is produced in the same way

the flu vaccine is produced each year. it is a new strain, just as we put new strains into the flu vaccine every year, and flu vaccination has a long-term, very good safety record with literally hundreds of millions of doses having been given. >> i was hoping i could get you to talk about something you touched on earlier, the balance of identifying when people need to seek care. some people will think they are fine and then start to get worse and need to go see a doctor, and they may be outside the 48 hour optimal treatment window for anti-viral drugs. is the cdc recommended that doctors start treating with antiviral later than 48 hours if it looks like someone is

developing severe disease? >> if someone is severely ill, then they should be treated, even if it is more than 48 hours. the most good is done if the treatment is within the first 48 hours. >> i am a producer with fox news. i just want to ask more about the vaccination that novartis has announced, a one dose vaccination. are we going to be able to have a one dose vaccination in the united states as opposed to two? >> we need to look at the data as it comes out. that study was done with another material added to it to boost the immune response. we do not anticipate we will be using that in most of the

scenarios that we anticipate now. we expect that the likelihood of needing to doses is higher. for the data coming out of china, we will have to review it. for seasonal flu, for kids under the age of nine, we currently use two different doses. it is likely that at least for kids, to doses will be required, but only time will tell. this is one of the things -- we are going to look at the data and understand the situation as best as we can. we will provide the best options for people to take to protect themselves and their families. >> a lot of parents are very concerned about this. if they feel that h1n1 starts popping up in their school or their day care center, if they

do not feel that the school or day care center is taking the necessary precautions, should they call their kids out? -- should they pull their kids out? >> kids and parents need to learn. there is a lot that happens at schools that are very important. we have had a handful of schools closed for a day or two. if your kid is sick, please keep them home. they will get there quicker, and they will not in fact people around them. schools should insure that kids who are sick are separated and sent home with a parent or caretaker, and that kids cover their cough, cover their sneeze, and wash their hands. if those simple steps are taken, the number of people who become infected will come way down. when vaccine becomes available, schools will be an important location to give the vaccine in many parts of the country. . .

this year, only time will tell what that number is. these use it -- the flu season this past year was very unusual. it was because you first had in normal flu season, which was a

relatively mild season. then you had h1n1 influenza. it occurred at of the normal time frame. only time will tell what will happen in the fall or winter. the message to take home from this study is that kids with the underlying conditions need to be treated promptly if they develop a fever and a need to be at the front of the line for a vaccine when it becomes available. >> operator, another question forfrom the funds. >> thank you for taking these calls. there was a note on the report that the struck me. kids up to four years of age were most affected with

respiratory syndromes. but they had a low percentage of cases in this age group, whereas 70% to 80% represented the other buyers. can you explain and expand on that? >> in parts of the country and the world where the flu is spreading, it has been very important for hospitalized patients, particularly for patients in intensive care unit, to determine what type of infection they have. the test for influenza is not only not necessary for those with moderate heat illness, but for severe illness, it is insufficient. there are many faults tests from the negative test. there are people in the intensive care units were doing it aggressive research.

it is not always h1n1. can be other things. only testing at that intensive care unit level of care can determine that. >> in the southeast, what are you seeing? we are seeing a lot of flu activity. what do you attribute that to? >> we are seeing a lot of h1n1 into one the scattered around the country, particularly in the southeast. the most likely explanation is that schools started earlier here in georgia where there is relatively widespread infection of h1n1 influence occurred it may also -- h1n1 influenza. this is one of the many things

that we have to monitor very carefully so that we can figure out what is going on. we can adjust our approach based on what is exactly happening. >> we have time for two more questions. >> thank you for taking the call. i wanted to follow up on their recidivism report. as you know, there are not a lot of health care facilities -- while there is a potential shortage of these, if there were to be a very large outbreak of disease, how would you like health care workers to respond to this information and how do think they should respond? >> we have just received the institute of medicine report. we are studying it very carefully. there are charged specifically to not consider economic or logistical concerns, such as

supply. as we look for guidance from health-care facilities, we will be looking at this in the coming days and weeks. >> thank you for taking the question. doctor, to questions -- first of all, in the. -- in the pediatric report, do you know where the kids pick up the in sections, the hospital- contracted infections? also, for the kids under 5 years old versus fivover five years o, is it true that it is deadlier for school-aged children than for older kids? most of those infections were picked up in the community, rather than in the hospital. in terms of relative severity, i think the jury is still out.

so far, it is not more severe. we do not know that is less severe. we are now at 500 deaths from h1n1 into one that at all age groups. that emphasizes that the flu can be a very serious disease. that means staying home if you're sick, covering if you call foresees, washing your hands, and, if you are severely ill, trouble breathing or have an underlying condition, get treated promptly when you have a fever. when the vaccine becomes available, make sure that we get as many people vaccinated as want to be vaccinated. thank you very much. >> in a moment, we'll have a briefing from the pentagon about afghanistan.

after that, we have more about afghanistan with remarks from prime minister gordon brown. later, at 8:00 p.m. eastern, we have highlights of the senate health committee debate on health care legislation that took place earlier this summer. >> the house returns tuesday at 2:00 p.m. eastern from its august break. members plan to begin the week with a number of bills of dealing with federal lands and historic sites. later, next week, a measure continuing federal programs to protect and restore the chesapeake bay -- we have live house coverage on c-span. the senate is also back next week at 2:00 p.m. eastern. they will begin with a general speeches. in the lot -- later in the day, we will turn to promotion of u.s. tourism to people of other countries. there's also a nonprofit corporation that would get fees from its foreign visitors.

that will be on c-span 2. lessons in leadership from the former head of syncom, a retired general tony zinni. part of c-span 2 booktv weekend. >> they spoke with reporters for 45 minutes.

>> first, we have some context. soon after taking office, president obama approved the deployment of 21,000 additional u.s. troops to afghanistan to help cope with the anticipated taliban defensive end to provide additional security for the afghan elections last month. our allies and partners also send significant additional troops to provide security. in late march, the president announced the comprehensive new civil military and diplomatic strategy for afghanistan and pakistan with the goal of disrupting, dismantling, and defeating al qaeda in order to prevent them from launching another major attack against our country. a new military commander was appointed to implement the military component of the new strategy. when general the crystmcchrystak

office, i told him to report back to me with his implementation of the president's new strategy. i received a report two days ago and informally forwarded a copy to the president for an initial raid. i have passed general petraeus, the joint chiefs of staff, and the chairman to provide me with a very dollars and of the assessment and situation in afghanistan -- to provide me with their assessment and evaluation of the situation in afghanistan. all of this is being done as part of a systematic process to make sure the president receives the best military information and advice on the way ahead in

afghanistan. as i said earlier, what prompted my request for these assessments was the arrival of a new commander in afghanistan. not any new information or perceived change on the ground. my request and the response are both intended to help us effectively implement the president's march strategy, not launch a new one. general? >> thank you, mr. secretary. i would just add a couple of thoughts. on process, let the secretary indicated, he has asked that she's and myself to review the initial assessment and provide -- he has asked the chiefs and muscle to review the initial assessment and provide our thoughts -- he has asked the chief and myself to review the initial assessment and provide your thoughts. we're going to do that with a

clear eye with not only the needs of afghanistan, but the needs of the force in general and our other security commitments around the globe. second, it is clear to me that the general has done his job as well, laying out for his chain of command a situation on the ground as he sees it and offering, in frank and candid terms, how he believes his forces can best accomplish the mission the president has assigned to him. that is what this whole thing is about, the mission assigned, the strategy we have been tasked to implement. there has been an enormous focus on troop numbers and time lines lately. there's lots of conjecture and speculation. i ended and the interest in those things and it is legitimate. those numbers represent -- i understand the interest in those things and is legitimate. those numbers represent real people.

what is more important in the numbers of troops he may or may not ask for it is how he intends to use them. it should come as no to sta surprise to anyone that he would use those forces to protect the afghan people, to give them the security they need to gain the influence that the taliban seeks. you have heard me talk for the last two years about afghanistan. you know how i remain concerned about the situation there. there is a sense of urgency. time is not on our side. i believe we're going to gain the initiative. we have a strategy. we have a new approach in implementing that strategy. we have leaders on the ground to know the nature of the fight they are in, leaders to know that the other people and the other families who matter just as much in this fight are the afghans themselves. our mission is to defeat al qaeda and to prevent afghanistan from becoming a safe haven again.

we can accomplish that alone. we will need help from other agencies in other countries. we will also need the support of the local population. in my view, the numbers that count most are the numbers of afghans we protect. as one villager told a visiting u.s. lawmakers recently, security is the mother of all progress. >> thank you, a question for both of you. support for the war in afghanistan is eroding. how concerned are you that the fading support will make it harder for requests to be fulfilled? how concerned are you about the idea that the war is slipping through the administration's figures? >> i do not believe that the war is slipping through the administration's figures. i think it is important, first

of all, the nation has been at war for eight years. the fact that americans would be tired of having their sons and daughters at risk and in battle is not surprising. what is important is for us to be able to show, over the months to come, that the president's standinstrategy is succeeding. that is what the general is putting in front of us. it is what we can, at least from a military standpoint, due to show signs of progress and those lines. there is always a difference between the perspective in terms of timing in this country and certainly in this city and what is going on in the country.

what i think is important to remember is that the president's decisions were only made at the very end of march on and this strategy. our new commander appeared on the scene in gen. we still do not have -- on the scene in june. we still does have all of the forces that he has authorized in afghanistan. we are only now beginning to be in a position to have the assets in place and the strategy or the military approach in place to begin to implement the strategy. this is going to take some time. at the same time, no one is more where then general mcchrystal,

and certainly the two of us, -- no one is more aware than general mcchrystal, and certainly the two of us, that the progress needs to be bichon. we understand the concerns of -- to be shown. we understand the concerns of the american public. we now have the roseresources ad the right approach. turning around the situation that many say has been deteriorating. >> this has been a mission that has not been well resourced. it has been under-resourced almost since its inception,

certainly in recent years. it is part of why it has gotten more serious. president obama has approved the troops -- approved the civilians that are just arriving on scene. i talked about his sense of urgency and i do believe that we have to start to turn this thing around from a security standpoint over the next 12 months to 18 months. i think the strategy is right. we know how to do this. we have a combat-hardened force that is terrific in counterinsurgency. the general believes it is achievable and i believe that we can succeed. it is complex. it is tough. we're losing people, as everybody knows. yet that is the mission that the president has given us and is in the one that we're very fixed in carrying out.

>> if you do not hear that congress is going to -- how you feel they will respond to requests for resources? >> i am very aware of the debate. i am a vietnam veteran. i am raised in a country that cherishes that debate. from a military perspective, we have a mission to do the best we possibly can to carry out. >> you have been concerned about the size of our footprint in afghanistan. in the middle of all this talk of virgin say -- of urgency, is it clear that general the crystal will ask for more troops? >> i am not going to speculate about what's resources -- what

sources he is going to ask for. the number of troops in afghanistan has nearly doubled in the last year. the number of allied and partner troops have nearly doubled in the past year to 18 months. there has been a significant increase -- a major increase just in the last few months. i have expressed concern about the footprint. i have expressed concern, as the chairman referred to in his remarks, about impact on the force and other worldwide responsibilities. by the same token, i take seriously the generals point that the size of the imprint -- of the footprint depends in significant measure of the nature of the footprint and the behavior of those troops and

their attitudes and their interactions with the afghans. if they interact with the afghans in a way that give confidence to the afghans, that we are their partners and their allies, then the risks that i have been concerned about the footprint becoming too big and the afghans seeing as in some role other than partners i think is mitigated. but i am very open to the recommendations and certainly perspective of general mcchryst al. >> the general has placed great emphasis on reducing civilian casualties. they have been dramatically reduced. he has placed great emphasis, literally, on how we traveled throughout the country, in terms of being mindful of those citizens that live there. and those kinds of things that he considers strategic

vulnerability is to our ability to focus on the people and to partner as the secretary has described. he has made this change is since he has arrived. those are significant steps in the right direction. >> can you talk about how this will work, his request for report to you for trips and whether they want a troop increase? will you be presented with options? in the end, if he says he needs more troops, how can you turn him down? give us a sense of that and how this will be presented and in what way? >> presuming he makes some kind of a request, it would be my expectation that we would handle it very much in the way we have handled every other request for resources previously, in both iraq and afghanistan. his recommendations or

alternative courses of action would follow the chain of command. they would go to general petraeus as the commander of central command who will offer his view. that will then be afforded to the joint chiefs of staff and the chairman and they will evaluate it and add their point of view. i will then add mine and provide that to the president. there will be a discussion in the interagency and debate about the pros and cons of various things. i will use the iraq security situation as an example. a lot happens in the dialogue and up and down the chain of command. i really do invite the chairman to add in when i am done here. when general odierno came in with his time lines and the risk that was susceptible -- that was

acceptable to him with the presence of combat units in iraq, there was a dialogue back and forth between general odierno and general petraeus and between him and the chiefs. a very merge the consensus that we probably could take somewhat more risk -- and there emerged the consensus that we probably could take somewhat more risk. i expect to live there is a recommendation from general mcchrystal, there will be the same kind of dialogue that there has been with respect to iraq. >> in fact, earlier this weekend, that chiefs and general petraeus and general mcchrystal at work to understand it from his perspective.

at our level and at general petraeus's level, he has to understand it. we have lots of troops in iraq and there is tension between those two theaters in terms of troop distribution. the chiefs have a global obligation in terms of the force. that does not mean that they do not consider that. it is their responsibility to consider that and we've that into the overall discussion and then make a recommendation based on how we see where a general mcchrystal is and how we see the overall mission. it is going to include risks and various options, if we get to that point. but we're not there yet. we're trying to understand both of the assessment and their will be a resourced piece that will follow. >> let me follow-up on the footprint that elizabeth was talking about.

he has been widely criticized. that he did not want a big footprint of american troops and he did not build up enough. have you thought about that? >> no, because, frankly, i was not here for that discussion. i will say this. i think there's a real mistake in comparing iraq and afghanistan. i see that a lot. i think there are real limits to analogies between the two in a number of different ways. for example, iraq has had a very strong central government for a very long time. that is not the case with afghanistan. that is a huge difference between the two. again, i think that the

footprint issue can cut in several different directions. i have been concerned about the size of it. and i would expect those concerns to be addressed. that is one of the things that i asked when we were in belgium for the general to address. >> specifically in afghanistan, what is the genesis of your concern about the footprint? >> history. and as a number of articles have pointed out, where foreign forces have had a large footprint and failed, in no small part, it has been because the afghans concluded that they were there for their own imperial interests and not there for the interest of the afghan people. so how the footprint fits into this, as the general suggested, also has to take into account

how the afghan people look at that presents. this has been my issue, something that i have worried about, ever since i took this job. first, we were not paying enough attention to afghanistan, but, second, trying to figure out is there a tipping point where the afghans begin to see us as part of the problem rather than part of their solution. i think that the approach that general mcchrystal has taken in terms of civilian casualties and in terms of the way we -- our troops interact with the afghans has given us a greater margin of error in that respect. i think it does affect the way the afghans look at our troops. >> the mission is to protect the afghan people.