bother me at all. as a business guy, i have looked at how does american business compete with the rest of the world? for every dollar that we spends on health care in america, somebody in countries like eng lapped or france -- england or fraps spends about 63 cents and our new competitors, india and china and some of the emerging nations, spend 15 cents. american business spends on average about $3,000 more per employee than any other country in the world. our health care costs are weighing us down. next slide. next slide. ma'am, people will get a chaps to make their point. here is what will happen if we do nothing. if we do nothing, you are going to see the federal budget deficit which is already too big absolutely explode. second point is -- with

continuing rising costs in health care, it is also going to make the rest of our economy less competitive because since health care costs are currently tax deductible, that again leads to our deficit. next slide. what does that mean for virginia families? if you look over the last eight or nine years, and these are not my facts. these are absolute facts. we can disagree with what we do from here, but this is where we ought to agree the starting point is. over the last 10 years you look at the growth in wages and growth in health care costs. if you pay insurance, and i got private insurance, most of you got private insurance. if you got insurance, you've seen your premiums triple over the last 10 years. next slide. if we do nothing by 2016, an average virginia family will spend 40% of their income on health insurance premiums. to my miped for most virginia families that's not sustainable.

next slide. so here is the price of doing nothing. we may disagree with what reform ought to look like and you may want to say this is your choice. but if we do nothing, the facts are clear. we will explode the federal deficit, we will see premiums double, and american business i don't think will stay competitive and the employees productive in the world. i will get to questions. last slide. here are the two -- i've got three guiding principles of what i am looking for in health care reform. quite honestly, there are some against and some for here. i probably don't agree entirely with either side. as a matter of fact, when i ran for senate, i wanted to a bipartisan, radical centralist. that means i get grief from both sides and i intends to get grief tonight. but my three principles around health care are number one, it cannot add to the federal deficit.

number two, number two, that we have to start driving our health care costs down for all americans all across the board. and number three, i believe the most important thing that we can do to start driving our health care costs down is change the financial increptives we have in our health care system. right now in america -- let me acknowledge we do have the best health care system in the world if you -- if you are having a heart attack or need an operation, we have the best health care system in the world. if you have a chronic disease which is where 70% of our health care costs come from, hypertension, diabetes, we don't do a very good job on managing that. what i believe we need to do, the mows -- most important thing that i don't hear enough of from washington is we need to change

the financial incentives so we no longer pay our doctors and hospitals and drug companies based on the number of tests you get or the number of prescriptions you get or the number of visits but on the quality of care you get. that's not impossible to do. it's not saying that means you have so socialize medicine and health care. no, you don't. there are companies all around america, there are companies like safeway and delta airlines, large employers that have shown that this can happen. so i just wanted to start with where we are right now and the costs of doing nothing and i wanted to give you my three guiding principles i am looking for that will frame all of the rest of my decisionmaking process on this very important issue. i thank you all for coming. i will turn it back to curry for questions.

>> again when i call a number, please go to the aisle nearest you and someone will bring a mic to you. number 0120. number 0166. someone will come to you. that's fine. just stay standing. 1490. there are two here. is one more down there? somewhere? ok. great. go to an aisle. sir, go ahead. >> my name is edmund. i have three kids, wife, live in

spotsylvania. i want to know how it's going to be paid for? how is it actually going to be paid for, no run around? i like the health care i have. i know if we go to a public option or anything else -- >> is that good now? the question was how is it going to be paid for? do you want me to answer it or do you want to add one more -- >> the recession has hit us pretty hard. i've had to claim bankruptcy because of it and i just like to know how it's going to get done

without any questions, without any run around? >> yes, sir. the question is how are we going to pay for it? you work the an automotive store, sir? i got to tell you, the only people who -- >> big business. huge business. >> i thought you worked for a small business. if you work for a small business the only people who pay retail for their health care are small businesses. and individuals. so let me give you three specific ways that i think we can pay for this. first, we spend $2.5 trillion right now. every study around has shown that 30% of those costs are wasted, duplicated, or give you one example, how many times do you go to the hospital and get asked the same question nine or 10 times? well, if you simply have coordination of existing care,

every system armeds has shown that you can save between 20% and 30% of our current health care costs by making the system more efficient. part of that is around electronic records, part is around better prevention of wellness. second thing you can do, i believe, and there will be people who disagree with me here, that if you are really going to drive down health care costs, that the most cadillac health care policies in america, that some large american businesses have right now, that give people $35,000, give you tummy tucks and everything else within your health care plan, that above some level you ought to start taxing those plans. third, third -- the gentleman asked me a question. if you are going to -- folks, we

can yell and you folks wone get a chance to ask the questions. we ought to be respectful to the gentleman who asked the question. 30% of the folks who are uninsured in america right now make more than enough money to buy a minimum health care coverage plan and they don't choose to buy it. i believe that above some level, whether it's $8,000, if you have that kind of income, just as we require you to buy car insurance, i believe that you ought to be buying a minimum insurance plan. what happens right now, sir -- what happens -- what happens right now -- ha happens right now because i've got a lot of friends in northern virginia, for example, 28-year-old making a lot of money, they're high-tech. they don't think they need health insurance. god forbid they have an accident. they end up on the front porch of a hospital and we pick up the

costs. to my mind, that's not fair or right. thank you for your question. i got to move on to the next question. sir, you will get a chance. >> can you hear me? >> good evening. >> good evening, sir. thank you for putting this town hall together. really appreciate it. i've got a few notes here but i want to give you a little bit about my own history. probably you can tell by my accent that i was born in a country, i am a citizen by choice, not by birth. it's an honor. there is a graveyard in scotland that is accommodating my younger brother who died at 42 years olds because he conts get a -- couldn't get a kidney transplant under a national system. the situation talking about nationalized health systems is asinine. one, we can't afford it.

we can't afford it, nor is it really a priority for the nation. there has ban lot of talk about the numbers of people who are uninsured. that's debatable. we know that there are 10 million uninsured legal aliens in the country. putting this in the context of the overall suspect it about time we closed down the borders and protected ourselves? i am an alien. i realize coming to this country is an honor. one more thing. nationalized health care is not a new thing. it's not a progressive idea. it's nearly 100 years old. it's about time after 100 years that you started listening to the populace. we don't want it. >> the question was -- the

question was, there was a comment in the question. the question was about illegal imgrapts. there is no health care plan or any health care proposal out there that will extend health care coverage to illegal immigrants. folks, right now what happens is we pay for the 46 million americans and others who don't have health care coverage when they show up at the emergency room. but none of the proposals -- excuse me. excuse me. excuse me, folks. let's move to the next question. yes, sir.

>> senator, so many d.n.c. leaders haven't paid their taxes in the last year. i was just wondering if you have, first of all. secondly, the country is $9 trillion in debt. you know, health care requires competition. without competition, we are not going to have service. we are not going to have choice. you don't have to rip and replace the existing health care plan in order to cover everybody. you can make minor modifications and you can test those modifications geographically across the country before you damage everything that's already been done. so we are all concerned about not necessarily the current

senate and congress totally collapsing the country although we are on path to do that but what about the senate after your senate and the next one down the road? every time we start a new program like social security or whatever it is, we ends up mortgaging our future. medicare is broke. medicaid is broke. they're going to be -- they're trillions of dollars in unfunded mandates there. so you got to find a different solution and you have to start over. you have to listen to conservatives. you expect wing it in the -- can't wing it in the d.n.c. >> thank you. thank you for your comment. quite honestly, sir, as somebody

who came into virginia that was deep in the red and left virginia with a budget surplus, i will match my fiscal credentials against anybody in washington or that matter anybody in virginia. as somebody who got virginia -- the best managed state in america and has spent a career in business, i agree with you, sir. we got to do something about this deficit. part of the points that i pointed out was -- sir, give me the respect of answering -- was that our current system. you said it, medicare is not sustainable unless we change our financial incentives. what guides me arounds mcreform will be back to this gentleman's cost here. it has to be paid for, expect add to the deficit appeds has to drive everybody's health care costs down. everybody in the private sect your as well. i absolutely believe that we need to continue our system

right now that has a private competition and has medicare and medicaid on a sustainable basis. unless we change the financial increptives, we are not going to do that. next question. >> i've got another set of numbers. let me read these off. 1500. the gentleman over there. 1494. 1494. ok, come on out. and 1495. i wept back and mixed it up. i am sorry. it's like bingo. one thing that i would ask, though, the more cheering we do and it's great that people are enthusiastic, but it's cutting into the number of people who are going to get a chaps -- chance to speak.

please, it will move along better. next question. >> senator, i will try to make this brief. i am not an orator so bear with me. first off, i would love to be in a position where i had some confidence in what is going on in washington and what's going on with the obama administration. until that time comes, i have a real hard time seeing a system put in place with health care that runs the risk of taking my rights and giving it to the government to make life decisions about me and my family.

with that, senator, i am asking for your help, to help us conservatives who happen to have elected you to office to help us get onboard with your program and what i am going to suggest is i am going to suggest that these 1,000-page bills that you folks in congress aren't going to have the time to read, i am going to suggest that you go back to your office, get with the obama administration, and let's lay it on the table. and by that, what i mean, sir, i want to know who are the people that are writing the language to these bills? do they support the constitution of this united states?

if they in fact do not, what do they support? we hear from much of the media, some of the conservative media, that there are people that are calling the shots in washington that have radical backgrounds, are communist affiliated and socialists. we, the people, do not support that type of government. >> next question. let me just say, sir, that the way the bills are writwritten, they're written in committee by the members, democrats and republicans. they're voted on. so you've had your question, and let me just assure you that

before any -- before i vote on any senate bill, i will read it, review it and we may not agree, but i will read and review any bill before i vote on it. next question. yes, ma'am. sir, you can be disrespectful to the rest of us. ma'am, if you would ask the next question. sir --

the 10th amendment -- >> sir, i would ask you to respect the over 1,000 people who are here who are abiding by the rules. you talk about rules, sir. common courtesy and respect is one of those rules. yes, ma'am. >> good evening, senator warner. >> good evening, ma'am. >> thanks for hosting the town hall tonight. while this question does not pertain to health care, it does pertain to government spending on clean energy. recognizing the american council for an energy efficient economy found that we can reduce our electricity consumption by 19% here in virginia through inexpensive investments in energy efficiency. will you vote and support planned energy this year? >>man ma'am, i apologize to you and everyone else because the disruptive gentleman didn't

allow me to hear your question. >> i am sorry. while this question does not pertain to health care, it does pertain to government spending on a clean energy. recognizing the american council for an energy efficient economy found we can reduce our electricity common sumpings by 19% in virginia through inexpensive investment in energy efficiency. will you vote and support clean energy and climate legislation and also, senator, we have 5,000 cars here today from virginia yaps and we want to turn them in to you today. >> thank you. the question was on energy. i think the bill that has come out of the house will need major changes. but i also believe this. i say this as a business guy, not as a politician. i believe with all my heart over the next 25 years, the area that is going to crow ate the most jobs and most wealth in the world is going to be the energy

sector and i want america -- you may not -- let me give you my answer. i believe that over the last 25 years, one of the reasons we have stayed competitive is because of our investments in information technology. i want america to lead in the energy sect your as well and i don't think either party has been very good about making the investments in next generation. i got to tell you, in my minds that includes nuclear energy and all the other alternative energies. we have to put it out there and i believe if we do that, american innovation will rule the day. next question. >> that wasn't a question. >> hello, senator warner. my name is paulette hodges. i want to thank you for being a wonderful governor and i am looking forward to you being a great senator. i have a lot of faith in you, and i voted for you and supported you for many years. i do have some questions today,

though, they're very brief. and i know that the obama administration claims that the a.m.a. supports his health plan. however, that only represents about 29% of doctors, i have been told. therefore, 71% of doctors are against the obama plan. should we listen to them? also cancer doctors and cardiologists are against it, i learned on television recently, and i think we should listen to them, too. the other thing is, the catholic church just came out very against the obama care plan because they say it will fund abortions. and i trust these people. so shouldn't we listen to them? this is my question. >> i think what we are going to do -- i apologize for your comments. i didn't hear all of it.

i will continue to listen to the people. i got concerns with a lot of the stuff that's happening on both sides of this debate. what i wish we could do is lower the volume a little bit, get some common facts and realize that i permly do not believe in a big single government payer system. i believe we have to keep a competitive base system but i believe if we don't reform our current system we will lead to bankruptcy at a national level and on an individual level. i would ask now on the questions because i am having a hard time -- i imagine you are having a hard time hearing as well. i will ask the folks to come up front so we can hear the questions better. next question. >> 1130. please come down here. come down here. 0602. 1410.

1410. >> this gentleman. >> my name is ken morganthal. at one point virginia had a very good insurance system. it was called blue cross, blue shield. then anthem decided they would take over and make it a for-profit system. why can't we have a co-op in virginia once again that looks out for keeping the costs of the health insurance policy low rather than looking out for the executives of those companies and trying to make as much profit for those executives who have been bailed out by the administration and keep a co-op?

>> the question was about co-ops. what we have to have is more competition in the significance tem with the insurance providers. co-op is one option. another option might be -- another option might be the opportunity to say some of these large employer plans that are out there, that are actually driving down cost, let people buy into those or have an option to join those. one of the things that i've got -- for example, one of the things, just so that this question will be asked at one point. let me get it out there. i believe that whatever is created, that i as a senator ought to live with just like everybody else. but one of the things you need to know, folks, is that one of the -- what i've got right now as a senator -- i don't have a public plan. i get a choice of private plans. but what most americans and a lot of virginiaians particularly in more rural communities and actually sir what i've got right now is a not-for-profit co-op

and i think that was one of the good models. but a lot of communities there is no competition. i am a free market guy. i believe you have to have competition to drive down costs. yes, sir. >> first i want to thank you for coming here toads and listening to all of us even though there are rowdy people here. my question for you is the current state of the plan right now does not exclude or have an amendment to exclude abortions. i want to ask you if you would pledge to support an amendment that would specifically exclude abortion from being under the benefits covered by the plan. >> the current -- the question was -- here is the question. the question was obviously about abortion. it's an issue that people have very strong feelings on both

sides. you know, i believe abortion should remain safe, legal and rare. i believe in pro-choice. you want me to answer your question. but the current law is the hyde amendment which prohibits any public funds being used for abortion. i believe that current law should be main taineds. -- maintained. >> thank you for being here, senator warner. thank you for taking my question. in my lifetime, there have been 11 men in the oval office with lots of different ideologies, educational backgrounds and parties represented. for the first time, i don't believe that the president that we have is a patriot.

i think that a lot of the concern and discontent that we have with this health care reform is less about health care than it is about trusting the agenda of the current administration. that's all i have to say about that. my question for you is where does tort reform figure in to the health care debate? . . let me say this to you

respectfully, ma'am. i respect your right as an american test free-speech. -- to free speech. and you have the right to say what everyone. but i 1000% categorically disagree with you. i believe that president obama is a great patriot, and i believe that we owe him -- [cheers and applause] [booing] and we all him just as we showed president bush -- and we've owe m just as we've owed president bush -- i never agreed with president bush's policies but i never question his patriotism. and i find it offensive in america -- we can disagree with that -- with each other, but i think we go beyond the pale there and i disagree. next question. [unintelligible]

>> i am going to call free numbers and you certainly want to be able to hear them. let me go ahead and called for in numbers, and while those folks are coming up, three questions from the internet that you can go ahead address while people are coming up. 0545, 0545. please come down. 0407. that is fine. 0259. >> there are three questions. the town hall is also being web cast all over virginia. the first question will be, how will help reform help with pre- existing conditions? we're probably the only industrial country in the world where people cannot change a job because they are afraid of

losing their health care coverage. now in my mind, any part of health care reform has to get rid of the prohibition on pre- existing conditions and allow people to move from job to job without that restriction. [applause] and this is basically, this is one of the biggest pieces of misinformation and disinformation being put out there. it basically says, if you like your current plan, and you do not want to change. there is no plan being proposed that i will support that will force people out of their existing plant if they have that and the like their existing doctor. >> why lie to us? >> i am not supporting any plan gets rid of those options. and there is no plan out there to my mind it does that. the third question is about small businesses.

one of the things i said earlier to the gentleman in the automotive area. you talk about folks are really getting the short end of the stake in health care, small businesses, individuals who tried to go into the individual market. one of the reasons why, because you pay retail. we're trying to say that whole notion that insurance is to get people into bigger groups said the chicken spread their risks. i believe that you have to allow small businesses -- one of the questions about how you lower the costs -- you have to allow small businesses and individuals to come into a bigger pool so that they can get the same benefits of negotiated prices that larger employer plans do and that frankly the government does. next question. >> you can say your name. >> i am hardcover from

pittsburg, virginia. -- laura glover, from pittsburg, virginia. i wanted to address the deficit spending. i agree as a conservative that we need health care reform. where many of us disagree is how it is done. one of the things i would like to inspire you to do in is to take on tort reform. last week, i believe it was, howard dean said that they would not take it on because the trial lawyers. i wanted to let you know that it would have the courage to take on the trial lawyers to, every person in this room and across america would stand up and take on the trial lawyers with you. we're not going to be bullied by lawyers. [unintelligible] we want to preserve our freedom. we want people to have health care. we are not evil.

that is my point. we want you to take on the trial lawyers and we will support you. >> man, and i get grief from one of the things that i said earlier, from both sides. i agree. toward reform ought to be part of the health care package. -- tort reform ought to be part of the health care package. if i was a really good politician, i would stop there. but i only believe that it is a piece of the answer. 36 states already have this and it has not solved the problem. we have to do a lot of things when you have health care system right now that is two to three times more expensive than anything else in the world -- and you go back to those first charge, if we do not drive down the cost of medicare and medicaid, the federal deficit, everything else, everything else is dwarfed by those costs. one other thing that i would add that ought to be part of this debate, and i get some

grief from both sides, i actually believe that it is time in this country that we put together a bipartisan group that looks at all of our entitlement programs to try to drive down our costs and get our deficit under control. and in that group would come out with proposals and would have to be voted straight up or straight down. the same way that we do on the other conditions. it is not a popular thing, but unless we can get our arms around this deficit, unless we can get our arms around this deficit, then i believe that we are not doing our duty as americans in terms of what we leave to our children and our grandchildren. with exploding deficits, it will decrease the value of the dollar and undermine america's long- term economic security. and back to your original question, i do believe that tort reform should be part of the health-care package. >> senator warner, thank you for

coming and answering that question. my name is ray farmer. one and make our current system more cost-effective and tort reform has been mentioned, but in addition let insurance companies compete across state lines? make a more competitive -- make it more competitive? in addition to these changes, you to sponsor legislation to make insurance plans more affordable and eliminate the pre-existing condition clause? that is something that can help fix the plan. lastly -- last comment, you have shown tonight the government has trillions of unfunded liabilities in medicare, social security, and medicaid. all of that, it is broke. what makes you think the government could run a new health-care program? i mean, it is a paradox.

[cheers and applause] >> here is your question. three quick responses. one is, sir, thank you for your question, but one is, we already paid for this -- these 47 million americans to stand up on the doorstep of hospital emergency room without coverage. we pay for it and $1,000 per capita higher insurance premiums and medicaid and medicare costs. i agree with you. i don't think it should be a big single payer government system. it ought to be more competition. i think your idea about across state lines makes sense. and also the tort reform makes sense. but at the core, and this is where nobody is asking me about this question, and as i mentioned 20 years of looking at this stuff, unless we change the compensation model, unless we change the financial incentives

so that doctors and drug companies and hospitals -- and i am not saying that they are all bad, they are not. they do a great job for the most part. but too often what they do is unnecessary tests and procedures. we have seniors who have seven or eight -- [booing] different specialists, not even knowing whether the drugs they are getting ashley could do more harm than good, and until we change the financial incentive, we're not going to change -- drive costs down. >> can you hear me? >> holding up so i can look at the paper. citizens of this great state, can you all hear me? [cheers and applause] i wanted to pay close attention to what i am going to say. the people here that are against health care are overwhelming,

ok? but listen to me. when we get up and cheer, all of these people that have signs saying we need this health care, they put up their signs. now what they are doing is they are riding on our backs and making it look like we are for health care. let them get their own issue. [cheers and applause] >> sir, i think this audience is divided and i think america is divided on this issue. and again, i will come back and start where i started, i respectfully wish that we could lower the volume a little bit, find out where there is common agreement around some of the current facts, and then go from

there. but i actually believe that this country and its commonwealth is divided on this issue. where i started the night, and if you leave with nothing else, this is one thing i do hope -- i am going to listen to all of your concerns but i also hope that you will take home the financial, blamed dollars and cents recognition that our health care system is not financially stance -- stable. it is going to break the bank. next question. >> 0122, 0122. 0061, 0061. 0158, 0158. 015 a? yes, ma'am, come on down.

>> back in 2006 i was hospitalized in paris, france. i've seen the government controlled health care system for standard when i was hospitalized there, i was told by mike cardiologists at the first hospital and if i did not have a good american private insurance, i probably would have died waiting in them waiting room at the e r. when i was asked about the treatment of there, he said that the treatment was stopped use here in the 1980's. i receive substandard care. government run health care does not work in france, does not work in britain, does not work in canada, how is it going to work here? [cheers and applause] >> serir, one of the things that

you said, i am glad that you got the treatment that she needed to cure yourself of the challenges that you faced. and i tell you, if you are right in terms of acute care, operations, heart attacks, we get the best in the world. but you know what? 70% of our health care costs in this country are due to chronic disease. diabetes, hypertension, we have a system that does nothing to prevent -- encourage prevention or wellness. if we want to talk about making our country healthy and saving money, it goes back to prevention, wellness, managing chronic diseases which we do not do a good job. we have a higher incidence of death from these chronic diseases than almost any industrial country in the world. but i am glad that you got the care that she needed. -- that you needed. >> thank you for being here and

i appreciate your commitment. sorry. this health care issue, we know it affects every american. and president obama promised bipartisanship. where is the bipartisanship on the committee? the you have any influence with anyone to get more independent republicans so that we have a more even committee to support everyone in the united states? >> a great question. the question was this -- about bipartisanship, and let me say again, you may have liked or not liked what i did as governor, but everything i did was bipartisan because everything was two to one republican, and senator baucus said that we wanted by partisanship and it has to drive costs down. let me just say this. the committees are divided almost evenly. what happened is that one of the

things i have been discouraged about, the number of republicans -- what i hope is coming out of the senate finance committee. this is where it is going on. i am afraid that the number of republicans who are negotiating keep dropping off. i that republican senators say to me, we're getting some much political pressure just to defeat president obama initiative, i think that if there is ever a time that we ought to check our d's and r's at the door, it is right now. >> i want to thank you, first of all, for giving us this opportunity. i worked in the low-income housing industry and have it for eight years. i have a couple of comments but i wanted to ask a question

first. do you think that there are enough resources for everybody to go around? >> do you wanted as a question? listen, the idea of -- one of the things that i believe is that we do not believe -- we do not do a good job of what works and what does not work in the united states. i think there are people -- who puts the most advertisements on tv, for drugs? we do not have an evaluation. the notion that and limited health care for everyone without -- with out any ability to have any cost control? no, i do not think -- there is no society in the world that can do that. the question is, how do we provide the care that people need and not limit choice and obviously gives people the medicine and health care that they need, but do it in a more cost-effective way?

there are many in this crowd -- do not look at other countries, look at our own that are driving down costs. if we do not, i am afraid to go into financial ruin. >> i thought you're going to said that there weren't enough resources to go around. my view on this government-run health care legislation -- health legislation, i am not going to college health care, because the minute the government gets involved, they are not going to care who lives or dies. [cheers and applause] they are not going to care how much it costs. so it cannot be health care. i think it is population control. in this nation, every day, 4004 -- 4400 babies are murdered. every day in america and there have been 40 500 million people that had been killed since roe v wade.

those are facts and you can look them up. i think liberals are about population control, because they think there is not enough to go around for everybody, and they want wheat and corn on their table. they won a measure that there is wheat and corn on their table and i do not care about the elderly that might died, they don't care about the new bonds that will never see the breath of life -- the newborn that will never see the breadth of light. so i am totally against this legislation. [cheers and applause] >> i do not agree with you. i do not agree with that view. but let me also say this, how many of you here are on medicare? how many on medicare, raise your hands? you know what, that as a government program. -- that is a government program. [unintelligible]

and it is not sustainable. and it is not sustainable over the next decade. not with the current costs structure. next question. >> 1344, 1344. cera 246, 0246. 1444, i've got been go over here. 1444. -- i've got bingo over here. 1344, 0246, 1444.

>> i wanted to thank you for being here because i know that this is got to be difficult with all the crowd. the health-care debate is putting this country, i think, and it scares me because instead of bringing us together it is tearing us apart. i mean, it is obvious for the people -- anger and contingent night. my question is basically, as far as drugs, about opening up so that we can get drugs other than on the internet and from canada and other places, and making sure that they are safe. that kind of thing. i want to know what is going to be done on that. one other quick thing.

i am embarrassed about how people are actually talk about our president. it makes me very sad, because i think he is doing a great job. >> ma'am, i agree with that. let me just say that one of the things -- the question was about drugs and i want to make two points here. and this, again, i know that i sound like a broken record on this but i think that is something that will affect all of us. i've got three teenage daughters and i feel an obligation as an american to leave them with a country that is financially stable. three years back, when congress and president bush at the medicare part d benefit, nobody paid for a dam of that. so if you are looking -- no one paid for a dime of that.

$800 billion of that comes from the medicare part d drug benefit, because congress passed it without paying for it. i believe with all my heart that thinking we can pass programs and not pay for them has to come to an end. about drugs, what i think is unfair about drugs says, and drug companies are, basically, americans pay much higher prices than anyone else in the western world, because we pay for the research and development for the drug companies and been around the rest of the world, they put on price controls to lower the cost and we get stock footing the bill. the way to solve this is probably not opening up canada, because that is not feasible. it will have to be part of our trade policies to say that we have to lower drug prices across

the world and not have the americans unfairly bear the burden for the rest of the world. [applause] >> ok, 0103, 0103. 0093, 0093. 0605, 0605. >> senator warner, will any of the legislation that is under consideration now allow medicare and medicaid to negotiate drug prices? it was banned, if i well remember, by the part d legislation. >> the question was, when added

the drug benefit a few years back, it did not allowed governments to negotiate better prices. now the drug industry has offered up $85 billion to be part of health care reform. i think that we can get more than that out of them. and back to disguise -- the most important question, how do you pay for it? part of this has been the health care industry itself has offered up almost $500 million, and i do not believe that it is enough. it is again about competition in negotiation and also about the earlier question, that americans should not have to pay more than the rest of the world for our drugs. and the way that you saw that he is your trade policies. -- the way that you solve that is our trade policies. >> 0827, 0827.

1348, 1348. 0223, 0223. do we have any winners? anybody? dollars go on to the next question. >> ok. 1347, 1347. oh, we've got a winner. once 363, 1363. 1447, 1447.

>> i like to know what is the deal with single payer and why you do not support single payer health insurance. >> the question was why i do not support single payer. because i do not believe a single government-run totally 100% government financed solution is the right solution for this country. i believe that you have have competition and maintain the best of our private insurance system but put more competition into it. and i believe that you have to maintain and have an ability to keep medicare and medicaid and veterans programs going, and again i go back, if we do not drive costs down, a decade how it will be a real challenge. >> yes, sir.

if in fact there are 47 million people who are uninsured, and those that need to be in short, how do you plan to save money and lower our costs without adequate personnel to handle? that could give us a million new people in this thing with no doctors and nurses to deal with them. >> a great question. how do you handle it? partly we need a system where we encourage more people to go into nursing and a system where we have more people to go in to technicians. we need a system that goes back -- when i was growing up, when you had more family doctors and general practitioners, and i think that is one way. but remember, one of the great misinformation out there is, 46 million americans that do not have health care insurance, 20% of them can afford to buy it and do not, and the others they get

sick, they show up at the emergency room and we pay for them in the most inefficient way, the emergency room. you were going to need more health care professionals and needs to come from nurses and technicians, and realizing that we need to empower more people in this health care workforce than just the specialists at top. >> i am pat gammon. i am very confused about the fact that a lot of people who are against having health care are not in a position where they do not understand what it is like not have health care. [applause] i worked 25 years, raising four

kids, trying hard to play by the rules, the canceled my health care, and now that i've reached the golden age of 65, i had been on disability for a couple of years. now i do not have enough money to buy debt second policy -- to buy that second policy, the policy with medicare which i do have. i just don't think people realize the differences that they have to deal with it. one of the questions i had about the product that is there now, is it going to cover prescription drugs and not plan -- in that plan, and will there be a second plan like social security? >> the last point, a lot of

people who struggle in this country and i know that you have had struggles. part of any program will include prescription drugs, but what you have got right now, the past time that we added a program that people like, this meant a car -- as medicare part d, it helped seniors with their drug costs. but we did not pay for a dime of it. we have to lower the cost and forced the rest of the world to raise their prices so that we do not get stuck footing the whole bill like we do right now. >> welcome back of fredericksburg. welcome back to the civil war. we are living at. as the lady mentioned earlier, this several has divided the country. once the decision is made, how do we bring our nation back together, reminding folks that

we are one nation under god? my question is, how do we bring our country back together again? >> the question was, one point is -- no matter what bill is passed, a single piece of legislation is not going to totally fix this problem. it is going to take people coming back. no one is ever going to get this entirely right the first time. we are going have to revisit this issue. but i believe absolutely that one of the things -- we have had some hard times, going three two wars and the worst recession in 50 years, we have got a lot -- way too high of job loss. virginia is much better than other states, but we have to look into ourselves. it is going to be a political

leaders doing a better job of finding a way to get along, but it will also take people here, going back to the earlier comment where i respectfully very much disagree with the comment, we have to realize that the overwhelming majority of people they get elected, democrat or republican are actually trying to do the right thing. [booing] and if you do not like what they're doing, then you ought to fire them. [cheers and applause] but our system is, this notion where we go around questioning each other's patriotism? that is not the kind of america i grew up in and that is not the kind of america will my kids to grow up into. -- i want my kids to grow up into. >> it is a very difficult situation for virginia. i pay around $6,000, with

supplementary medicare, and my wife who has not much of a condition, she pays $4 a month. were looking at $500 a month, $6,000 a year. will our prices come down with that? and i am sure that many of the people here, i do not know if they know about it or not, but i want a planned b of the drug coverage. i found my prices were higher but plans d than buying it directly. but what i found out, and he -- people did not know about, is the patient assistance program. you have to look at the internet for patient assistance program. there are 475 pharmaceuticals that are willing to give their medications -- they have certain prerequisites, but there is a

patient assistance program and i really advise everyone to check on it. will that be in the bill? >> banking for your question. sir, i am not going to vote for any plan that does not lower costs. we're headed for financial disaster. part of what you just said, he raised the issue about the number of drug companies and other things out there on the internet. the only industry that has not been transformed by information technology is health care. it makes no sense that information technology, in terms of efficiency and effectiveness and ability to compare and get good information -- you cannot go out and prices from doctors or different procedures on a hospital. we ought to have those choices and that information as consumers. what health reform -- reform has

to include is privacy protection of electronic records, so that you have those choices so that you can compare prices. we do not have that right now. >> there are a couple of questions from the internet here if you want to go ahead and asked and answered. i will go ahead and call the next numbers. 0277, 0277. 1472, 1472. and 1497, 1497. >> one question from an individual in virginia beach, will you vote for house bill 3200 as presently written, yes or no? no, i would not vote for it as currently written. because it does not do enough to drive health care costs down.

second, why isn't congress making insurance a truly affordable by detaching it from employees? you know, our whole system of health care in this country basically that created in world war ii. we created employer-linked health insurance. some people have said, you need to scratch all of that. if you had a clean piece of paper, you might. we do not have a clean piece of paper. we need to preserve it but we need a lot more competition than what we have got right now. >>-caitlin and i live here, and i was wondering, if you cannot support a single payer system but would you support a public option? the way to increase competition,

people could buy into a government auction as just another choice? >> the question is about a public option. one of the things that kate and asked, you never -- and another people built very strongly on this. this is you can -- never came up when there was a debate between senator obama and senator clinton. this never came up between senator mccain and senator obama. what i think is, and you ask people about a public option, you get 10 different descriptions. i do not support a plan that just extends a government-based system that is not paid for. i do think that we need competition. i am looking a lot at co op plan based on a non-profit version. how do we take some of these large employer-based plants that are driving down costs and allow people to buy into them? i would say that i do not support this overly written

government option at this point, but if you do not see competition down the road, you may say that it be revisited three or four years from now. but we can do this by increasing competition. people will say that we hold it. medicare and medicaid have much lower administrative costs and insurance companies. that is right, but medicare and medicaid just simply process claims and do not drive down costs. i know i am a broken record here, but unless we get the financial incentives to align the right way, we cannot afford the current system for 04 -- or reform. it was good evening, senator warner. thank you for coming here tonight. i have several questions here that we of research and

carefully written out, but i have a question for all of you, for all of you in the media, and for all of you nationwide. just because there is a difference of opinion between each side of the health care bill does not mean if you do not let the bill, that you were making in a race issue about the president. that has to stop. [cheers and applause] >> i don't think anyone has suggested that, but i do believe -- i do find it very unsettling. i did not agree with president bush on a lot of his policies but i never questioned his commitment or his patriotism. you may not agree with president obama, but i absolutely believe that he is a patriot and a great american. i find it offensive when people question his patriotism.

[booing] >> please let her ask her question. >> i realize that there are a lot of people that do not have medical care, and it is necessary for those things to change to help those. i think a lot of people are upset not necessarily because of medical care, the that is a huge part of it, but larger is what is happening to our government. it is being destroyed, in my personal opinion. i am a high school government teacher, and i have caught these kids the constitution and i would like to know specifically article in section of the constitution that gives the government their right to run our health care. [cheers and applause]

>> i take by your question -- i take by your question -- i take my your question that you would get rid of medicare and medicaid. let me make sure that i understand you. you're advocating doing away with medicare, right? because that is a government program. [inaudible] i want to make clear that you are suggesting doing away with medicare. but there is no place in the constitution that specifically says health care. there is no place the specifically says education. there is no place in the constitution -- there is no place in the constitution -- there is no place in the constitution -- there is no place in the constitution -- there is no place in the constitution that talks about the right to get a telephone.

but we have made those choices as a country over the years. we have made public education and right. we have decided as a country right now, and as long before this debate took place, that if someone shows up and they have had a car accident and they are injured, that hospital is not going to turn them away if they are injured, whether they have insurance are not. now if you want to revisit that issue, if you can articulate that and make that a debating point, but we have already made that decision. unless you are saying we should turn away people from a hospital, no matter how sick or injured they are, we have already decided that, but it is not in the constitution. well, actually, right now what we have is for people who do not have insurance, those costs are passed on to those of us who do, and those are passed on to

the taxpayer in higher costs in medicare and medicaid. those are just plain facts. but thank you for your question. whoops. >> i have two questions, really. what about health care for people that are very old, and i am talking 90, i have two in my family that led to 102. well this health care carry them or will they close the door and let them die? >> you have asked a great question, because my family as this issue right now with my mom. i think the most offensive part of this health care debate, and i take this personally, whether promoted by ignorance or malice, but people have said that they are going to limit senior care. i find it offensive that anyone

has even suggested that. no one has suggested that. i do believe that people ought to have the ability to make informed choices about how they want to spend their last days and have those choices honored, and people to disrespect that so much and disrespect the millions of virginia and families who are sorting through that with their doctor and their minister, i find it extraordinarily offensive. >> we have time for three last questions. these will be the last three numbers. ok? 1118, 1118. 0063, 0063. 0130, 0130.

do we have three winners? yes, we do. how are you doing? >> good evening, senator. i have got a question. i am retired military and i have traveled the world, and at the same time i had karen different country. when this comes about, will i be forced to go into some kind of system because i have my own insurance? i've also starred in my own business, so what about my employees? well i have to buy insurance for them or be taxed? but where there is nothing any plan that i would support that would limit your choices if you have an existing plan that you like, none of that would change.

you're starting a small business, my business is starting small businesses. i know what it takes to meet a payroll, and i've had times when i could barely scrape it together. there is no plan that has come even for any small business below either 25 or 50 employees that would force anyone to purchase insurance. all right? there is some debate when it goes above 25 or 50, when you have some requirements, but no plan blood that that had been proposed. -- below that that has been proposed. dollars baker coming to speak to us tonight. i'm from fredericksburg, and first off, you were very learned and you have been in business. you are very articulate about the needs of reform for our health care system. yet the senior leaders of your party seem to be following --

espousing the ideas of what you would not support, the single payer and/or a public option at this point in time. we will see how bad does. how would you bring sanity to the senior leadership in your party as a junior senator, so that they will not be -- they define clinically as insane to keep running into the same question and trying to get to the same outcome over and over again when they think they can fix health care with the single payer and/or a public option and he has failed everywhere it is tried. [cheers and applause] >> listen. let me tell you, one of the things that we need is more competition. a co-op, a proposal that would look at a -- buying into larger

plans, making sure that there is actually insurance and -- actual competition in the insurance market, but existing a public plan that does not drive the financial incentive planned down is not going to get my support. i think we have to change financial incentives across the board. , in private insurance as well as in the public programs, medicare and medicaid. what i have also said, and i think my governor -- my record as governor said this, i will stick to what i believe in. i made everyone in this audience mad when i was governor when i shut down the dmv one wday a week. to save money. i think it is time and we're dealing with the worst economic crisis in our lifetimes, other than those of you that live to the great depression. it is going to take folks r's and d's at the door.

i commit to work with both republicans and democrats to do that. the folks that want to shout me down, they can fire me five years from now if i do not get it done. >> i have a basic question about costs. you talked about the spending and money, and passing the medicare partd without paying for it and how bad is a problem now. al is what we are doing now any different? how is what we doing in america any different than that? we have had a bailout, ok? we have the cash for clunkers. if we're going to provide all these people with insurance, how was that going to save us money? >> i couple of comments. thank you for your question.

by the way, i voted against the extension for the cash for clunkers program. two, as i said, whether looking at the question around reimbursing doctors, hospitals, and drug companies based on quality not volume, whether it is saying that people that made more than a certain amount of money should buy into some minimal program so they don't end up in a free rider system, which basically we had, looking at some of these costs, some of these insurance plans that pay not on an individual basis but on an actuarial balance basis, and at some point above some number, i would look at putting some dealers something on the does. critics fee -- i would look at putting somefee on some of those. but the start -- these problems

did not happen in january of this year. bear with me. last year at this point, because failure of financial oversight this country went into the worst recession in 50 years. [cheers and applause] our last president -- and listen, let me make this point -- one of the things -- i have told you how i think. i wonder how many of you realize that our prior president, that all of the cost of the iraq war and the afghanistan war were never put into the deficit. [booing] folks, folks. you can shout -- you can yell and shout

but these are facts. eight years ago there was a surplus and then there was a deficit. both parties -- [booing] both parties bear responsibility on this one. [booing] >> let me first of all thanke -- i know how strongly you feel but let me add one last thing here. if you question some of these numbers, you do not need to believe me. you can go to a whole series of websites that will validate all of these numbers. one of the things that i would ask you respectfully is don't just believe me, but get your facts. look at the facts. second thing is this -- we will

-- i thank all of you. this debate is not going into night. it will not in next week. i would ask at this point that one thing we do remember, and it was back harold banisters question earlier, what i hope and my question -- and my heart more than any single thing is that however this issue is resolved, that at the end of the day we will realize that there are more things that bind us together as americans dead separate. i hope that we keep that in our hearts. thank you all, and goodnight. [captioning performed by national captioning institute] [captions copyright national cable satellite corp. 2009] >> would you start the dialogue for getting medical -- military

personnel of the federal employees plan question are >> i will look into that. we are you to greta's obligation of all. >> we are the only federal employees that are excluded. >> i'll talk to my office. >> thank you for doing this. i am the chief of anesthesiology at a large medical center here. one question, a lot of physicians' concerns with a government auction, and i think they believe that the obama plan, it is not going increase the number of decisions. in lives -- we have people looking for a way out of medicine. i am in critical care anesthesiology. the president's plan, and i can tell you this is the talk of the o.r., the senior leadership in the ama, but at 3200-white plan,

especially with the rates as doctors looking for the exit signs. there is nothing in this bill that will force this into a government auction, which is true, but if you have a government auction at medicare rates, and you end up with very rapid crowd out of private insurers, people will not be specifically for stan, but as the private insurance is crowded out, they will end up there by default. >> that is why i am looking at competitiveness. where we may agree or disagree, but the current fee-for-service basis, it is not going to get right. you need to be compensated based on health care outcomes? you do a great job on what you do in operations, but you know this better than nine.

we do a horrible job on chronic care, and hospitalization. >> if there were more moderate voices like yourself, we can have more reasonable debate. the party leadership seems to be on the left. but a lot of what we do in emergency medicine is driven by defensive medicine. i can promise you that when you talk about ordering multiple tests, so much is driven, especially by the trial lawyers and concerns of getting sued. >> that needs to be part of the mix. >> and when you say you will not support anything that increases the deficit, a lot of people are concerned that the accounting process, the cbo looks at things in a 10-year span, but at the expenditure start later, it is an accounting trick. your one of the few people in the senate that has run a

successful business, and obviously you can say the accounting tricks that make this look less -- >> i apologize that this will be the last one, but one of the things that the cbo does not do, that we've seen demonstrable in this country and elsewhere, they get no credit for any prevention and wellness. you know that 70% of our health care costs are from chronic diseases. [unintelligible] if they end up on our doorstep -- thank you. you are welcome to contact my office. i promise to 1.5 hours. please e-mail me. i apologize, those, but thank you. nobody is quite a test that. -- nobody is going to touch that. thank you, everybody.

>> to come back. we love you. >> deal of a number where i can reach you? >> senator warner, we love you. >> tonight on "q&a," t. r. reid ta