radio sh he show's partnership, this is the result of that effort where again the summer of tea parties and opposition and american voices and spirit was heard and tonight, despite what the president may or may not say, the american people have been represented by this amazing health care petition, the largest public policy petition ever presented to the congress in the history of the united states and we're very proud of that. . ever presented to the congress in the history of the united states. and we're very proud of that. we're very proud of wt@@@@@@@@@r p "@ @ @ n'

washington that says no, give us back our health care. give us our choices, and give us health care the way we want it. we're proud to be here today, god bless you for your support, and god bless america. thank you very much. >> mike, thank you very much for those comments. thanks for all of the things you say on the air. and thank you for getting us to the first 50,000 so easily. it just led us along a wonderful path that has been very helpful to us and very good for the country. i'm now going to briefly introduce eight people who are going eight members of the senate and members of the house

that are going to speak to us briefly about what they see happening in the congress and what they think of our whole free health care now plan. the first will be house republican leader john boehner, then house republican whip eric cantor, kay bailey hutchinson from texas. and she gets a special award because texas had 165,000 people sign the petition. and that's the biggest group that there is. representative mike pence, chairman of the house republican congress, senator jim demint from south carolina, tom price from georgia, pete sessions from texas, and john shady from arizona. there he is right there. the newest arrival. they will make some comments to you in order. so, john, you're first. >> well, pete, thank you. let me say thank you to the national center for policy

analysis. let me also say thanks to salem broadcasting and the radio talk show host who encouraged 1.3 million americans to sign a petition to save their health care. on behalf of my colleagues we'll accept these petitions from the american people. and on august, the american people spoke loudly and clearly. they didn't want government messing with their health care. this was just another example of the voices that are being heard. i was in a tea party on saturday with 18,000 people about a mile from my home in west chester, ohio. and they made it very clear that they don't want the government involved in delivery of their health care. what they want is they want us to take the current system, which is the best system in the world, and they want us to work to make it better. and on behalf of all of us, i just want to say to the 1.3

million people who sign these petitions, we will not let you down. let me introduce the house republican whip eric cantor. >> thank you, good afternoon, leader, governor. i too want to join here and congratulate ncpa on what is the largest petition drive ever to have your voice as the american citizens be heard here on capitol hill. i'm told that we are at over 1,307,000 individuals and counting. that's extraordinary, that's democracy at work. and that will allow us to stand up and propose that we give the american people some guarantees. that we will bring along our

colleagues and the majority of our colleagues in the house of representatives to insist that we will not see a government option, that we will not see a government trigger, that we will not see a government replacement of the health care system in this country. >> the petition drive free our health care now also has been successful because it has offered some positive solutions and visions for the way forward. and what we are anxious to do tonight is to listen to this president and hope that he will begin to focus on areas of agreement. this campaign and this petition has demonstrated there are certainly areas of agreement in this country where we can begin to make the health care better for all americans. but we must make sure the priority is not just on getting it done, that we get it right.

congratulations and it is now my distinct honor to present to you the gentle lady from texas, the united states senator kay bailey hutchinson. >> well, i'd like to ask the governor to come back. because i had a great meeting with some of the texas tea party members and they gave me a t-shirt that says a lot about how people feel about this. national health care, a lethal injection. so this needs to go in the archives of the ncpa. thank you very much. i want to thank the ncpa because they have shown another level of the grass roots movement that is bubbling up in this country saying we don't want our health care hijacked. 85% of the people in this

country like their health care. so why don't we try to fix the 15% that isn't right and not ruin the 85% who really like what they have. that should be the goal of health care reform, and we can do it if we work together. some people have said this isn't a grass roots movement. this is the most legitimate grass roots movement i have seen in my entire time in public service. people are coming to meetings who maybe had gotten complacent, who maybe thought everything was going to be okay in our country and then they started seeing that our health care, the most personal of all things to us is going to be ruined by a government takeover. and people understand it. and let me say this, we have alternatives. we can reform for the 15% who don't have or don't like their

health care. we can do it with bills like senator demint's that i'm co-sponsoring that will allow every person to have a tax credit, a voucher to give to a family or a person to buy their own health care and they can take it with them for their lives so they will know what they have. they will be able to bond with their doctor, get the care they need and be able to be on a level playing field with everyone else who has health care. and it also has medical malpractice reform, which we must do if we're going to bring down the cost of health care. so let's band together, keep this grass roots movement going and let's take or health care system back and fix what's wrong and keep the part that's good for everyone else in america intact. that would be the bipartisan solution. thank you very much. >> and my good friend, one of the great house leaders of the

policy committee, congressman mike pence. >> thank you, senator. thank you governor du pont and the leadership of the ncpa and to all of the distinguished voices both in the congress and in the public debate. i am honored to be a small part of the delegation that is receiving this extraordinary demonstration of the voice of the american people. this historic petition marks a bookend on a period in our national history this august when the american people have made their voices heard as never before. when i was home in indiana town hall meetings, my constituents made it clear. they want to see this congress take action that will lower the cost of health insurance and lower the cost of health care in the long-term. but as these over 1 million

petitions attest, the american people don't want a government takeover of health care at a price tag of $800 billion in higher taxes every year. the american people have spoken and continue to speak the only question today as the congress convenes in an extraordinary and historic joint session is now that the american people have spoken at town hall meetings and by these petitions, is washington, d.c. listening? stay tuned. but make no mistake about this. in this cause, republicans in washington, d.c. are on the side of the american people and we are on the side of freeing our health care now. thank you. >> thank you, mike. in my office when we get a letter or an e-mail or a call, we assume there are at least 100

people who feel the same way. this 1.3 million probably represents at least 130 million americans, probably more than that as we see the polls around the country. i think what we see in these boxes are fundamental shift of power. from this capitol behind us and this nation's capitol here to the american people. where people are standing up all over the country, not just about health care, but about freedom overall, about the growth in government, the spending, the debt we're accumulating. they don't like the direction of our country, and they're standing up, they're speaking out, and they're going to take their country back. a big part of that effort has been these folks behind me and out all over the country, radio talk shows who are increasingly more informed, using information from blogs, actual bills that are loaded up, fox, cable, and

other cable tvs. people all over the country are more informed, more engaged, more outraged and more activated. tens of thousands of people who are coming to washington this week. to let their voices be heard. when americans stand up and speak out, there's nothing we can't do. there's nothing more important right now than to fix what's broken and keep the best health care system in the world. thank you. >> governor du pont, thank you so much for bringing the petitions to washington, d.c. during the month of august, the american people's voice was undeniable. to those that held town halls and those did not that the american people asked questions about what this health care proposals would mean. and quite simply, i think it boils down to three questions.

what is the role of government? what is the promise that government would make when they engage themselves in health care for all? we look up and see where massachusetts, a small state has tried same or similar. they are $9 billion in debt. and it crowds out their responsibilities to public education and public safety and other essential elements that government must perform. secondly, the relationship that a doctor would have with their patients. this is something that every single person has understood is really not a privilege but a right. we understand that the government would be making decisions instead of a patient and that wonderful doctor who they had chosen. and lastly, the question as it comes to how will we possibly

pay for this when america is engaged in the largest unemployment in 26 years? we need to have a plan to make health care better, but not one where government would become the responsible party in a position that they cannot sustain in the long run. so to hugh hewitt and mike gallagher, we say thank you, not only to the american public, but for bringing this message so loud and clear to washington, d.c. we get it. thank you. i'd like to at this time if i could to introduce one of the leading idea makers in the united states congress. he's a republican from arizona, my dear friend, john chadic. >> thank you, pete. i want to begin by thank you governor du pont and thanking dr. john goodman. he's been in the trenches of this fight for years and the

work he's done has made this effort possible. this is a unique moment in american history.@@@@@åsh@ they took thetime to read this petition and understand the health care date in america and speak out. and as mike pence said, the question now is, is washington listening? let me make one thing clear. you may have been told that health care is complicated. and you may say to yourself what does free our health care now mean? it means one thing, one thing that will change health care in america that doesn't exist today and is the cause of all of our problems. you know what that one thing is? patient choice. in america today, the vast majority of health care is bought by your employer for you, he or she buys a plan and you don't get to know what's in that plan after the purchase has been made. the plan hires a doctor.

you don't get to pick that doctor. the plan picked the doctor, your employer picked the plan and you're out of the equation. if you're unhappy with its service, too bad. if it mistreats you, too bad. if it denies you care that you think you're entitled to, too bad. you get to go to your employer and complain. that is not the way this economy works on any other issue. we have a series of four demands on the petition that really comes down to this. charge, let them make choices, then the insurance market will have to respond, costs will come down, and quality will go up. and we as republicans -- you bet -- we as republicans say there is an agreement on some of

the critical issues. i hear people say what about pre-existing conditions and what about the uninsured? every republican bill introduced in this congress, whether it's jim demint or tom coburn or tom prices, every single one of those bills covers preexisting conditions and ensures that those people can get health care at the cost of everyone who doesn't have a pre-existing condition. and everyone of those bills, go get them, go read them, covers every single american, every single uninsured american. and you know what we do? we don't put them in a government program, we give them choice. the same choice we want for our health care. it's now my privilege to introduce a leader on health care, and a leader of conservatives in the house, dr. tom price of georgia. >> thank you so much, i'm so

pleased to join my colleagues and friends around the nation to accept the 1.3 million signatures on these petitions to talk about one of the most important issues facing americans today, and that is whether or not the government will be making health care decisions. and as a physician, i know that when i would treat my patients that one of the things that would make them the most angry is when they understood that it was either the government or insurance companies that were making decisions for them and they weren't able to make on behalf of themselves or their families. it's either the government in charge or the insurance companies in charge, right, you all have heard of that? the fact is there's a better way, the right way, a correct way, and that's a third way that puts patients in charge. patients and their families in charge. others have mentioned there's positive solutions and we've put them on the table. we've put solutions on the table that will make sure every single american regardless of their

financial status has the wherewithal to purchase insurance they choose. we put solutions on the table that solves our preexisting challenge and the portability challenge. you ought not lose your insurance if you change your job or you lose your job. there are ways to solve that doesn't put the government in charge. we put solutions on the table that says that fundamental decisions, medical decisions, that patients and their families and caring and compassionate physicians ought to be making those decisions, not folks in the buildings around here. and we have addressed the incredible issue, the challenge of lawsuit abuse that is driving up the cost of health care in this nation to the tune of hundreds of billions of dollars. and we put all of those solutions on the table without raising your tax dollars one penny. that's what we ought to be doing. positive solutions, i thank you for coming out today, i thank dr. goodman and governor du pont and all of the individuals involved in the free our health care now effort. this issue will be decided this

fall with your help. we'll move in the right direction, which is the patient's direction. thank you so much, god bless you. >> i'm john goodman, i'm president of the national center for policy analysis. at the ncpa, we're interested in opposing bad ideas, but also interested in working with scholars around the nation to find solutions to these very difficult problems. because of our concept of how savings accounts, there are now 12 million families across the families who are managing some of their own health care dollars. we need to do more of that. we need to liberate employers and employees. we need to allow employers to do what is now illegal in almost every state, and that is help their employees obtain insurance which is personal and portable. that they can take with them from job to job and go in and out of the labor market. we need to allow individuals and small businesses the opportunity to do what large companies can already do, and that is buy insurance in a national market.

and we need to have tax fairness so that people who have to buy their own insurance get the same tax breaks as people who get insurance through an employer. now, over the last three months, we've been working with radio talk show hosts across the country, there are four of them that want to talk to you this afternoon. they are dennis praguer, hugh hewitt, they have all played a very important role in making possible this 1.3 million signatures. they talked to these people every day on the radio. dennis, where are you? >> we've been given two minutes and we're used to it on talk radio. here it goes a couple of points. number one, we're told the moral issue is the one owned by those that think that increased government taking care of americans is -- that's the moral way to go. the moral issue is not owned by the left. increasing government is not a moral idea.

i have a motto and i believe it. and the history of the world of since the early 20th century proves it. the bigger the government, the smaller the citizen. people get worse as government gets better. that is why we have such passion on this issue. we want americans taken care of. republicans don't want health. they don't want their children to be doctored properly. are people nuts? we care less about the health of our families than democrats do? is that insane? this moral issue does not belong to the left. it belongs to the right on this issue. because when government gets bigger, people get smaller because they learn the government and the state will take care of my neighbor, not me. that's the biggest lesson of all of this. you raise an american generation to believe they don't have to do anything for their neighbor because the government will do it. that's why americans give far

more charity per capita than western europeans because western european knows the government will take care of my neighbor, i don't have to. we have the moral idea. we who want smaller government and bigger people. that's why 1.3 million people signed an arcane petition. whoever thought people would get so passionate about a health care bill? it's because our listeners and we who broadcast know how much is riding on this. and let me tell you one other thing, these are not insurance executives in here. these are not rich people in here. this is your neighbor in here, even your unemployed neighbor whose name is on this bill. and i'll tell you one other person whose name is on this bill, my own cardio doctor. a cardio thoracic surgeon in santa monica, california, who voted for barack obama. yes, i attend, i am taken care of by a liberal doctor.

i have no problem with that. he's a very good doctor. and he is now both written and gone on my show to say he regrets that vote because of the utter damage that will be done to american medicine. that's why we're here today and i thank you. and now, it is a pleasure to introduce. i wish i could introduce all my colleagues, but we're going to do one by one. michael medvedev, who is our living encyclopedia. the only talk show host in america to attend yale law school with hillary clinton. michael. >> on the surface of it, doesn't it seem like a little bit of an uneven debate? tonight, behind us, the president of the united states, the leader of the free world with his magnificent eloquence and ruffles and flourishes and circumstance is going to be speaking to the entire world

about his vision for bigger government involvement in health care. and here we are with 1.3 million individual americans, ordinary people, the same kind of people, ordinary people who came out at tea parties who came out at town meetings, who made themselves known, who expressed themselves. seems terribly uneven. except it's a tremendously important demonstration of two different visions of health care and of society. one vision is top down. you make a big decision in congress, you make a big decision in the administration, and the rest of the country has to follow. more regulation, more tax money, more direction from the top. the other decision, the other vision is from the bottom up. ordinary americans making decisions for themselves, taking

initiative for themselves, choosing their own health care, choosing their own doctors. why not do it the american way? president reagan said every important change in america begins with a discussion at the dining room table. people are talking about this all around the country. we're talking about it today. let us put forward that vision and fight for that vision and despite the seeming imbalance, we can win on this because america has always been a country that brought about change and fought for freedom from the bottom up. somebody else who understands that extraordinarily well, my colleague and the best lawyer by far on talk radio, hugh hewitt. >> thank you, michael. in this 1.3 million signatures, there are hundreds of thousands of signatures of seniors. i just want to pause on that for

a moment. they're very worried you cannot take hundreds of millions of dollars out of medicare and not diminish the quality and standard of care for senior citizens of america. the president has deserted these seniors, the democrats have deserted the seniors, aarp has deserted the seniors, but the national policy for analysis has not, and the 1.3 million signatures underscores if this goes forward, the only bipartisan thing going on on the hill is bipartisan opposition to this health care program being put forward by the president tonight. there is bipartisan opposition to it, senior opposition to it, middle class opposition to it. across every demographic in the united states as represented by these petitions. i hope the congressmen are correct when they say they have been heard and i thank you for coming out to watch this today. to conclude this talk show round table, janet's been doing it longer than any of us. >> let me say a word if i can about talk radio for a minute. you put all these hosts together

and you can say whoa, what a lot of hot air. even though the first descriptive word of who we are is talk, we listen. we've been listening to our audience who is not somebody who is a fringe member of the right being moved by some maniac in some room in washington, d.c. these are normal people who have said enough is enough. in fact, i would venture to say that for all of us collective in our concentric circles of the world do go all over the united states from one end to the other. the vast majority of people listening to our radio didn't want to get involved in politics or government. mike pence says 20 or 30 people at a town hall is a good day. people are showing up because something has changed. this debate has gone beyond the

pale of health care reform. who we are, and how we will govern ourselves. this is a much bigger disease. and speaking of diseases, there's a rampant disease in washington. it is called tone deafness. and let's hope that based on all of these petitions, these public servants who work for us will stop talking at us, will start listening to us, and will help us look well to the ways of our own household. thank you. >> that's a pretty good group. >> i'm going to close in a few moments. but if there are any questions from the press, the people who are here would be glad to take them. well, if not, thank you all very much for coming. john and jeanette goodman and jeanette goodman is standing right there. they've made it all happen.

i'm sorry, yes? >> could some of the speakers up there tell us what they hope obama would talk about this evening? >> the question is from our very important media speakers. what do they hope obama would talk about tonight? >> well, i would hope that he would say that he and members of his administration have been listening to some of the feedback they've been getting at town hall meetings all over the country. and what i'm afraid he's going to say is that he wasn't listening at all and he hasn't changed one iota of the elements of his plan. but people have clearly said there are all kinds of things about what's being proposed that we don't like. the worst thing he can say is we won't listen to anything any of you said. >> well, since you used the word hope, i'll answer. i would hope that the president would say my fellow americans,

having an open mind, i have decided to look at other countries that have implemented other countries in the west that have implemented state-run health care. i looked at canada and realized that that was failing. i looked at the united kingdom and realized that was not only failing, but people were having to wait such long times for simple treatments that they were dying while waiting. and then i was told that france was really doing a very fine job in a certain mixture of government and private. and then today's papers i read that that system is going bankrupt. so my friends, because i am an intellectual and because i love the american people, i am scrapping this plan. >> yes, ma'am? >> do you see any area where there is agreement between folks on the right and folks on the

left just general americans and maybe even the politicians here too that could pass? >> the question is with the right and the left talk that we see, is there any general agreement between those two groups as to which way health care ought to go? >> we heard today that every single one of the republican bills that has been introduced and some of them are very comprehensive and very sweeping. those bills all include points in common with goals that president obama has beautifully articula articulated. the goal of protecting people with pre-existing conditions. the goal of putting on caps so that families don't go bankrupt all the time from their medical expenses. the goal of giving people more knowledge of the insurance they're getting, and more choice. the president, i'm sure tonight will speak about choice and competition. and i'm glad for that. because what we need is choice and competition. but enlarging the role of government is never a way to

increase choice and competition in this republic. >> you know, before there was an election last year, the help plan that john mccain advocated was a health plan that drew a lot of praise from liberal health economists, people over at the brookings institution from a lot of democrats. and then we got in the election, the obama folks spent several hundred million dollars demagoguing mccain's plan. the smartest thing president obama could do is just endorse the mccain plan. it would insure just as many people as he's trying to insure anyway. if he did it correctly, there would be no additional costs to the government. so i would say, you know, it doesn't have to go quite that far, but there's a lot of room for coming together. but not when one side is demagoguing the ideas of the other side. >> well, thank you again for

joining us. we hope you'll see you again. and we hope you'll call your congressman tonight and tell him what you've heard and what he or she ought to do. thank you very much. [captions copyright national cable satellite corp. 2009] [captioning performed by national captioning institute] >> the house and senate meet tonight in a joint session to hear president obama speak on health care. our live coverage gets started at 7:30 p.m. eastern. the speech is scheduled at 8:00 and followed by the republican response by representative charles boustany. that's all tonight on c-span. >> as the debate over health care continues, c-span's health care hub is a key resource. go online, follow the latest tweets, video ads and limpings. watch the latest events including town hall meetings and share your thoughts on the issue with your own citizen video, including video from any

town halls you've gone to. and there's more at c-span .org/health care. >> a look at proposed health care legislation and the impact the new system would have on both employers and employees. we hear from former senators bob dole and tom daschle at this event hosted by the bipartisan policy center. these an hour and 45 minutes. >> i want to thank all of you for coming and welcome for coming. i'm judy woodruff and delighted to be here on the discussion that's on a topic on everyone's mind. health care. i want to thank the group better health care together for organizing this program. and by the way, i don't know what all the fuss is about the president's speech tonight at

8:00. this is where the action is. [laughter] >> right here at 12:00. we're going to get in a few minutes to our all-star panel. you see them seated here at the front of the room. first, to kickoff our program, we are fortunate to have two former senate majority leaders, one republican, one democrat, who know the legislative and the political ins and outs of this city better than anybody and who together help to found the bipartisan policy center. they are two individuals who believe in working across the aisle. and we're going to ask them to set up the discussion with some opening thoughts of their own. and without furthera do, i would like to introduce former senate majority leader bob dole

from kansas. please welcome senator bob dole. [applause] >> i need a little help carrying myself. judy, thank you very much and thank the panel. they probably know more than a few others in the room and certainly more than i do, but not more than tom does. but we're happy to be here and we have had this opportunity with the bipartisan policy center for over a year now. try to see if we couldn't sit down two democrats and two republicans. george mitchell decided settling the middle east was easier, so he left our advisory panel and there is one vacancy now. baker and i got him on the run.

tom can do the work of two people. so it's been a great experience and one that we really spent a lot of time on. senator daschle, without a doubt, knows more than anybody on the panel about health care. written a book on it, studied it, knows it backwards and to forwards and the rest of us are playing catchup. the staff would say this is ok. just initial right here. and i didn't do that. i didn't understand that, but i didn't initial it. and i think for the most part we got into what we were supposed to be doing. we were supposed to be advising others on the base of what we know and what we learned and had hearings around the country and listened to experts and did everything we could to make certain we'd get this done. as so often happens, you get all done, it boils down in a

sense to politics and what can you pass, what will congress buy. and you think it would be a slam dunk for the democrats because of the numbers. you look at the senate, it's bullet-proof and house, bullet-proof. you say what's the sweat. the democrats have the numbers, but i do think and i do hope and i know tom feels that way, that we could end up with bipartisan legislation. i really believe it's in the interest of the president and the interest of my party, republicans, to end up with not two or three senators or eight or 10 house members but a solid bipartisan majority for the legislation. and we're not certain what it is. we hope there will be some surprises tonight that might get the attention of some republicans and might make it a little more easier to line up more republicans. so bipartisanship means a lot

of different things to different people. one is that you gee with my position and that's bipartisanship. that's the kind that i really prefer. [laughter] >> trouble is daschle has the same message and he's smarter than i am and a lot younger, so what am i supposed to do? but it was a lot of work. but i went back after i left the senate. i didn't write the book but thought about the things that happened while i was there that really meant something to the american people and whether or not it had bipartisan support. and almost without exception -- i mean if you've got the votes you could make me swallow almost everything but you can't make me keep it down. you look at the americans with disabilities act, it took several years to get that in a place where you could pass it.

and when you did pass it, it had overwhelming bipartisan support. the social security amendments of 1983, pretty much the same. and that bill, we had things that nobody liked. we offended every interest group in america, which made me think was probably pretty good legislation and it passed with strong bipartisan support and checks are still going out until the year 2017 and maybe even later. we thought it would be later than that when we finished the bill. anyway, my point is there's something in it for both parties. president obama can say the democrats pushed through the bill, the health care reform bill. republicans sat on the side lines. i hope that's not the case, but there is always a little danger in that. if i were president and it's

not that i didn't try it eight or nine times -- [laughter] >> i would like to know that there was bipartisan support, because i think it sends a signal to the american people and they're a lot smarter than some people think they are. they know who's an r and who's a d and if it is an r&d, it is pretty good legislation. i think it's in the interest of the president to be bipartisan. the minority and majority party, it's in their interest. we hope to gain in offyear elections and we're not going to do it unless we have something to show for it. i have been on both sides of these whether you do it or don't do it. maybe the best strategy is to put a sign on your desk that says no, call me later.

but i think initially that would probably sound pretty good to people who are upset about it and you might be able to sustain that for a while. but after a while, in my view, the american people are going to wonder what were the republicans for. and i'm certain there will be people around like my good friend like senator daschle and others to remind them what we did or didn't do and we will be doing the same thing. there's nothing wrong with that. here wer very important speech tonight. i was hoping the president would introduce his own bill and just take ownership and say, this is my legislation. this is what i have decided after all the hearings and all the protests and all the talks and all my business with democrats and republicans, this is the bottom line. and as he speaks, have the leaders introducing legislation and then he would take it from

there. apparently, he's not going to do that, but may do something close to that by being specific in what he will accept and will not accept. because i think up to now, we have had all this in the house, but we have too many bills floating around. four in the house and senator bachus has his bill in the senate and the senate bill has the best chance of maybe finally getting some real bipartisan support. i have been talking to grassley and enzi and to snowe and murkowski just to say i'm not calling you to say be for some specific part of the bill, i'm just calling you to say don't give up and hang in there and work with senator baucus and

senator grassley. senator grassley would like to do something. he is the republican leader in the finance committee but hard to expect senator grassley to provide the leadership when he turns around, nobody's there. he's buy himself. and so he has been working hard and so have other republicans. i don't mean to denigrate the republicans who have taken a different position. some are principle opposition. they have the right to be in opposition. and they have the right to offer amendments and have a right to debate and right to vote. and i think once we get focused on this is what the president says he wants, now what do we do, where do we go from here? do we offer a substitute as the republican party? do we offer amendments? work together? the president has indicated he is going to spend a lot of time

with leadership in both parties at the white house trying to pound out just one little thing at a time. there's more in this bill than the public option. i know that's important to many in this room, but there are hundreds of provisions in this bill. and maybe i thought that was a diversion to talk about the public option and let all this other junk get through -- i don't mean it that way, but other controversial areas to be slipped through because all would be focused on the public option. but i don't think that's the case, but it could be. here we are. in the morning, we'll know pretty much what's going to happen. if there's absolutely nothing new, well nothing new is going to happen. and i would like to see something happen. back in 1977, we had the 3-d

bill which contains many of the provisions that are in the present legislation. so 31 years is kind of a long time to wait, particularly when you're 86. [laughter] >> and you are really worried about room service and things like that. [laughter] >> i have the privilege of introducing a man who's had great influence on president obama, on his thinking on health care. and i can truthfully say who knows more about the issue than anybody i know who is in or out of congress and no offense to any of the experts in the room. but tom has written a book and he really understands this. he has made hundreds of speeches and has gotten into

the details. tom understood in our negotiations, the four former leaders, with no vote, no power, no anything, but some credibility with former members and some credibility with the public. tom understood -- i don't like mandates, but i like the public option even less. so i was willing to see a tradeoff there. get rid of the public option. i don't know what tom's thinking was, but we didn't end up with a public option. we did end up with not the kind of trigger that snowe has but a trigger that could send a bill to congress but could be debated upon and voted on like any piece of legislation if the insurance companies fail to clean up their act when it comes to pre-existing conditions and the other key issues. and so tom and i have worked

together. in fact, i take a little pride in getting tom to come to our law office, which by the way, if you need any more information -- [laughter] >> i have some pamphlets and three people as you go out who are going to stop you and other one to get you ready for the meeting. it is a good law firm. and we are serious about business. i mean when i get it, i give it to some real lawyer. i gave it to bob dole, wonder what happened. but you'll like the result. so i'll give it to a good lawyer. i don't need any further introduction of tom daschle, who i worked with in the senate. we never had a public

disagreement. we disagreed on a lot of things, but we never did in public. i think there has been a slight change in the way congress conducts its business and works with each other, one another. but -- and we had our problems, too. i'm not here to criticize the senate, because we certainly weren't perfect by a long shot. but one person who kept us on balance and kept us on course and kept us on the right -- i wouldn't say right -- kept us on track is tom daschle. tom. [applause] >> bob, thank you for those very, very generous words. i don't know who once said it, but they said that sultti is a

disease that starts at 7 and leaves at 70. i like that and the direct line that my friend, bob dole, takes. it's been one of the joyce in my professional life to work with this man in different contexts and it has been a terrific experience. and i care for him deeply. judy, thank you for your introduction and delighted to be part of this panel. i remember it was -- i think it was mark train had to follow somebody like i'm just following now and he came to the podium and said, the previous speaker and i before this program started exchanged speeches. you just heard my speech and i forgot what he was going to say.

there is no word that bob dole just has shared with all of you that i disagree with. i start with that. over the course of the last 18 months, the bipartisan policy center, through theen rossity and support of the robert wood johnson foundation worked on an idea. and the idea was simply can four former leaders come together and reach conclusions about this complicated lay of the land on health policy in a way that might offer some blueprint, some approach that might be helpful to congress as they deliberate. it took us 18 months, two democrats and two republicans and george, as bob said, departed a little early. but the three of us finished the work. and it was hard. i was working with two

extraordinarily capable formidable former leaders who know the art of a good deal, who know the legislative process as well or better than anybody in this town and in spite of the fact that we had everything going for us and two people on the other side of the table who wanted to get to yes, it was difficult. it was challenging. and there were moments when i wasn't sure we were going to get there, but we got there. and as i think back, how was it we got there, but it still seems so difficult for others to achieve the same thing? and i think the answer in part is we didn't feel any peer pressure. we were there as independent contractors representing ideas, but nonetheless, there. and there was no politics. there was zero politics. and so if you can eliminate politics and peer pressure in this town, you can get it done.

i wish them luck. but i know this, every day in this city in ways large and small, we make history. bob and i had the good fortune to make a lot of history as two leaders for a period of time and history is going to be made tonight, today. as we speak, history is being made perhaps in the senate finance committee, perhaps as the group continues to work to resolve their outstanding differences and the president of the united states is going to give a speech to the nation in a joint session that will forever more mark another important element in this debate. history will be made. whether it's large or small depends in part on whether or not we can minimize politics, minimize peer pressure and recognize how important this job is. this has evaded us now for over 70 years, you could argue over

100 years, the first time it was in any platform, it was in teddy roosevelt's platform in 1912 as the progressive party, calling for national health care. so we have been at this for a long, long time and failed and failed and failed. and i was part of the last failure. and i vowed at that time -- vow is too strong a word -- i asserted at the time that we have to figure out a way to deal with this. we just dealt with it increment tale and we have made a little progress for kids, thanks to bob dole and others who made progress on portability, but we didn't make a lot of progress and frankly we have fallen behind in every context as we look at health care, quality, access and cost today. well, i tell you, you just heard one of the finest leaders

and legislators in recent history. and you'll forgive me if i recall another famous leader, someone who was my inspiration on this issue for the last 25 years and that's ted kennedy. like many of you who either watched or attended his funeral, you couldn't have helped but be moved by his son's eulogy and that moment when he was at the bottom of the hill trying to get up having just survived cancer with one leg and ex claiming to his father there's no way i can get up to the top of this hill. and his father says, we're going to the top of the hill if it takes all day. and they got up to the top of the hill. and teddy kennedy junior never

forgot it. and there were people in that church that day who shouldn't forget it either. for 70 years, we have said, we can't get to the top of this hill. it's too hard. it's impossible. well, nelson mandela once said a lot of things seem impossible until they're done. this can be done. we know that the status quo is for the mess we're in and we're in a big mess when it comes to health care. costs are out of control. we have 50 million americans who don't have insurance at least part of the year and maybe at least another 60 million or 70 million americans are so underinsured and 18,000 people a year die because they don't have access, die because

they can't even get in the building. so the status quo is the least acceptable of all of the outcomes. and while there's a lot of differences among everybody on this panel today, a lot of differences, but we're not hearing nearly as much as how many similarities there are and common ground there is, how everybody -- and i could be proven wrong that everybody here wants universal access. everybody understands the importance of insurance reform. everybody understands we have put into place effective cost-control measures. and nobody at this panel, nobody is satisfied with the assessment of our quality today when commonwealth, one of the most prestigeous organizations said we are 19th out of 19 industrial countries when it comes to outcomes.

nobody can be satisfied with that. legality's hear more about the common -- let's hear more about the common ground and about less what separates us and let's do what others would have us do, let's climb that hill, let's get to the top this time. let's make history. let's do something that makes our mark this generation. when that happens, we can all be proud. thank you very much. [applause] >> we are going to get under way with our panel and we know that senator daschle is going to be joining us. we would love for senator dole to stay and join us. and that's going to be his decision. ok.

but if we wanted him to know if he changes his mind, he is welcome. and i'm going to be asking questions and going to be having conversations among this group up here for another 45 minutes or so and then open it up to you in the audience. be making notes about what you hear and be ready to engage. and as senator dole leaves, let's give him one final round of plause and thank him. [applause] . .

have.

i think most americans think that because we outspend the rest of the world in terms of aggregate dollars on health and on a individual basis, we're getting better results. we're not. i don't think people realize that. france, which we like to criticize and tease, the world health organization ranked france's health system best in the world. they live longer, don't have the infant mortality problem and they don't have the obesity rate. those are three signals that our system is failing. >> i didn't go around and introduce everyone at the table. that's charles kolb. i'll call on annie hill, from your perspective, what are the most important points of agreement? what would you add to what mr. kolb said? >> i would agree in yen with

all the three thing he is said. but maybe to be a little more specific, which will probably then start to be a little more controversial, is how do we accomplish some of those things. that's the challenges we've seen play out over the last few months is about how we get there. there's actually four things we're looking for, three, i'll use three of them. so one is that we do think there should be an employer mandate, that all employers should pay to level the playing field. we have many employers picking up the cost, covering workers that work at other employers. the second thing is we think that, and there has been a couple of committees that have addressed it, but we don't want to forget people that are under 65 but are retired, that is actually the most expensive group to cover and we want to make sure that those people are taken care of in some way. some people just haven't retired because they're ready to go out and kick up their heels and have a good time.

but they actually are too ill to work, they have a family member to take care of, they've lost their jobs, and because that's the most expensive group to cover, then it's hard to go out and get independent coverage. sometimes they have chronic conditions, pre-existing conditions, so it makes it difficult. >> i'm going to stop you there. if you're going to make a short list of specifics, let's have some discussion about that is everybody in agreement on what she just said about what kind of employer mandate there should be. leslie dodd of wal-mart? >> as the nation's largest private employer, we've also supported an employer mandate for a variety of reasons. first, we feel every american should be ininsured. also those of us as individual whors providing health insurance are subsidizing those who aren't. they get the worst care, the most expensive care, it adds to the economic burden on the rest

of us as well as the social burden. every employer should play a role. there are going to be small businesses that need a break. there are some small businesses who deserve to be exempt and others who deserve to be helped. we think every company needs to help shoulder the burden. >> no daylight between the two of you on that? ok. you were going to list, you had a couple of more things you wanted to list. >> one other thing is that as far as insurance reform, is that we think the best way to get there is to have a public option and that there has to be another alternative for small businesses that it can't just be open to everyone, but there does need to be that option available. >> ralph camden, kelly service, how do you see, where's the agreement among the group of you about how to take care of individuals who don't have coverage now? >> i think that charlie and others laid out lots of the

principles we very much agree on. i would want to add one more principle and come to your question, which is the sense of urgentcy. i think we all shared a sense of urgency. in our case, i'm particularly bothered by what i see as declining american competitiveness because of outcomes on health care. we all talk about the cost but we don't understand given how much is borne by the employer and how much is borne by the taxpayer, how many companies are choosing to move jobs because the costs of employment is becoming out of whack. when we talk to entrepreneurs as to why they're not starting new companies, access to health care has become a critical reason cited, right up there with access to credit which just beat it out in the last

survey, given the current crisis. we, like wal-mart are willing to support an employer mandate. everybody has to play. there's no choice. i don't think a company can choose not to participate. the form of that participation, i think there has to be room. there's no -- i don't believe we get to an end decision by this early in the game ruling out any of the possibilities as to how we achieve that employer mandate. i happen to be more of an advocate of a free enterprise solution than some of my colleagues around the table. i think the more important part is, we've all said collectively the outcome we're excited about is access to health care coverage for everyone. how we get there, there's some room for good-natured debate along the way. >> andy stern, president of the service employees international union, what would you add? what are the points of agreement here? >> i think they've been pretty well covered. i think we appreciate the number of people who have said

we need to move from a sick care system to a health care system. and keep paying on the basis of quantity not quantity. in the end -- quantity not quality. this means wellness and best practices. we all agree you can't cut costs unless you change the whole paradigm. >> you all are making this sound easy. >> sets a positive tone. >> and we're going to start out with a positive tone. eric dishman with intel. >> i agree with a lot of what's been said here. intel agrees with yube versal access to quality coverage. i don't think we believe there's a false di cotmy between having a competitive insurance industry and a government system in place to make sure bad things don't happen. we are in favor of innovation and trying to keep costs down.

i agree with senator dole's comment, there's far more to the bill than just debate over the public option. if we allow the entire debate hob held hostage -- to be held hostage to that one issue, we risk are solving many other things. >> yet that is where so much of it has centered. >> it is because many of us believe it's the best way to achieve the goals we all share which are that we have competition that keeps -- makes insurance companies get us the best deals and best care and that we have choice among plans weand think that a public choice is a good thing alongside private insurer choices. keep them competitive and push on them. we definitely need to bring down costs. unfortunately in the current market, we're not seeing private insurance companies do that. we see it as part of the bigger whole a whole in which we also

have an exchange where people -- an insurance exchange a marketplace, where people can get insurance with an end to discrimination based on pre-existing conditions or the pulling back of coverage when people get sick. we see it as part of insurance reforms, of rules for insurers, and just to go one step further in terms of the overall, how everything fits together, there are some who look at insurance reform and say, why don't we just do that? you can't just make rules for insurance company the premiums will go up if you make rules. they've been avoiding sick people, if you start making them take them, they have to charge more. you can't have a system in which people can wait as many would, understandably, to get insurance when they get sick. we've got to have everybody covered, everybody choosing, everybody responsible in order to proceed on good, strong coverage, affordable coverage and the kinds of cost

containment we've been talking about. >> i want to come to senator daschle on something you said. on this question of just doing insurance reform, i mean, is there agreement here that that's not enough? just getting the insurance? because that argument is still out there. >> no matter who pays and how we sort of solve that problem if you don't do delivery reform and do care differently, you're not going to deal with the doubling of the number of seniors over the next few years and you're not going to odo business as usual for the 47 million uninsured you add. >> and it doesn't cover the 25% of the work forest who works in nontraditional modes, the temporary employee the independent contractor the self-employed professional, one or two-person office the current model doesn't work. >> why is that argument still fletting -- floating around from some quarters? >> one can wonder whether those who make the argument that just an incremental change is the right thing to do or can even

work. we're saying it can't work. whether they're really seriously committed to doing what we need to do to get the job done. >> senator daschle, i know, i think you said this too, we know senator dole said there's more to this thing than the public option. having said that, it is a big -- it's the 800-pound gorilla, 800-pound elephant, whatever it is in the room. and the sense is growing that it's just not going to happen. that the house may want it, but the votes are not there in the senate. where do you see the state of play right now in the public option? >> judy, i think that it's important for us to define what a public option is, first of all. i think, judy, -- judy has articulated it reasonably well. it's a place where people can come that have, until now, had

very little opportunity to get good care. i find it interesting that opponents of the public option generally say that the reason they don't support it is because it would be so popular, everybody would flock to it and that its success is the reason they don't think it should be incorporated. that logic evades me. but i have to say that we haven't had the first vote, we haven't had the first day of debate on the senate or house floor. i think the congress needs to work its will. let's see what happens. if the votes aren't from there, there are several alternatives to public option a fallback a state public option, there are ways to address it. who says this has to be the last word on health reform, whatever happens in 2009? clearly we're going to be revisiting these issues from time to time and if it's as popular as i think it may continue to be, i think there's almost an nevittability to a public option at some point down the road. but i agree with those, we can't let any single item in

this keep us from getting to the larger good, which i think is meaningful coverage, meaningful cost containment, meaningful improvement in quality and far better choice. i think if we do that, we will have achiefed a great deal. >> the difference, judy, with this group is, that we're not arguing that the choice is between doing nothing and doing something. we're just saying, we've all committed that we are going to do something the issue is what's the better something and what's the achieveable something we can get done this cycle. >> for the purposes of the audience and this discussion, what about the trigger as an option? pluses, minuses? >> actually for us, we've been lucky we've managed not to make the public option precisely for the arguments and discussions people have had here. from a business perspective and from also trying to listen to all the people who shop at wal-mart who have a concern about this, who are struggling

paycheck to paycheck in a difficult economy, and what they're worried -- they want this problem solve bud they want to feel safe and secure about it. one of the concerns we have is the debate is more about positioning and less pragmatic, more and more people get scamplede when more and more people get scared, the politics gets harder. one thing we think is important is to talk to the american people. i think the president will undoubtedly do that tonight to give them a sense of reassurance, to remind them that the current system is not sustainable, whether for them as individuals or the american economy. we need to change that. and we can change in a way that they can feel safe and secure. they can feel safe and secure if they have insurance, and they can certainly feel good if they don't have insurance today. if we can control the cost of health care, those businesses paying for health care can have some assurance that it's worth supporting this bill more fully. i think really, to us, that's a big priority that we kind of establish, re-establish the

momentum, re-establish a safe place in this for the american public and then move forward. >> given that, what the media is looking for right now is some evidence that there's a coming together on this public option question and i don't want to beat a dead shors, -- horse, but i'm interested in hearing from you all, is there language in the back of your mind, in the front of your mind that you're hearing that you see the two sides coming together on? >> it's the devil in the details. senator daschle pointed out, you're reacting to a notion of a public option that so many people have so many different notions of it's not clear what you're signing up for. you've heard us all say competition is good, regulation is good, there's a balance between the two. at the end they have day we need to see specific proposals to respond to. very scenarios where intel could get behind the public option, if it's a level flaying -- playing field and the

government doesn't have an advantage. there's ways public options could be set up that would be horrible. this language that most people don't understand around public option, what's the difference between that and universal coverage? how does it relate to single payor? there's a lot of slipperyness about this language that breeds that fear and ambiguity. that's what we have to clarify. >> i think the question is, whether there's likely to be a market failure. a number of us want a market-oriented, incentive-based set of reforms. we've just been through in another sector of the economy a whole series of market reforms -- excuse me, market failures where people never thought there would be market failures. on the one hand, those of us at c.e.d. are for a market solution, but we have to think about, what happens if three to five years into this, there's a market failure. we don't have a view on the snow position but some sort of

back stop against a market failure strikes me as a reasonable approach. the devil's in the details but the principle is whether there's a market failure and we've seen that market cans fail because they don't always have perfect information or the structures are messed up or the incentives are messed up. >> what's the view from seiu -- we know you're for a public option, no doubt about that. but what about some middle ground? a trigger or something else? >> i think i would disagree, i don't think the media is looking for people to cogget. the media is looking for people to be split apart. i think what the president said and what senator dole and tom said is there's a lot of agreement here. what's going on with this group, there are democrats and republicans, business and labor, but we're all americans. we think we need to do something for our country and we think we can find a way to do it. when it comes to the public option, it's what you ant and what's achieveable.

if someone wants to empower this group of people to reach agreement, we could. but the truth is, we have to vote. we've had this discussion. it's been wonderful. i admire the president and the leadership, it's gone on, taken up a lot of of -- of time, it's been heated and passionate and a little disagreement. there are 435 people down the street who have to make a choice about the future our country, we're tired of having the debate, all of us, i think we want something done. >> what would seiu's position be? >> we want the public option. >> as it's come out -- >> we have to decide like everyone else what do you do when you don't get everything you want. and is the perfect the enemy of the good? >> i think we think there's support out for it, but i think the devil is in the details. there's a lot of great points made, i would agree with leslie, there's been so much fear generated, especially over

the last 30 to 45 days that just the words public option has become a lightning rod. there's so many ways it could go. i'm hoping that when congress is now back together, there can be some good, solid debate around some details and hopefully that effort will start tonight with the president's speech and get this debate back on track so it's not just a yelling match and a lot of negative stuff that obviously is played out in the media and that we can really get down to the serious business because this is something that i think we can do, but it's also something that we must do. i mean, the time's now. >> what do you all believe the president needs to say tonight or do tonight, and i don't mean in specific words but what needs -- what has to happen tonight. what does he needs to accomplish tonight in order to advance the cause of health care reform? >> there's both a substantive and an educational component for tonight. for me, at least, i think the educational and political component is the most important

to restore a sense of momentum, to restore this notion of a safe ground to education people that the current system is not sustainable and create a context in which i think people on capitol hill, in a sense, there needs to be a lot less positioning and more progress. i think if the president can also make the clear political case that failure is not an option. failure wasn't good for the democrats in 1994, it left a legacy they weren't happy with. and failure won't be really a good political option for either party in this debate. to me, it's less about the details the president says and much more about momentum, the confidence, and a sense of purpose he puts back into the debate. >> i'm going to make a process suggestion. i agree with what leslie said. yesterday he played educator. we he went into schools, that created some controversy, but i think his remarks were pretty good i think he has to educate tonight.

but i also think there's one other important thing he has to do, he has to act. i'm going to put this on the table, it's unscripted, it's not a c.e.d. view, but i served in the first bush administration, the h.w. administration, i remember the very controversial 199 -- 1991 budget bill. the bipartisan house and senate sequestered themselves for a period of time at andrews air force base. i think the president has gotten criticism because he's given a lot of good speeches. i think the american people want to see action. if the president gets out and gets in with the republicans and think democrats, the ranking and leaders of the committees and actually starts making something happen, three weeks after an air force base summit they can all go out, presumably in a bipartisan way, lock arms, and sell what they've done. >> senator daschle is that a

realistic idea? >> i think that's exactly right. my -- we need a speech. i don't think we should minimize the important of this speech because i think there are three audiences. the american people is the first audience and i think he needs to rearticulate and redefine what his vision is, what is this all about to clear out all the the junk, and to set straight what it is we're trying to do. secondly, i think he needs to talk to the congress and share with them, with greater specificity, this goes to the point of action, we need to show clearly how we're going to get there how we're going to do this. he needs greater specificity, which i'm quite sure he's prepared to provide. the third audience is to his democratic colleagues in he house and senate he needs to remind them what's at stake here. democrats have to prove we can govern, that this isn't dysfunctional governance at its worst, but that we can truly

govern and rise to the occasion and address one of the biggest domestic challenges facing our country right now and that as others have said, failure is not an option. at the end of the day, it has to be the beginning to the action. because without it, it's just more rhetoric and that isn't enough anymore. i agree completely with what andy said. this is about getting to the votes. now it's time to start voting. >> i think one thing the president needs to do is shift the tone of the debate. we are positioning health reform as an obstacle to overcome. it's given its economic impact on the impact on the daily lives of people. no one has had the discussion that health reform done right autoto stimulate our economy, ought to generate a million new virtual care workers to do disease management and independent living from home. we're so in a mentality of what do we need to take away, as opposed to what do we need to do to position our country to

help us care not only for our aging part of the planet but to deliver technologies to the rest of the world. >> are you faulting the administration for this? >> it's not so much a fault as a missed opportunity. there are real ways in which health reform done right can create new jobs. this is the internet for the health and wellness of the future. europe and other parts of the world are heavily investing to own that agenda. we need to be embracing this as a going to the moon, space race type of opportunity. >> we've let this debate get focused on trying to minimize what each individual fears they're going to lose. it's a total loss of the symbols. we have no aspirational goal. we should be talking about the fact that as a country, it is unacceptable to have 40-plus million uncovered. it is not american. we should talk about that we've lost our ability to compete in the world. that's not right.

we haven't said what is everybody going to gain from this? what do we become? how do we become a better country? how do we become more competitive? how do we as individuals benefit from this proposal? i use the language, it's time for a grownup speech on health care, we've had all the tantrums we need. it's now time to talk about what is at stake, not in terms of what we lose but the opportunities that we will lose if we don't take this chance. this ability to gain them. >> with all due respect, everyone here at this table agrees with that, but there are interest groups, many individuals out there, who disagree that everybody deserves health care. there is a significant view held by americans, some americans, that the government doesn't have the responsibility to look after, or we as a people don't have a responsibility. >> if the argument, we can

argue, as again, lots of room for debate about how do you go about providing the care. the bottom line is as a society we're paying for that choice right now. those who show up at the emergency room uncovered receive care. may not be the best care, may not be what we want them to achieve. but it's expensive care. we bear, as a society, the failure of our system. it is time to, and the discussion of we have the best health care system in the world, we don't. we have the worst health care system in the industrialized world. we pay more than everybody else, get less of an outcome and whether we as a society think we should bear the cost of health care for every individual, we are paying for the outcome those health care decisions for every individual now and there is no difference. we should do it in a way that's most compassionate and that makes us more competitive. we have chosen to do it in a way that's least compassionate and damages us as a country.

it is not sustainable. >> i'm -- i actually would take issue with whether it's really that day they don't believe people shouldn't have health coverage. i think that they are confused about and not accidentally because of the activity of many who oppose health reform about what it takes to get us there. i think the biggest challenge to taking that aspirational view, carl is that so many opponents of reform, who are reluctant to see this change for a variety of ideological and political and interest reasons gain so much from scaring people into thinking they've got more to lose than gain. we're hearing a strong argument the president -- we're confident the president is going to be making, that it's the stat cus dust quo we can't afford to keep, that the fear is undermining our capacity to give all americans what they

need, the affordable, quality care. it's true for those who have insurance and for those who don't. we've got to get the system affordable for everybody. >> i'm going to continue to play devil's advocate. those voices you're describing are not going to go away because of the president's speech tonight. how does anything change after today? >> what's wonderful about our country is we have a way we make choices. you know. we have elections. we have a congress. we elect people. and we don't expect everyone agree. you know. there is no censorship. whether we want to call them tantrums or, you know a big discussion we've just had, we've reached a consensus in america, by my definition the consensus is that everybody has been hurt. everyone has been hurt, now we vote. we make choices. that's all leadership is about in the end. making choices. our leaders now owe it to america to go up to that hill in the capitol and debate as long as they want and take the

votes and we'll either decide to be on one history or the other, i hope we decide to solve this problem that this country has been unable to solve for over 100 years now. >> i think charles put his finger on it. some of the discussion thus far enabled people to think, we're going to have change but it's not going to touch me. when you're talking about fundamental, structural reform of 16% to 17% of the g.d.p., there are going to be winners and losers. you can't do it any other way. i think andy's right, possible winners, possible losers have every right to be heard. they should play a part of this, continue to be heard. but it's now time to decide. we can't -- i just don't think we can have incremental reform. the demographics won't allow it, the cost increases won't allow it, the ethical and moral aspects of having 45 million people in this clint uninsured will not allow it, our

competitiveness won't allow it. you can pick any factor or combination you want, it's not going to change. there are winners and losers, i think that has to be discussed openly and accurately. >> why do any of you believe at this point that the president's plan is going to pick up more than one or two republican votes? >> as i listen to my former colleagues, judy, and you know, they've had the experience that most of us have had, they've traveled the country, they've been home in their states, they all know, they know in their hearts that the status quo is unacceptable. they know we can't sustain the current path we're on. they know from a competitiveness point of view, they know from a quality point of view. these problems are very real. we may differ on how we get there. there seems to be unanimous agreement at the 80,000 foot

level, when you get down to the 5,000 foot level, there's disagreement. but at the 50,000 foot level they know we have a problem. we need to bring everybody the realization that, look, no one is going to get everything they want no one is ultimately going to get their bill passed. this is going to be an amal gam of ideas and compromise. let's all accept the fact that the worst possible outcome would be to accept something that we know is unacceptable, the status quo. >> andy has talked about votes and tom has, too, i think the other mark of leadership is whether people find a compromise. sometimes that's even tougher than taking the vote. we're at the beginning of this phase as people have discussed and i think one can have some optimism that as the choice becomes in a sense more brittle and also as people recognize the need to find some common ground, there are going to be members who stand up who say

they'd rather be for progress than partisanship. we've seen that happen in this town before on issues less important, where the arguments were less clear. so i think you have to go with that sense of optimism, as this gets narrowed down, the people who are elected to represent and come up with solutions will indeed choose to do that. >> i'm thinking back to what you said, senator daschle, about how you and senator dole and senator baker were able to come to agreement in the absense of peer pressure and politics. i also recall, i don't think it's telling tales out of -- out of school, that it wasn't easy for you to come to compromise. there are real differences of views. as you both said, you and senator dole you gave some, you did some things you -- not your first choices. you did come to agreement. what you've demonstrated in that bipartisan action is that it is possible, substantively to come to agreement. the question you're raise, judy, is does the president

standing up now and making it clear we can't afford the status quo is going to make it politically possible to come to that agreement. >> let's talk about one thing i read this morning and yesterday, that the president may have some new language on, and that's malpractice. like tort reform legislation. let's talk for a minute about whether any movement on the part of the administration on that issue would make a difference. one way or another to you. eric? >> i think that's another issue that's going to have huge controversy. i've come into the 21st century and started blogging. i've been trying to do research before i open my mouth about malpractice. what i'll tell you is i can find reputable studies from reputable organizations that say malpractice is a huge issue and others who say it's not, it's a smoke screen. i as an american citizen and fairly informed person about these issues i don't know what

to believe. i'm a social scientist by training. we study thousands of doctors and nurses and patients, i will tell you that the fear of malpractice, whether it's legitimate or not, is driving physicians to behave badly and differently and they're worried about it and it's a big part of their lives. whether or not the actual laws need to be changed, i don't know. but the issue has to be addressed. it's hovering in the cultural atmosphere in a poisonous way. until we dissipate some of that, it's hard to move forward. >> it has the advantage of putting another chip on the table. what happens if you say everything should be open for discussion, we should be open to mandates, to public options, but to say, we're not open to discussing malpractice doesn't work. if everything is on the table, malpractice has to be one of the chips on the table. pragmatically, in terms of cost impact, it's not the biggest thing we can do oto lower

costs. i have seen, also a social scientists, i have seen studies and my wife is a nurse who says it has a chilling effect on and alters behavior inside hospitals, but your question was a political question. i don't know that it is a game changer in and of itself. but i again would argue if we're going to go into this in a spirit of let's make a solution happen, all the chips and all the items should be on the table so we can get to a rational set of tradeoffs to get to a good solution. >> i would say we have to be careful here. there is a difference between policy and politics. i think we saw a lot in the stimulus bill. people reach out to try to make compromises, expecting the resip rossity would be a vote for my -- reciprocity would be a vote for my bill and all they got wasn't that.

i think malpractice will bring people who wouldn't vote for the by the democrats and max bachus should get sainthood for the patience he's shown but there's time that, you know, i run across people in every trip i make talking about this issue, pat and john lose their 100-year ranch, roberto walker loses her health care and finds out the next week she has cancer. we can have lots of policy debates here. if this is about building a bipartisan consensus, fine. if this is about changing the bill and be like lucy on charlie, pulling the football out every time he's ready to kick it, i'm not for that anymore. >> we should find some foundational bipartisan issues. i think the malpractice has the potential to erupt as much as other things. we should be choosing what we agree upon. there was a huge focus on

chronic disease in what tom daschle and others wrote. we should declare a war on obesity like we've done with other things in the past and hopefully more effective than some of those and looking at how do to the change the care model to look at that. those kinds of things we can agree on. if you pick out malpractice you get a lot of great sound bites, but we're not going to move on. >> i think i want to go to the audience for questions. i'm interested in hearing some of you talk about the proposal out there to tax insurance companies for the so-called cadillac, high-end plans that are offered but why don't we go ahead and go to the audience and i understand we have individuals with microphone, i can't see because of the lights, raise your hand, we'll try to call on you, who out there would like to put our

panelists on the spot? >> as if you haven't? >> i'm trying. >> let's see is this a bashful crowd? >> so far. do we have somebody? please stand up, tell us who you are. >> mark meade, i'm a consulting underwriter for the evil h.m.o.'s. all of my clients are in favor of reform. cost, quality, malpractice, they're not against anything. and they've been very supportive, they've not got out and urged their members be against anybody. but the one thing that i see is, we do have certain problems within the insurance industry with some of the larger, the giants that are unresponsive that occasionally act

irresponsibly. what would be the difference between a big insurance company that's unresponsive and a big government plan that was unresponsive. >> do you want to pose that to any one or two panel members? >> the people that are supporting the government option. i can't see it any different because i've worked with government plans, tenncare, massachusetts health care reform, other ones that aren't responsive. and i just see us setting ourselves up for another situation where we just have one more big player who is unresponsive to the public. >> let's go to senator daschle first. >> i think it's a great question. it's a very important question. i would say that the answer is in a word, recourse. what happens when you're up against a big insurance company? unless you're a big shareholder, there's very little you can do about it. what happens if you're up against a problem with regard to medicare? you have at least 535

advocates, including your own congressman and your two senators to advocate for you. your access to recourse in cases involving public policy with a government plan at least give you an opportunity for recourse. that is action through the legislative or executive branches of government. >> i would just add to that, first of all, a characterization, we looked at what was being proposed in the house legislation, the public plan is not huge. the private insurers grow at the same time that people are in a public plan and what the -- those who want it are emphasizing is that it makes sure there's not just one or a couple of players in any given market which is the present situation. where they dominate and are unresponsive. you put a public plan, accountable as senator daschle says, into the mix and the great thing is, you then really

do have competition that can change the whole marketplace. >> anybody on the panel want to take issue with that? >> i want to say, whatever we do with the public plan, it has to set a faster pace for adoption and innovation and has to, you know, it can't set reimbursement rates at a less than cost situation where the costs get passed on to private employers in that hidden balloon squeeze. >> can you just comment now that you've heard from senator daschle and judy feder. >> i disagree with them, i work with the d.o.i.'s across the country, and in most states we have aggressive insurance commissioners, we have panels that represent them. you see horrible cases, i would have to say, hire me to help sue insurance companies because i've done that on two occasions work great success. yes, there are incidents where these people have stepped out of line, but at the same time,

they have been rather severely beaten up and have to pay very large settlements for their inactions. i just don't look to the government as being any more responsive than a private industry with proper oversight. >> well, i think the whole idea behind the explain and this notion of choice is that if we have a true level playing field, ultimately it's going to be the american consumer who will have the opportunity to move from one to the other if they're dissatisfied. that's number one. i guess i would just draw a distinction. i think you're right that there are those cases where insurance companies have either acted, not illegally, unethically, and they have been called to the mat for those improper activities, in many cases, however, what involves

decisions for patients is perfectly legal. just the whole notion of eligibility and a pre-existing condition and all the issues involving eligibility for coverage, those issues are totally legal and may not warrant a lawsuit but still in many cases undermine a patient's or person's ability to get the kind of coverage and care they need. it's in those cases where i think having better advocacy is important. and i would hope that a public option would add to the advocacy options, not detract from them. >> anybody else on the panel? ok, another question. this gentleman here in the front or maybe somebody back, i can't see. if you could stand up and give us your name. >> terry gardner with small business majority. i'm wondering how you think the reforms we see in the bills in

congress now are going to deal with the problems in rural, by rural, i mean we have a lot of small states, 10 states under one million people, 20 states under two million people and the same states have pretty intense insurance concentrations, 70% or more, and lastly we have provider monopolies in those areas. so is the marketplace you're talking about going to work there? >> leslie? >> i don't know enough to answer that one either way. >> the small business has tremendous amount to gain from establishing the exchanges and new rules for insurers, public and private. go back to your, even with the rule, they've got a tremendous amount to gain. they're paying the -- and you know painfully from your membership, small businesses are paying far more in overhead to insurers to cover marketing costs, advertising costs than

large employers. what's likely to be accomplished with the exchanges and the congressional budget office documents this, is it brings those administrative costs way down so that essentially you're making, you're giving the small employers the same opportunities that large employers have to get insurance in the marketplace we're holding accountable. we may disagree on how, but that -- the exchange and the rules and public plan in addition can hold the whole marketplace accountable. there's a tremendous amount to gain and you know that small employers are -- even owners are unable to get coverage for themselves as well as their workers. the exchange, the subsidies, the special tax benefits for small business are a tremendous boon. they're big winners from the health reform proposals we see moving through the congress. >> judy, would that allow people to buy across state boundaries? the one bill has state

exchanges, we've supported regional exchanges, getting rid of limitations on the sale of insurance. >> i'm not sure which whether it's regional or state based. i think the key here is that the rules under which insurers operate and the marketplace that enables the reduction in the marketing costs are what is key. the advocacy primary seen sounds like, and i know yours is different, being able to buy across state lines has unfortunately been primarily about avoiding regulation and essentially undermining the spreading of risk. i think that that's what we have to avoid. >> does that answer your question? is that what you're getting at? >> in a rural state, take wyoming, 573,000 people a couple of companies controlling 80% of the market you create an

exchange in wyoming, what have you really changed? i understand insurance reform. >> essentially, the issue, you're going back to my conversation with this gentleman, about what you need with a real competitor and senator darnl's argument about a public plan or leadership in bringing costs down in general. i'd say you need another competitor in that exchange. that's what you were looking for. you do and that's the goal of a public option. >> if i -- i was just going to say, judy put her fixer on the most important -- her finger on the most important thing, to create an exchange that allows for a lot more competition than we have today. the exchange concept, i'm from a small state, south dakota, i would argue it may be too small to create an exchange in a state with a few hundred thousand people, like wyoming or south dakota. so it may be that regional exchanges make more sense so that you increase the leverage

and increase the actuarial advantage that comes with larger numbers. that's the most important step. we also have, as with wyoming, huge problems with regard to providers. we have a provider shortage. we have an infrastructure short abbling. part of health reform is to encourage greater utilization of providers and greater numbers of providers. weave chronic nursing shortage a chronic primary care provider shortage. we've got to address those shortages in rural areas in particular. i would hope we could reinvigorate the national health service corps, create manager opportunities to go to school, get your medical association, be part of the medical service corps for a few years and in many cases people stay where they're located as national health service corps members. but provider shortages are also something that have to be addressed and i think health reform can do that.

>> i want to add one point about, we can't, again, even with our rural initiatives focus only on insurance reform, we've got to be thinking about delivery reform. if we're not developing telehealth and other ways to let our providers operate in different ways, we can't let a -- send a veteran looking for a routine pacemaker review across the state when they could go in 20 miles across the state lines. i don't hear people talking about that very much in reform. >> did you have something? >> if you look at some of the problems massachusetts had as they instituted their program, they weren't able to aheave the positive impact they were looking for because of a shortage of primary care providers. clearly we've got to deal with the supply and how we're distributing, you know,

specialties and so on within the area. it has to be fixed. the moving from two to three competitors, even if you provide a national option, doesn't do a lot for the competitive field. it's going to take in smaller state, regional exchanges, regional groupings to get up to a real competitive situation. >> this gentleman has had his hand up for a while in the blue shirt near the front. tell us who you are please? >> i'm smark shep with crane's work forest magazine. i have a question for the business representatives and the labor representatives on the senate finance committee blueprint that's come out and presumably will lead to the finance committee's legislation. for the employers, could you back this bill given that there's no employer mandate in it but there is a tax that would be assessed or a fee that would be assessed on employers for employees who go to a condition an insurance exchange and for labor, could you back

this bill even though it doesn't include a public option but it does include a co-op, given that this bill might be the best chance for 60 votes in the senate? >> let's start with leslie. >> the spirit of the conversation has been had here, it's too early to be for or against a total bill, that's not the way things are being discussed. in terms of the specifics, i think we as a company have felt there are d -- an employer mandate in a sense fairly distributed is a more fair way to have things distribute the bachus proposal as we've seen it, it's important for us to recognize at wal-mart, our plans based on twarle volume would be -- on actuarial volume would be exempt from any of these plans. it creates reasons to look at

income of the family income of the people you're look to hire, it creates disincentives to hire workers from low-income household. to us, that's not a preferred option. employer minnesota date is a fairer way to go about this issue as a whole of providing share responsibility. >> i'd just like to make a general point, i should have made this an hour ago, matt miller is in the audience, he's written a splendid book called "the tyranny of dead ideas," and one chapter suggests the whole system needs to move away from the employer-based system that emerged accidentally after world war ii. and you can go back and forth as to how much or little you want to keep an employer role here. the problem is, we've got a flawed structural system that grew up by accident after world war ii. it is completely anomalous. in fact it's anti-competitive in today's modern economy.

it locks people into immobility. it frustrates job mobility. so we actually did a poll a few weeks ago and found that i think it was 62% of business executives agreed that the current employer-based system was simply unsustainable. they agreed with an effort to find alternative ways. i think the widen-bennett bill is less structured around the employer system. we would not fare mandates, wouldn't like taxes. and the president called for bold reform. if you're going to have bold reform, it means changing the structure and changing the incentives that all the players have, so i see some of these questions as more tinkering with a system that is fundamentally flawed. >> are you saying that's enough, just to undo, let the -- >> you'd do some other things, kind of look at the tax preference, there are a number of really bold things we haven't got intoon too -- into today and if we're going to put everything on the table, those

types of issues need to be addressed as well. >> i think in the end here we want something that works for the gentleman who talked from wyoming who is trying to figure out how to keep the health care costs down, honestly, we represent the workers at two of the most familiar co-ops discussed in minnesota and washington state. they are not an infrastructure or framework you're going to build a statewide system from. it's sort of saying we can go from new hampshire town meetings to govern new york city through a town meeting. there's an essence and nature to a co-op that makes it work in a certain dimension but won't be a huge national competitor to an insurance company. it's a wonderful idea. it's just not going to work. the real question is, how are we going to find something that does allow people in wyoming or maine to not have excessive costs because there's a lack of competition in i happen to believe the public option is the way to do it.

>> i would agree with andy on the public option piece that while i admire and applaud the work that's tried to be done by senator baucus and trying to get a bipartisan solution, that's the bill that we would be least in favor of, of all the options out there. on the funding side, we wouldn't be able to support that option at all. we have a huge concern about the excise tax that will be put on health care plans. it seemed way too complicated to figure out as far as depends on the demographics of your work forest, the age of your work forest, the location of where you're at, what is a cadillac plan. you know who decides that? there's just too many things. and it doesn't include the employer mandate we think is the best way to go. huge concerns on that. >> employer and employee mandates have been -- have become terms like public option that means what the listener

wants it to mean. everybody should have to participate in the health care system, be it on the employer side and the employee side. how we structure that participation, there's a lot of room for debate. you can fuss much around it. but what you can't have are employers saying that the way they're going to be competitive is to not provide health care. that's wrong. you also can't have employees choosing to say, i'm not going to access health care because i know ultimately i could throw myself upon the public system if i had to in order to receive care. that's immoral and irresponsible also. on the mandate side, i've got a wade range of options i'm willing to consider. there are those i like more than others, not worth getting into. but everybody has to participate and come back to comments made at the beginning, to those who would find it difficult to parties bait pause -- participate because of income levels, we niped to talk

about subs dis. and the companies who can't participate, we'll work on that but everybody has to participate. kelly has said that from the beginning. >> there's a surprising amount of agreement on that we keep forgetting about that. that's what's different this time. a lot of sectors are saying, this happens now, we're at the table, we want to stay there until we work it out. >> there's aeverywhere except the congress. >> that may be true. >> did that address your questions? i saw other hands ternttively going up out there the woman on the front row in the jacket. >> hi, joyce free dan with internal medicine news. everybody talked about being in agreement with providing high quality health care yet one of the provisions to address

quality and comparative effectiveness research has engendered a lot of controversy and people, you know, are starting to say it's sort of a back door to rationing and so forth. so i want to get anyone on the panel who cares to, their opinion on that issue. >> i'll start by taking a shot at it. three things, first of all, this is again one of those hao hype bollic myth-mick -- hyper bollic myth making practices that i think is very unfortunate. i would suggest that one simply look at the best institutions in the country and what do they do? what does mayo do? what does cleveland clinic do? what does intermountain do? every single one of them adhere to some sort of evidence-based approaches to good medicine. every single one. you can't find an institution of high quality that doesn't say, well, you know, we ought to figure out what works and then ask everybody else to do

what works. so it's just logic to the next step when it comes to health care delivery. it's kind of like the consumer reports on good medicine. how could you be against consumer reports on good medicine? that's what we're talking about. yet this has gotten way out of whack, it's like death boards and the other craziness. you have to bring it back, that's in part what i think the president is going to try to do tonight, to recognize that there are some things that are beyond question. one of them is, how can you encourage everyone to recognize the importance of good, evidence-based practices? does that mean there's a cookie cutter approach? no. there isn't. ultimately it's going to be the doctor who is going to make up the best decision on the spot with regard to how one covers a certain set of circumstances. but something is -- something as basic as checklists, you'd be amazed at how many accidents and how many problems we could

avoid if doctors just used checklists. as they went into medical procedures. so it's, to me, an essential part of good quality and i just hope that common heads will recognize that, i should say cooler heads, and find common ground on the issue. .

>> they use google. they can make better decisions with real-time information. why isn't there more time spent in actually insisting that that real-time information is provided to the business community in the manner in which using intell, you've got to get involved and not hand this decision off to the lower-level employee. >> lack of transparency on whose part? >> carrier's part, insurance

companies. >> vendors being whom? >> it could be pharmacy benefit managers, brokers and consultants. all of those companies out there that make a great deal of money. the more money that a client spends on their health care benefit -- a client has their medical benefits go up 18% the next year. meanwhile the carrier got a a 18% race and the broker got an 18% and the they went back and got the raise knocked down to 15%. nobody showed the company that is footing 80% of the bill what's driving the cost of where the problems are and how to fix it and how to engage. there is no time spent in that area. >> i agree with your point about transparency. but i want to answer a question. part of the problem that you have identified is -- goes back once again to the structure of

the system and so economists have made an argument that part of what you've described is the logical result of how employer-sponsored benefits are now treated by the tax code and that individuals when they make decisions are really insulated from information about the full extent of the costs of what they're acquiring. it is a very controversial issue about the tax treatment of these benefits, but would that be part of your concern as well, because at least some economists have said that's one of the reasons why we don't have more transparency because consumers are making decisions in ways that are different when they buy a car or shopping at wal-mart. >> the data and information that i'm referring to is not so much detailed information on joe smith and mary sali at your organization, but specific on

your population on an aggregate basis. it's not everybody driving the cost. not 100% where you have to go out every year and shop the plan, it's just 18% to 22% of the population that is at high moderate risk if you educate them and give them the tools and again you are not doing it on a specific violation then you can lower the costs today and implement the increases tomorrow. but that doesn't exist. >> i wouldn't paint all of the providers or insurance companies with any all encompassing brush and i would say that we've worked with many who have made information available to us to help us pinpoint changes that we can engage in. i hold wal-mart as one of the incredible folks using the information that you have and have an active voice in better health outcomes for your employees. it's not all up or down.

but i think it's nearly impossible for an individual to have access to the information. i view that as part of what was an outcome and hope is achieved that was embedded in some of the stimulus packages. it was understandable by individuals. one of the principles that we had been on agreement upon is the need for individuals. charlie, you were beginning to talk about that, take more accountability and responsibility for their health care outcomes. they need to be an active party. part of that is dependent upon access to information. >> which in many caseses noit available. >> not at all. >> i want you to weigh in. >> i agree with you that organizations like wal-mart is doing. what about the organization is having 50 employees and get

information 18 months after the plan has begun because the costs and risks have already hit. business managers manage every aspect down to the penny with data and information but don't do that with health care. >> i do think that when we talked about that there really needs to be total health care reform and needs to be a system and turn it from sick care to health care. but i do think on the transparency and carl started to get to it, aside from transparency on the physician side and the rest of the medical community, there has to be transparency provided to the individuals and actually the health care consumers. i know from bar ainbsh bargaining contracts and health care has been a big issue, one of the buzz words has been scrumer-driven health care. and my take on that is that that is a fallacy in this country in this day and age.

there is not the information provided to the individual to make those kinds of informed decisions. i do think that is an important part that people needs to have to have that information. people are willing to be responsible consumers, but they have to have the information provided. there's no way you can go out and see how your doctor or hospital is rated like you would see how a restaurant or hospital is rated. >> it is a big part. it is essential that as we begin to make better choices, we have better information. and that's what we're talking about is how can we create better information so that informed judgments can dictate our decisions a as we go forward. that's true for the consumer as well as the provider side. >> that's what the president needs to be adding to his message. i was thinking about his

message to students and his theme needs to carry personal responsibility. if we don't get off this all you can eat culture and all you can resource culture, part of what we are going to have to establish is a new could haven ant, we have a responsibility towards health and wellness. we have learned some really bad behaviors. >> a lot of change for many americans to accept. >> i want to add to this. i think what you're talking about is not just individual choices, you are talking the way employers manage their health plans. and i think the delivery reform side of this, which is all of us are committed to in terms of getting a better value for our dollar is part of the picture along with the responsibility. the investment in information technology will be successful if it is gathering the kinds of data you are talking about and making them available to

everyone in the system whether to individual consumers or to doctors and patients in managing their own care or to businesses who are managing health plans. there is more attention to that than i believe your comments would acknowledge, although i think the push is good. the other piece is that the delivery reforms that we need to get value for the dollar, there's a tremendous agreement on how to get from here to there, which i think has been underattended on the reporting of the proposals. there is tremendous agreement on using initiatives with the medicare program, which has been a successful leader of change in payment and delivery in the past. and needs to be more aggressive than it's been to offer doctors and hospitals new opportunities to essentially be successful and to gain resources by managing chronic care, by emphasizing prevention and coordinating cross providers and we see that in the legislation that is moving through the congress, the offering of new incentives,

which when led by the private sector or done in partnership which everyone would agree with between the public and private sector offers us tremendous potential to gain the efficiencies that we all know, including the health care industry, are not only essential, but absolutely possible. if we reform our system. >> we spend a lot of time trying to understand our health care bills and our health care plans and we have a pretty good track record over two generations of trying to drive transparency and the supply chains. so there is a lot of expertise about that and a huge amount of frustration when you apply it to the health care system. as we sit there trying to do it, you cannot do that as an individual payer. you can make steps about what the people have talked about. until you have this systemic delivery reform. we ensure over a million people

and we are the nation's largest employer. because there isn't a clear line into your sploir, i ultimately don't believe without the kind of structural reform we are talking about, no matter how smart we are and how much i.t. we have and trying to make it more efficient that an individual purchaser has the ability to see through that and drive those changes even with a lot of incentive to do that. >> it's about teaching and education. it's a shared responsibility as many of you mentioned before. if you are an employee and get a company credit card and go away on business, you probably stay at the westin and eat a steak dinner. if it's your money, it will probably be the holiday inn and eat at mcdonalds. people don't think about the expenses as they should. the 160 million or so, they

need to teach and educate them but need to have the data to do it first. >> we only have a few minutes left. we've got only a few minutes left. we'll try to bet to -- get to both of you. >> matt miller, centers for progress. just a quick question about, what's the potential ell role of antitrust enforcement in trying to control cost sns we don't hear about it in the debate, but as i understand it, the local market power of hospital chains orance yeah groups are one of the biggest drivers of these cost differences. without getting at the local market power there through some kind of antitrust action, it seems like it would be hard to change that equation. maybe judy or senator daschle. >> i think you are absolutely right in that we have seen over many years a justice department

and federal trade commission that have been asleep at the switch in terms of monitoring the kinds of concentration that is developing and pursuing more anti--- more pro-competitive strategies and what we are seeing are seeing some changes in what is coming out of the f.t.c. in terms of a much more competitive agenda. you are right to add it to the picture. >> i do think it's important, though, we recognize as we try to create this framework that information sharing and some sort of appreciation for best practices not only in delivery, but in administration and in other factors really have to be understood and addressed in a way that doesn't ignite more antitrust action, because i think that there is some importance here in greater transparency and greater information sharing and greater common practice that may

ultimately trigger some of these issues. we will have to find the right balance between concern for antitrust, but also concern tore the importance of sharing good practices across the board. >> and one other question back there. do you still have a question, sir? >> kim joseph, "national journal." a lot of pressure is being put on the insurers in the bill. but a lot of the cost is built into lot of large hospital chains. what do you think is the best idea for trying to push down costs on hospitals especially if there is more competition in insurance. it might mean there is less than a single insurance company negotiating costs with providers. >> who wants to weigh in? >> just a quick start on that. i think that one of the biggest things we can do is avoid unnecessary hospitalizations. there is tremendous agreements

that we hospitalize too often and not giving enough care up front and we have a real problem with re-admissions to hospital because the care isn't given, in part, the reason not always the case and what we are looking is payment and delivery reforms in which a primary goal is to get better more efficient use of the hospital. >> i would just add, all the things we have been talking about, we've got to change volume to value. we have -- we can't reward volume procedures. we have to have a lot more transparency. we have to bring down administrative costs. administrative costs in hospitals are inexcusebly high and we have to find ways in which to move administration from the 19th century to the 21st century with greater i.t. and recognition that we could have the costs of administration of hospitals and other providers throughout the system.

changing our paradigm from illness to wellness, they will all make a big difference and all critical to costs coming down. >> final question. we do need to wrap it up. i want to ask each one of the panelists, how will we know in the day, two or three whether we are moving toward agreement on this big, big important question? what are the signs you're looking for. charles, start with you. >> if the president leads. the president leads. >> and how do you define leads? >> i think he has to lay out a plan of action on how to get there. senator dole in his op ed on august 31 criticized the president for being a cheerleader. he needs on get on the field. >> what's in the senate. >> next few days? >> on or after the 15 of

september. >> focus. you can't solve all the problems at once. senator daschle said we're not go to go fix it now, we need to keep doing this. they can't solve everything and that's part of leadership. >> i would say a narrowing down of the discussion so we're coming much closer to a bill on each side recognizing there still needs to be reconciliation. >> what are you looking for? >> if we can see some of those members in both parties that are in the middle be willing to take political risk of their own and stand up and be for something, that will be a sign we are having some movement. >> judy? >> i would go with recognition from our elected officials along with the discussion in general that we got to do this and everybody needs to be on the side of getting it done or there is a real risk not to, political and other wise. >> i think the political judgments are much more well

informed colleagues here, but assuming there is a listening to the public via our representatives on this issue, when the public changes the conversation to what is to be gained from this reform, i think then that provides an umbrella. i'm an optimist and i think that helps. >> senator daschle, you get the last word. >> i would say all of the above. [laughter] >> all seven suggestions were exactly on target. i only add, we have to have a schedule. we've got to get this done and the only way is to say ok, we have to have a vote in the committee, do it this week or next week. we need to have votes on the floor and do it within the next couple of weeks and move forward. and the house and senate both have to put a schedule down for consideration of this legislation certainly before the end of october. >> i think we need to send a transcript of this discussion

to all 535 members of congress. thank you all. what a terrific panel you've been and thank you in the audience. [applause] [captions copyright national cable satellite corp. 2009] [captioning performed by national captioning institute] >> the house and senate meet tonight in a joint session to hear from president obama

speaking on health care. white house officials saying that the president will enter all the major questions on the issue, including how to pay for covering the millions of uninsured americans. our live coverage beginning in 10 minutes at 7:30 eastern time. the speech by the president scheduled for 8:00 p.m. and the republican response will follow by louisiana congressman charles boustany and we'll get your reaction by phone and twitter as well. that's ahead on c-span. >> now, senate minority leader mitch mcconnell and house minority leader john boehner voicing their opposition to health care proposals. this is eight minutes.

>> good afternoon everyone. leader boehner and i want to welcome the president to the capitol tonight. and one thing i hope we don't hear tonight is that we need to do a massive comprehensive bill or nothing. that strikes us as not the way to go forward. the only thing we know so far about the democratic plans that we've seen is that the -- they are bipartisan only in their opposition. in fact, the only thing about the debate so far has been bipartisan opposition. so i think what we ought to do is concentrate in the areas where we agree. i think there is uniform agreement that we ought to try to deal with the cost issue, increased costs for millions of families is a serious problem. but crafting a bill to drive

the cost up even further for those who are covered and happy with their coverage strikes us as not an appropriate way to go, nor do we think raising taxes to pay for it is a sensible thing to do. among the things we could do obviously is to do something about dropping lawsuits against doctors and hospitals that almost everyone in the system -- senator mccain and i have had an opportunity to do health care forums across the country and one of the things you heard is that clearly billions and billions are lost every year in defensive medicine practices as a result of the massive amount of lawsuits that doctors and hospitals have to deal with. we don't think it is agreeable to have massive cuts to medicare in order to start a program for some other gupe of citizens. medicare has serious problems already. estimates are that it will be

broke in seven years. there was a thought we would reach in and take $500 billion out of medicare in order to start a program for others strikes us as a bad idea and not the way to go. insurance reform, most of our members are important to insurance reform. this is the kind of thing that i think could be done on a bipartisan basis, tead address the issue of pre-existing conditions. many of our members prefer interstate competition. portability, allowing you to carry your insurance from job to job, all of those are the kinds of things that strikes me we could do on a bipartisan basis. there is no disagreement on the need to strengthen what people have, make insurance more accessible and lower cost for everyone. those are the kinds of principles we could rally a broad bipartisan agreement.

you have to be suspicious of a bill that has over 1,000 pages in it. and the bigger these bills get, the more complex they get, the more costly they get, the more opportunity there is for mischief. in summing up my remarks, we ought to skinny this thing down and target the problems in the system that we can all agree on and try to go forward on a bipartisan basis. that is the way to address this very significant issue. with that, john. >> senator, let me join you in welcoming the president to the capitol tonight. we are all interested in what he has to say. but i hope he has been listening to the american people because i think over the course of august, they've raised their voices loud and clear that they don't want this massive government takeover of our health care system. but it appears that the president is going to doubledown tonight and try to

put lipstick on this pig and call it something else. and it's a phrase that is used around here many times that it appear the president is going down this path. i just think that listening is what a lot of our members did over august, listened to the american people and their concerns about where the democrats are going with this government takeover of health care. i would hope that he would come to the house tonight and hit the reset button and say, all right, listen, we've heard the american people. it's time to stop what we're doing and let's start over. and as senator mcconnell pointed out, there are a number of bipartisan issues that we can work on. but it is as simple as this. if you look at what they're doing, they are basically proposing to replace the entire current health insurance system with this big government-run controlled system.

americans know and we know that the current system works well for a lot of people, doesn't work well for all americans. and why wouldn't we take the current system and help make it work better. and senator mcconnell pointed out some of the areas of agreement, whether it's medical malpractice reform, whether it's small businesses coming together to create larger pools so they can buy health insurance for their employees like big businesses and unions can today, the portability of insurance, there are a number of common sense things we can do to make this plan better. i would hope the president would soon realize that that's what the american people want. they want the current system to work better and don't want it replaced with a government-run plan. >> senator mcconnell, if the proposals you and congressman boehner announced are enacted, how do the 47 million americans

-- how many will be without coverage? >> we know that c.b.o. estimated that the bill produced in the house would leave 37 million uninsured after 10 years. so clearly, if the goal of that bill was to reduce the number of uninsured, i don't think it would do it. i think the best way to begin to get at it is to equalize the tax code. right now, as you know, if a company provides health care for its employees, there is a deductible on the corporate tax return. if an individual goes out and buys insurance on the open market, it's not deductible. equalizing the tax code would make more progress toward covering the uninsured than this massive big government bill that has been produced in the house. after 10 years of experience with that, the c.b.o. says we would have 37 million unemployed. >> mr. boehner, can you address the selection of mr. boustany from louisiana, why he was

picked. we know he is a physician. >> dr. boustany will be giving our response tonight. he spent 20 years as a cardiac surgeon. he has worked on this issue for a long time. he is also the person i asked to sit down with democrats who were interested in having someone they could work with on our side of the aisle. so i think he is the perfect guy to give our response and i think he will do a good job. >> some people might not respond to him. he is a complete unknown. >> they'll get to know him tonight. [captions copyright national cable satellite corp. 2009] [captioning performed by national captioning institute] >> coming up tonight on c-span, we start with a preview of president obama's health care address. live at 8:00 p.m. eastern, the president speaks to a joint session of congress. and the republican response to the president's address will be given by representative charles

boustany of louisiana. >> this will health care system of ours is badly broken and it is time to fix it. [applause] >> despite the dedication of literally millions of talented health care professionals, our health care is too uncertain and too uncertain and too bureaucratic and too wasteful and too much greed. after decades of false starts, we must make this our most urgent priority, giving every american health security, health care that can never be

taken aware, health care that is always there. that is what we must do. >> 16 years ago almost to the day, president bill clinton spoke before a joint session of congress in an effort to gain support for health care reform. now tonight, it's president obama's turn. in about half an hour, the president will enter the u.s. house chamber and do his best to convince members of congress that the time for health care reform has come. we'll listen to the president's speech in full here on c-span and here the republican response from representative charles boustany of louisiana, who is also a medical doctor. and following the president and representative boustany, we'll hear from you via phone calls and tweets. to help us analyze the president's speech, we are joined by casey hunt. she'll walk us through the latest developments on capitol hill and how events over the august recess have shaped the

debate on health care. what's the president's goal tonight? >> well, peter, you know, it's three-fold. he needs to take control of the debate that has in some ways gotten out of hand in the past several weeks. you saw in august all of the town hall meetings, various members of congress went home in their districts and found a lot of angry constituents, people willing to stand up in these meetings and say fairly unpleasant things about health care. the debate slipped out of president obama's hands. and as his top domestic priority, he is hoping to stand up before the members and reassure them that he is, in fact, taking the rins on this effort. for democrats, what he needs to do is reassure liberals, those in his own party who are adamant that a public option needs to be included, he needs to reassure those democrats that he supports that but is going to rebehind -- remind

them that it is one piece of a larger reform bill that includes beneficial provisions and things that the american people would benefit from. he'll also need to look to republicans who have adamantly opposed health care and who have spent weeks attacking it, who stand to benefit quite a great deal from its failure here in congress, he needs to reassure them that, in fact, there are all kinds of provisions in here that they can support, preventing people from being dropped from coverage when they get sick, requiring that people cannot be -- i'm sorry, requiring people with pre-existing conditions to be covered, things of that nature. so he has quite a bit to accomplish. >> do you see him challenging, attacking the g.o.p. or reaching out to them? >> he has released some excerpts of his speech already

and one of the things he is planning on saying is that his door is always open and he is willing to listen to ideas from whom ever wants to walk into his office. he has condemned the scare tactics and says he won't meet with anybody who is intent on doing something like that. rsh in the excerpts released by the white house, this is something else the president is planning on saying, which is, there is agreement in the u.s. congress on about 80% of what needs to be done putting us closer to the goal of reform than we have ever been. do you get that sense also reporting on capitol hill? >> there is agreement on major provisions, but at the end of the day, this becomes a political issue. and for republicans looking to get re-elect nd 2010 or looking to win seats in 2010 and for democrats looking to hold onto the seats, this issue becomes a

polarizing one and not one to deal in percentages. that said, this is a massive, massive bill, thousands of pages and yes, there is quite a bit in that bill that members do agree on. as i said before, preventing insurance companies from dropping coverage for people, requiring anyone that anyone with a pre-existing condition be covered, making it more affordable for people to get coverage by regulating the insurance industry, there is agreement on all those things. the major sticking point has been to include a public option in the plan and that unfortunately -- >> is the president willing to drop the public option? >> he is planning tonight to stand up there and reiterate his support. he is in support of a public option but not go to go insist that the package include a public option. he was asked or his press

secretary robert gibbs was asked this morning whether or not the president would be willing to veto a bill that did not include the public option. he avoided that question. i think it's looking as though some of the more liberals -- some of the more liberal democrats who are adamant that a public option be included might be disappointed with the president's push for that particular provision in the legislation. >> has the president's staff been meeting with democrats and republicans? >> well, the house republicans have not actually met with president obama since april, which is something that republicans have seized on recently, especially because he says in his speech that his door is always open. he has been meeting prime mearl with democrats and in recent days he met with the senate majority leader harry reid and speaker pelosi. he also had a conference call with the liberal caucuses in the house, the congressional

black caucus and congressional hispanic caucus and congresses progressive caucus who are insistent that a public option be included in the bill. he says he is open to listening to new ideas, he has been seeing them at the white house. >> there was a bit of action on the senate side. earlier today senator baucus held a press conference. here's a little bit of it and we'll get an update of what's going on in the senate. >> the time has come for action and we will act. we are going to move forward if we get this bill done at the end of the year. i have met with my senate finance colleagues and we have a path. i will put out a chairman's mark early to mid-next week. i will move that to markup on health care reform the week

after next. this is our moment. we have spent many weeks and months on this crucial issue and now is the time to move forward. >> senator, are republicans on board? >> i expect and very much hope that there issue will be some republicans when i issue the mark next week and we go to markup the following week. my door's open. but irrespective of whether or not any republicans, i do think that there will be, i'm going to move forward anyway. we have to move forward and i told chuck grassley that just about an hour ago. i mentioned that to other key senators a while ago, so we will have a mark and put out a mark next week. i very much hope and do expect republicans will be on board. i don't know how many. but if there are not any, i'm going to move forward in any event.

>> has anything changed your thinking on whether or not there are votes on the public option versus the co-op? >> i think frankly with increasing conviction the public option cannot pass the senate. as each day goes by in talking to senators, private statements and public statements and some statements earlier on the other side of the capitol, it's my view -- and i could be wrong -- it's my belief that the public option cannot -- >> what has happened in the senate today, particularly with regard to the so-called gang of six? >> the finance committee chairman max baucus will release the senate finance's version next week. he is the last committee to

deal with the legislation and only bill so far that has a chance of securing bipartisan support for passage. the senator made news today because he said that he will go forward with or without republican votes on that plan. that's a switch from previously where he has insisted that he continued to negotiate with the five other senators on the finance committee, three of whom are republicans, senator mike enzi from wyoming, senator snowe from maine and senator grassley from iowa, the ranking member of that committee. >> so how big are the differences between what senator baucus has forecasted his bill to be and h.r. 3200, the house-committee-passed bill. >> the differences are mainly in two areas, one is the public option. the house-passed bill includes a public option that would be a government-run insurance plan that would be available to people that can't get insurance through their employers, people who have to buy in the

individual market and pay three times as much for their health insurance. baucus's plan doesn't include a public option but state-based co-ops. they would make grants and loans to people who are interested in starting health insurance co-ops, which are nonprofit organizations helping individuals that own them. that's one major difference. the second major difference is an employer mandate, whether or not businesses will be required to offer health insurance. under the house plan, all businesses that have a total payroll of less than $500,000 are exempt from the employer mandate, but everybody who pays out more money than that is required to pay health insurance to their employees. if not, they have to pay an 8% tax to the government. under max baucus's plan, employers are not required to provide health insurance.

instead they have what is known as a free rider option, which means if they have employees who are eligible to participate in the exchange program that the bill creates, which is to say if they don't make enough -- if they make so little money that they are receiving government subsidies to buy their health insurance, the corporation has to pay the government a small fee to make up for that. >> we want to show you a large picture from the u.s. senate floor. the senators are getting lined up getting ready to come over to the house chamber. about a three, four-minute walk across the capitol. and they are getting ready and will be marching through the hall and we will show them when they come in. back in the house, another press conference on health care was held today, and this is by the republican leaders john boehner and eric cantor. here's a portion.

>> gr morning. i think it's very clear that the members of the republican conference feel strongly that the public has awakened, that the wind is at our back because of the fierce debate over the president's health care plan. >> mr. boehner, the president is going to endorse a public option, but not necessarily draw a line, not necessarily say it has to be in the health care bill. if he does that tonight, how significant would that be towards -- >> there has been a lot of focus on the government option and the plan that a lot of democrats are supporting. it's not the only bitter pill in their plan. they have a mandate on every employer to offer insurance and if they don't, it's a big tax. and this will make it more difficult to create jobs.

matter of fact, probably cost our economy jobs. this $3,800 tax that's being proposed on individuals if you don't buy health insurance is another nonstarter. so it really is just time to stop, hit the reset the button and sit down in a bipartisan way and deal with what we can deal with to make our current health care system work better. >> has the g.o.p. proposed any reforms? >> they said quite a while ago they were planning on releasing a health care plan of their own, but they have yet to do that. >> so was august a big surprise to the obama white house? >> i'm not sure that it was a surprise. i think everybody when we left for the august recess without having passed a bill in either the house or the senate, people were expecting to go home and hear from their constituents.

i think they were taken aback by the level of angst people were. i think that is why you saw obama announce in early september that he was going to be making this speech. and just in announcing the scheduling in the joint address to congress, it has happened before, but fairly rare. obama has managed to convince chairman max baucus to release a health care plan. he had a deadline of september 15 previously, but there was some question as to whether or not he was going to meet it and the republicans were resisting to make sure they had a bill by september 15. the announcement of this address and chairman baucus to get his plan out there really changed the landscape. >> you can see the senate marching through the hall, the old house of representatives on the way to the new house chamber, which was built in 1835 and they will be taking

their seats and we will be showing you that activity prior to the president's speech as we always do here on c-span. another press conference on health care was held by john larson and representative becerra who are leaders in the democratic caucus. here's what they had to say. >> we just had a terrific caucus, an opportunity for members who have returned from conducting more than 1,027 town hearings. but bound and determined to make sure that a, they will not be intimidated by any outside force, any status quo in just say no group is not intimidating this caucus. member after member who got up and talked about what happened to their district came away affirming the fact that america is not for the status quo.

it's for the reform and change that is about to come. we are pleased this evening that the president is going to address a joint house and senate gathering and understand that he will lead the way in terms of moving this agenda forward. but to hear people like leonard boswell who went into this session saying i don't believe i can be for a public option, talking strongly about how now he is convinced after talking to his people about a public option. mike doyle, a former insurance agent talking about the fact that insurance rates are going up by 38% and 39% in his district and people are coming to the common sense conclusions that once they've dealt with all the misinformation and flat-out lies in many circumstances, that now it's time for the truth to unfold. i believe that the president

will be that truth deliverer this evening and that this democratic caucus will come together and pass a bill and put it on the president's desk. xavier. >> vice chair of the democratic caucus in the house. it was a wonderful turnout by members. every seat was taken and they have asked that we do another caucus meeting. we're going to do it tomorrow morning, because it seems like people got refueled in august, whether they did town hall after town hall or not, looks like members are ready to get to work and looking forward to what the president has to say. >> speaker pelosi, vice president biden. the president just arrived. he will be going in very quickly. john larson and representative becerra talked about having another caucus meeting for the democrats and seemed positive

about the august meeting, what's your assessment. >> they have some things to be positive about and they will need to have another caucus meeting in the wake of president obama's speech. there has been a lot of people in holding patterns simply waiting to find out what the president is going to come out and say and change what people are saying tomorrow. it will be a good opportunity for the house leadership to talk to their members about what happens tonight. >> very volt by the rank and file against health care because of so many views? >> i wouldn't say there is a volt among the rank and file. there is definitely a split in the party between the liberals and moderates who feel they can't support a public option in the plan. representative mike ross from arkansas, moderate blue dog democrat led the charge in the house energy and commerce committee looking for more moderate modifications to the bill. he got them. and as soon as he came back, he said he couldn't support the

bill because of what he heard from his constituents. i spoke with another member, baron hill from indiana. he said he came away feeling like his constituents were interested in supporting a public option and could back a bill the leadership is pushing. i think you will see disagreement but they are not clear cut as some would have you believe. >> thank you very much. we'll take you to the house chamber after the president's speech and republican response. we will be back with your phone calls and tweets. the president's speech estimated to run about 42 minutes. .

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