and there would be no waiting. this is what we are about. people who have health care crisis, maybe we will have a better relationship to be able to find common ground on health care. i challenge our members here in this congress, you can talk about the side shows, you can talk about the small things that are going on or could be important back home, but when you have an issue like health care reform that's before this congress, that it took great courage against the naysayers to courage against the naysayers to create social security which is nity for individuals that when they lose everything else, social security is there, when someone passes along and they are able to leave their survivor benefits, even if they didn't make the kind of money, they didn't leave the kind of inheritance they would

like to leave to their children to be able to leave survivor benefits for a child or a spouse, or when you look at when someone's injured on the job with social security and they fall under disability, social security is there, it's not going to pay for everything, but it's going to pay for something. you have been paying for it out of your check. you mess with social security now, you have a problem as an elected official. i'm so glad, mr. speaker, in the 109th congress when the previous administration wanted to privatize social security and we fought it back with not only dialogue on the floor, amendments in committee, holding town hall meetings back home, we fought it back and if social security and folks had private accounts out there running in the stock market and last september, where would social security be right now and the

trust fund? i want to make sure everyone understands that it takes courage. medicare in the 1960's, oh, the government's trying to -- no one is trying to take over anything. want to make sure seniors have coverage in the time they need it when they're 65, that they can take the option if they want to use medicare or private insurance, that this country will not turn their back on them. and now in this legislation, we expand the medicare trust fund and really work towards find wasting out corruption and bringing it under some sort of control so we don't find ourselves in a situation like medicare part d, let's not worry how we're going to pay for it and increase the debt. . that was music to my ears

because we're -- you know, we're here and i've been on the floor for almost seven years now talking about these issues. some of the individuals talking about the debt. i'm like, where were you when all of this was happening? and you said nothing about it and you did nothing about it, and now we're trying to do something about it in a bipartisan way to make sure that we don't put onto the debt i think makes perfect sense. but medicare, looking at it for where it is right now, it's a public option. and the public option, i must add, mr. speaker, the small part of this bill is far more conservatives than medicare. a, you have to fall under a certain income requirement. b, you have to first go into the exchange to get the private insurance. but you also have to be insured and covered. that means individuals that

don't have skin in the game now, people that are saying, hey, i'm going to throw the dice, i am going to go to c.v.s., walgreens and i am going to medicate myself and find myself in a situation where i got to go to the doctor because i have this lump in my neck or i have this pain in my side or i finally went to the doctor after my wife or my significant other, you know, pushed me to go to only find out now i have a situation that i must go in. now they find themselves in the emergency room. and everyone that has insurance can look forward to $1,000, $1,200 either in co-pays or premiums the following year because that individual is not insured. now, some people make that choice of saying i just want extra money to spend. some people make that choice, most make that choice because they can't afford insurance. i think it's important that we have to note that the congress had courage to start medicare,

and because of that courage so many seniors, 65 years old, has a medicare card in their wallet and it's first up right under the driver's license or right under their debit card to pull out because it's the card that they pull for because they have it. and every town hall meeting i had, and, mr. speaker, i had town hall meetings. there was no prerequirements. you didn't have to come to my office and pick up, you know, show thaw live in the 17th congressional district in florida. you didn't have to, you know, go toing the magnotometr. 500 seats, have a civil discussion. if you disagree with any position taken, respect the next person and allow that individual to speak. that's american, that's bipartisan, and that's what we'll continue to do, mr. speaker, because when we pass this insurance reform as it

relates to health care, that's not going to be the end. this plan right now the way it stands will not be fully implemented until 2013. that's a long time. some of it will be implemented as it relates to patient rights and insurance rights faster than other components of the bill. but i want to tell the members, and i want to share with the members that as we go and we talk to our constituents we should not just fall off the low hanging fruit saying, well, someone's perfectly healthy and says, i don't feel we need to do this, i think it's important as a leader because sometimes you have to share with people things that they may not see from a broader perspective. to say, yeah, i don't know what they're doing in washington. they don't need to do -- this congress is made up of individuals that have elected, especially here in the house -- you have the greatest democracy here in this chamber because you cannot be appointed to this

unless you are appointed to be the chair while, you know, we're trying to find a speaker or what have you. but as it relates to a general member of congress, there's a special election called. if someone was to come and come to the well and say i'm resigning, there's no appointments, you have to be elected to this body. so it's democracy at its best. and nine times out of 10 comes from the ranks of the legislature or city council or an individual that just got fired up on an issue and started knocking on doors and found themselves in this chamber. but so many times in washington we look at this change agenda, we get stuck on this thing of who we had lunch with last or how leaders get drawn out. i don't think that leaders come to washington, d.c. to sell out. i think they're drawn out. and what i'm saying abouting with -- about being drawn out is you find yourselves walking

in the halls here in washington, d.c., and you get enough people, congressman or senator, good to see you. you know, great speech. it was good. you start listening to those individuals even though it's ok to get compliments versus those individuals that are back home that are fighting this health care crisis. and that we have to make sure that everyone understands that. and so i tell my constituents, if you agree with the last word out of my mouth or not, you tell me what you feel and we will have a discussion on it and we will do the best to try to give you the kind of representation that you deserve. so i think it's important that we bring reality to this debate. mr. speaker, i'm going to close by saying it's important that

we continue to get input from the public. it's important that we continue to share with our colleagues the importance of bipartisanship. it's important that we are responsible for what we say and put into the congressional record. it's important that we allow this process to move forward so that we can have a working document from both house and senate that can then go to congress and that we can vote on this floor in the affirmative for. and every piece of landmark legislation, mr. speaker and members, there are always -- there will always be sections and components of that legislation that a member would disagree with. i haven't seen a member say, you know, i am 100 -- everything in that bill i love it. that's like reading a book saying i agree with every

chapter. i thought it was a good read. there's always some comment about that eighth chapter could have been a little better or more work could have gone into the 12th chapter. but i think it's very, very important that everyone understands in the final analysis when we look at health care reform that every member, every governor, every mayor, every city council person, every member of congress has to be engaged and has to make sure that it's not about their health care. it's about the health care of the people that they represent. so if you have health care, i'm bringing your health care costs down because you will have more of a choice and competition will be there to bring your health care down. if you have health care, the quality of your health care will go up and that you'll be able to see your doctor and you'll be able to continue to move on. and in the bill that we're --

we have here under consideration in the house, if you leave your job you can keep your health care. the ongoing bleeding of medicare will be repair and reform. the ongoing health care crisis in so many communities that are weighing down small businesses will be better because of action. and so i think that there is some principles there that those of us that have been elected to lead -- i'm not talking about standing on first base and looking at second saying i am not going to try to steal second, i am going to stand here and let that person when they hit, they may get a single, i'm going to stand here and make sure i get to second base. it's not time for that kind of leadership. it's time for you to cheat up to second base and try to take it, because you're taking it because you want to win. and we want to make sure that

the people in this great country of ours win. we want to make sure that they have health care. we want to make sure that small businesses are able to provide health care to their employees. we want to make sure that health care providers provide the most professional health care that they can. and we want to make sure that we as leaders here in congress that we go see the wizard and go get some courage and get a heart while we're there. and share with people the things that should be shared with them even if it's the minority view. discourse is good, action is better. mr. speaker, it was once again an honor to come before the house, and i look forward to coming back. and as we break for this week, hopefully we will come back ready to do business at the top of next week, and i feel good the direction this debate is going on, after the republican

response, after the president's speech. thank you, mr. speaker. i yield back the balance of my time. the speaker pro tempore: and announces to the house her approval thereof. -- under the speaker's announced policy of september 3, 2009, the chair recognizes the gentleman from iowa, mr. king, for 60 minutes. mr. king: thank you, mr. speaker. as always, it's an honor to address you on the floor of the house of representatives. i came down to get my material, prepared to rebut the gentleman from florida, and i found myself a little bit void with major objections. i appreciate the tone of the gentleman and the presentation of his delivery. and we will find places we disagree. we need to find places where we can agree. i would say, mr. speaker, that it did not contribute to bipartisanship to have the resolution that addressed joe wilson here this week. that dropped a partisan divide down between this chamber. and if anybody thinks we were

more likely to get a good solution on health care on that they would be completely mistaken, mr. speaker. i make that point. at the beginning of this, i appreciate the bipartisan dialogue of the gentleman from florida. and we recognize that we come from two different places philosophically. the world looks entirely different if you look at it from the side of constitutionalism and free enterprise and individual responsibility than it does if you look at it from the standpoint that the government should be providing the resources to people for whatever reason might be their misfortune. in fact, i serve on the judiciary committee and i've been on that committee between the congress and my time in the iowa senate my 13th year. i'm one of those rare nonlawyers on the judiciary committee, mr. speaker, and so i tell the lawyers that gives me a decided advantage in my approach.

in any case, this country is a country that is established on the rule of law and our constitutional values and on personal responsibility. and when we do those things that take away personal responsibility and when we punish the people who are the most productive among us and take away their incentive to continue to be more productive, they have more of a tendency, then, to slow down their productivity. some of them will stop. some of them will say, i cannot keep funding this government that is asking more and more sweat from my brow or in the return on the capital that they have formed. and so they give up or they move their company overseas to places like china or india, or they simply don't add on to the production line of the factory. whatever the case may be, we get less growth in our economy when we punish the people that are producing. . reagan had a way of expressing it. i don't know if i can get it right.

if you tax something, then you're punishing it and if you subsidize something you can expect it to grow. and reagan had a clear understanding of this and we need to have a better understanding amongst the consensus here in the house of representatives there always is another story, another anecdote, another way of looking at an individual case that may not represent the broader whole. we need to be a wise body in the house of representatives, a wise body that looks at data, understands the psychology of the people in this country. our job is to improve the average annual productivity of the people in the united states of america. and if we do that, we will increase the average annual productivity and it will improve the quality of life, expand technology, medicine, anything you want to address. but if we turn the safety net into a hammock and take the net

that keeps them out of the bottom and crank it up to the point where it becomes a hammock, they will lay in it and become lazy. and so we have had an intense health care debate going on here and i'm grateful for this. i'm grateful that we're able to have the time throughout the month of august to have town hall meetings all across this country, town hall meetings in florida as the gentleman just said previous. iowa and every state i know of. members of congress having town hall meetings. i want to thank my senior senator, chuck grassley from iowa, for engaging in the negotiations, the debate and the dialogue on the health care issue on the senate side that may well have been the single most important key factor that allowed the debate in health care to be extended through the month of august and past labor

day and get us to where we are. if it hadn't been for senator chuck grassley goishting these health care issues and the gang of six in the united states senate, it's possible that they would have found a way to ram a bill through this chamber and put us through the senate and on president obama's desk. if that had happened, the tea party people would have had a different reason to come to d.c. the town hall meetings wouldn't have taken place that way. this run over by big government isn't just to do with health care at all, but the current issue of big government seeking to run over the individual freedoms of the american people. and we have watched and this would be the 17 of september today and now day after tomorrow will mark the one-year anniversary that secretary of the treasury, heny paulsen came

to the capitol and insisted that we present him with $700 billion check so he could buy up the toxic debt that's on the financial markets and be able to avert a financial meltdown, loss in our currency and financial institutions which could have caused the global economy to crash. that's how it was presented to us. he said give us $700 billion and no strings attached and if you have any ideas, don't try to offer them because i have been working on this for 13 months. therefore, whatever you come up with will only make my good idea worse. just be quiet and give me the money. that was essentially it. we advised him that when you ask for $700 billion taxpayer dollars, you have stepped into the political arena, not just being shielded in the u.s. treasury. and it was harder for him.

he got $350 billion and another $350 billion to be ear marked and to be signed by a president to be elected later. henri paul sen's trip to the capitol at a time when he predicted there was going to be a major financial meltdown of global finances, the u.s. economy being at the heart of it. he couldn't guarantee us nor could he predict that his effort and strategy with the tarp money would actually be successful. but he did predict that if we didn't do that, we would have an economic meltdown at least to some significant degree. that's a year ago. since that period of time, we -- we had president obama that flew into town to meet with president bush. we had presidential candidate john mccain did the same. they sat around the table at the white house along with the

speaker of the house, republican leader john boehner, the leadership in the senate and they came out of there with i'll say not quite a unanimous position but to go forward with the tarp funding. most of the democrats voted yes. half of the republicans voted yes. split the party over here and didn't split the party over here. spending money doesn't bother the folks on this side. the tarp money was released at half of it in october and followed by an election. and this tarp money was voted for and supported by then senator and candidate for president, obama, who certainly asked for the balance of that tarp funding as president and got it. so this tarp money is president obama's economy. that's the component of his

solution. and as part of the negotiations as to why they were taking place with the presidential candidates and the white house, president bush knew there had to be a handoff to the next president and the next president was sitting at the table in the white house. it could have been john mccain or president obama, but the next president, they were both there. the next president was sitting at the table. so as they bought into this, this responsibility for the $700 billion lays at the feet of the president of the united states, barack obama. he supported this program. he voted for it. it's a matter of congressional record. and behind that came the necessary, many argued nationalization of freddie mac and fannie mae, two government-sponsored enterprises that barney frank argued in 2005 that he would not support a government bailout or subsidy of

fanee and fredee. and yet, just three years later that's what happened. and in additionally, freddie mac and fannie mae, $100 billion of taxpayer money each and $5.5 trillion in contingent liabilities went along with the geel that the federal government nationalizing the deal. formerly a private organization. now nationalized, nationalized by the white house and the leadership and the government. with that came, the large investment banks, just couple of days ago was the anniversary of lehman brothers going under and the nationalization of three investment banks, a.i.g. that was insuring the risk of the mortgage lenders as they

packaged up and marketed these mortgages off on the secondary market, broke them up, repackaged them and sent them up the financial chain. the value of those mortgages were evaluated and the risk of their default was evaluated by a.i.g. there wasn't anybody looking over the shoulder of a.i.g. there were other things that went along with that, but the nationalization of freddie mac and fannie mae and three large investment banks and a.i.g. is flowing along with the president engaged in this all of the way. then we saw 400 some odd billion omnibus spending bill without debate and examination. it was, we have to keep the government running and kick the can down the road and here's a

big stack and in it is spending of over $400 billion. and we had president obama calling on this congress to give him $787 billion in the stimulus package. and i remember that discussion as he came forward to our conference to talk about and asked for $787 bill yonch. and he said president roosevelt didn't spend enough money. that is not the quote. he said, president roosevelt lost his nerve and got to woreying about balancing the budget and didn't spend enough money and the result was that in the second half of the decade of the great depression, we had a recession within a depression which brought unemployment up again in the latter half of the 1930's and then came world war ii which got us out of the great

depression. that's almost all of the nutshell that was delivered by the president that day. and as i listened to that, i thought, mr. president, you and i took a completely different lesson from the great depression. and wherever his economic studies came from and where he evaluated this, mine, among other things and reading a significant amount of material and analysis of the great depression -- of course my parents grew from that and out of that and the things they learned also were branded within myself and all of my siblings. they told stories of how difficult it was during the great depression. but i went back into the public library with the intention of writing a paper about how f.d.r.'s new deal was a good deal and brought us out of the great depression. as i read every newspaper in my hometown from the stock market

crash in 1929, i went through every paper looking for the stories that had to deal with the new deal and the programs that f.d.r. brought through in the new deal, preparing to write a paper that would show how the new deal got us out of the great depression and moved america forward, how farms were saved, how businesses were saved, how jobs were saved. as i read through each newspaper throughout all those years from 1929 up until the japanese attacked pearl harbor in december of 1941, i had all of these notes that came from story after story and i looked at the ceiling, mr. speaker, and i began to wonder how am i go go to write this? i can't find evidence here in the newspapers that support what i have been told by the people that talked to me in the classroom. so i wrote the paper and i wish

i had a copy of it today. i would love to have that and introduce it into the congressional record and give some other people insight into what i was thinking at the time. i remember clearly that i couldn't justify that the new deal was a good deal. and the conclusion that i drew and i certainly looked at a lot of material since those years, 40 years ago, perhaps, the conclusion that i drew was that the federal government spent a lot of money, they borrowed a lot of money and they set up a debt that's hard to recover from. when the government wasn't willing to tighten its belt and got the idea to spend and borrow money, i couldn't buy that. i couldn't submit to that and i came with a whole different philosophy, a philosophy that for me grows out of "wealth of nations" that adam smith wrote

that is the foundation of free enterprise. and the pages in my book, you go throw that in a fashion to understand how adam smith articulated it and even though he doesn't use the term invince i believe hand, we use the term invince i believe hand of the consumer makes those decisions. i talked about this last night. if you are a baker and baking bread and someone out there selling bread at $1.5 a loaf and goes on the shelves in the story and bake bread that is similar or better quality and sell it for a $1. you might get your spot on the shelf and the guy with the name brand has two or three shelves filled with bread and yours at

$1, in comes the consumer and think i could save a quarter if i just buy that brand of bread. why don't i try that. they bring home this new loaf of bread. if it's good, they will buy the brand over and over again especially if it's cheaper. the store owner realizes he is running out of those six loaves of bread and the other bread is getting stale on him so he widens his shelf space to the bakery who is selling at a lower price. and that's how the good bread takes over the bread that's not as good at the higher price. that's how the free enterprise works. pulls the bread off the shelf and looks at the price and quality and that's how decisions get made across the country and across the globe and that demand

is created by the consumer, is what drives the production signals into all of our production in the country, and that is, how many loaves are you going to bake. let's say you can produce 10,000 a day and now the demand is so great that you can't meet the demand any longer. as a producer, someone's marketing, you make a decision whether you want top expand or you might decide i'm as big as i want to be and i could get a little more money for the bread that i have. so you can raise the price. the price of that $1 loaf could go to $1.15. and the consumer chooses on quality and not price and it can transition back and forth in a myriad of ways.

this is the wonderful foundation that has built western civilization, free enterprise economy and often completely misunderstood of people who never got involved in commerce, didn't make a capital investment or try to produce something, a good or service that had value and had to compete against somebody else trying to figure out how to produce a good or service that was of higher quality for a lower price than their competitor. . that is a blessing to our economy, to our nation, to our western civilization. the president of the united states and probably the majority in the united states senate and this congress see the world differently. they think they can manage an economy. they think they can go nationalize these entities and government can manage better than individual consumers and people can manage.

to me that's a breathtaking concept. all of my training and my experience in my life goes back to if consumers can make the decision and people that are engaged in business can do so for a profit and the selection process is what makes it all work, why would we inject government in to make decisions? government can't make better decisions than consumers can or individual patients can. there is no history of that happening anywhere in the world that i know of government making better decisions. now, it's true, the government has to do some things. they have to take care of the broad good. we have to do as abraham lincoln said, defend our shores, carry the mail. he said do for the people for that which they cannot do for themselves or leave them alone. we are a long way of leaving us otherwise alone and now the government wants to take over roughly 1/6 of this economy,

the entire health care system in the united states and perhaps replace the entire health insurance industry and perhaps and likely replace the entire health care delivery system with a single payer one size fits all. that's what's going on in the united states of america. and, mr. speaker, i'm going to just ask your attention to a little flash back i want to offer that will take us back to 1993 and 1994. this, mr. speaker, in the flashback mode takes me back to september 22, 1993 which was the last time that a president of the united states spoke to a joint session of congress on a subject matter -- in an occasion other than the state of the union address, the most

-- otherwise most recently a week ago last week on wednesday evening when president obama spoke to a joint session of congress and advocated his national health care act. but this was september 22, 1993, bill clinton right back there in front of where you are, mr. speaker, and he was -- he gave a speech that was about the national health care act that they wanted to get passed. then hillary clinton was engaged in often closed door meetings to try to find a way to put out a health care bill that could be a single payer plan that would set up all the health care in america and make it work. this is the infamous poster that shows hillary care with a network of new government agencies all tied together. this is a real legitimate flow chart, and in fact this is lifted off of the archives of "the new york times." i had one similar to this and probably identical to it that

hung on my office wall throughout the 1990's and off past the turn of the millennium. but this shows -- this shows this massive growth in government. the government agency and programs here along this side, mr. speaker, shows patients and a global budget, the h.m.o. provider plan which doesn't have a lot of support these days. here's an ombudsman, another ombudsman so we have liaisons between people in government, a regional health alliance, a corporate health alliance. they have accountable health plan here and accountable health plan there wired through to a provider plan. it gets pretty complicated. here's your h.m.o. plan down here. the global budget and the patients. this -- and here are more government agency programs. and some these ackry nims i don't -- acronyms i don't remember. but i know this is a congloom ration of acronyms and the

growth in government is what scared the living daylights out of me as a man who was running a construction company which i founded, and we had a number of families that worked for me and we worked together. we provided health insurance for our employees and retirement plan for our employees. but i didn't want the government to come in and tell me what i could buy and couldn't buy. i didn't want them to take away my choices to work with my employees. i want to be able to offer them the best plan i could, the best employment package possible because good people are good policy are good production and a good product comes out of that. and you simply cannot do a good job unless you have the right people in place. we wanted the best people we could hire. we wanted to provide the best benefits package possible. i didn't want the government to limit that. and yet, here's this flow chart out of me that i said scared the daylights out of me. this is hillarycare, 1993,

1994. this is a bill that brought senator phil gramm to the floor of the united states senate right down this hallway directly ahead of you, mr. speaker, to the other end of this building when he stood on the floor of the united states senate said this would pass over my cold dead political body. this is what again scared the living daylights out of me 1993, 1994, and it scared the living daylights out of the american people. and eventually shut down and killed this initiative that was brought to the floor of the house here by bill clinton september 22 of 1993. they really thought that they had put the plan in place. they had the constituency base and a method to get this bill passed, but the american people rose up and said, no, they have had enough, they wanted to maintain their freedom. and they have done so with regard to health care for another 15 years or so. i guess i'll say 16 years. but, mr. speaker, things have changed.

this is the old bill. the house has passed out of committees a new health care bill. now, if you think black and white, all of these new agencies, the weight of government that a patient would have to wade through and the hoops they would have to jump through -- and we all know what it is like to deal with government. the bureaucracy is ever present. the government ends up with a monopoly and no one that works for a monopoly wants to treat you and there's no competition there to improve the quality or the service. and so here's the black and white hillarycare flow chart. here is the new modern technicolor -- some call it the jellybean flow chart that comes from h.r. 3200, the main bill that has passed out of several committees of the house,

including the ways and means and the energy and commerce committee. this new flow chart shows a bill that's different than hillarycare in some respects. it doesn't take it all with one giant bite. it takes a great big step towards a direction of socialized medicine in my view. it doesn't guarantee that it ends up being socialized medicine but it certainly will cause a significant -- certainly cause us significant concern that's what it will end up being. these circles or boxes or squares are existing programs or government agencies. the color ones are new government agencies that have to be created in order to have the bureaucracy to manage this h.r. 3200, the government option plan. the part of this flow chart, mr. speaker, that concerns me the most resides down here in the center bottom of this chart. this chart which is available on my website if you're

interested, mr. speaker, you can simply just google congressman steve king. and on the front page, the homepage of my website is a link that will take you directly to this flow chart and one or two others that are quite instructive. but on this flow chart, here's the part that i'd ask attention to. the bill -- and this is the vehicle that we're working with here in the house. this isn't something that's not been legitimized by committee passage. it has been. here is a new agency. the health choices administration. it creates the health choices administration to determine what choices the american people might have when it comes to health insurance. a new government agency to determine what health insurance is legitimate takes it out of the hands of the states and puts it into the hands of the federal government. i think the states take too much authority there myself. and the boss, the person that heads up the health choices administration is the new

health choices administration commissioner. now, he's not named and could be a she. this individual is not named as a czar because i believe the people that wrote this bill understood that america's full up to here with czars. we're overfull with czars. the president has at least 32 czars by most definitions and perhaps as many as 47 by other definitions. they're circumventing the confirmation process that vets these candidates for cabinet positions and other confirmation level appointments. and instead the president is appointing people that circumvent and eclipses the authority of people in cabinet positions. how about -- how about the middle east peace czar who has stepped above the secretary of state when it comes to negotiating peace in the middle east? how about the former -- what do we call him? the green economy czar, the

former czar, van jones. a lot of people had something to say about him when we learned that he was a self-avowed communist and he had radical ideas. finally, when the americans found out about van jones, the pressure that came caused him to step down rather than the president to dismiss him. how about executive pay salary czar? what is the white house doing with a position that doesn't exist in the constitution but someone who's going to look over the shoulder of executive pay for major corporations in america and determine if the c.e.o. can be making $1 million a year and having no heartburn about what michael jordan made or, let me say, how about -- how much money tiger woods makes playing golf? no heartburn over that, but a lot of heartburn over someone that's actually making money and concerned they're making too much and they want to tax

that, this class envy. remember, if you're making less than $250,000 a year you don't have to worry because this president won't raise your taxes. joe the plumber drew the line very clear and he did that in a way that i know wasn't planned in advance. it just came from his heart. he wants freedom, looking forward to maybe sharing the stage with joe the plumber next week in st. louis. but the czars, we have too many. and we shouldn't have any. there should be congressional oversight over these -- over these high level positions. if the president of the united states can appoint cabinet-level people and they go through the confirmation process according to the constitution in the united states senate and that happens, that's a good thing. but when he appoints people that has authority over czars that aren't subject to congressional oversight, that's a bad thing. this health choices

administration commissioner would be for all intents and purposes a czar, a czar with authority to be able to write all kinds of rules. he's not a -- well, a commissioner is what they call him. i call him the commizczarissioner. a commiczarissioner would make a decision about what private insurance policies would be approved that would go down into this -- from these -- these are the private insurers right now in this white box. and in order for them to become -- well, they are a traditional health insurance plans. these are the companies here in this little box, 1,300 health insurance companies in the united states. 1,300 separate companies selling health insurance in the united states. remember when president obama said we need more competition in the health insurance industry? did he say he thinks the

appropriate number for health insurance companies would be oh, 1,3001, because that's what he's talking about, conceptually. 1,300 private insurance selling in this white box here, mr. speaker, a policy combination so that the variety is extended to approximately 100,000 different policy varieties that are offered by 1,300 companies. and the president's view is we need to put some competition in place. i think we can do that some easy ways, but i want to make sure that we understand what this means. . the commissioner would write the rules on what health insurance policies would qualify under this bill to be sold in the united states. so, i could guarantee you if this bill passes in this kind of form, then there will not be

100,000 policies available for people to choose from, policy varieties, because the health choices administration commissioner would regulate them in such a way that a number of them would be disqualified. they couldn't become qualified plans. we know that's true, otherwise there would be no reason to create the health choices administration commissioner and no reason to have language in the bill that establishes the qualified health benefits plan, this is the purple circle on your left. the qualified health benefits plan. that 100,000 plan number would be reduced, i think by a significant number. i think the health choices commissioner would write regulations that would chop those 100,000 policy varieties down dramatically and reduce the numbers that are offered and they would argue that it confuses the consumer, so therefore we have to consolidate that and offer something that

the consumer can understand. and then, the other motive would be over in this other purple circle the public health plan, the public plan, the government option over here in this health insurance exchange. so the government option then has to compete with what's left of the private insurance companies and the private health insurance policies, those that aren't regulated out of existence by the new health insurance czar. now, let's just imagine and pick a number here and i don't think anybody has any idea, but if these 100,000 policies that are available today become 50,000 policies almost at the beginning of the new regulation and as the competition from the government option begins to take hold, those 100,000 policies became 50, are reduced to 10,000 policy varieties and then divide that by the number of states and you get one size fits all for all of

the states and you can reduce your 10,000 again to maybe 1,000 and then if you died it by five again, you end up with 200 policy options maybe. took the 10,000 policies and divided by the 50 states and that's about 200 policy opportunities that one can buy. reduce the number of companies as well. the companies would consolidate and merge and start writing policies that were at the direction of the health choices administration commissioner, the czar. so the federal government would write new regulations for two reasons and in the end it would be so they can compete with the private sector that has been december mated by the new rule. and they will set the premiums of the government option. those premiums will have to be left with the private health

insurance. they'll set the premiums and then write the regulations so the private health insurance has difficulty meeting those standards so that the federal government can compete in this business. and in the end, this purple circle here with 1,300 companies and 100,000 policies gets shrunk down to a tiny circle. and this little purple circle, the public health plan, the government option, grows bigger and bigger and bigger until it encompasses all of the health insurance in america. now some will say, mr. speaker, that this is radical reaction ary talk. it is not. there are patterns that have gone before us that we can learn from. in 1968, the federal government passed the federal flood insurance program. now there were private property and casualty companies that were selling flood insurance at that

time and wasn't much demand in the marketplace as there is today. we have had a number of natural disasters and floods that have taken place that brought this to a head in congress, so they passed legislation that set up the federal government in direct competition with the property and casualty insurance companies that were in the private sector selling flood insurance to people that were in the flood plains. this is complicated and there are lots of ways you can make this argument on either side whether the government should or should not have engaged in flood insurance. but they engaged in flood insurance. and when they did, they also directed that national banks that were writing loaning money on mortgages on real estate that had -- that were in a flood plain, those loans had to include flood insurance as part of the law. so if you wept out into a flood plain -- and by the way i have

one county that is 40% flood plain and the missouri river bottom is about 40% flood plain, to invest in anything in that flood plain, you have to buy flood insurance. that is federal law. so over time and in shorter period of time than one might imagine, from 1967 when there wasn't flood insurance available but only through private until a few years after that, the bill passed in 19 and took a while to -- in 1968 and took a while to get it implemented, the federal government squeezed out the private and took it over and created a market by setting a mandate that if you're going to buy money from a national bank you have to pay the premium for flood insurance. the big government people would argue that's a good idea and provided flood insurance for

people that didn't have it and took us out of the business of seppeding disaster money. it didn't get us out of the business of sending disaster money. katrina in new orleans, the second round was $5 billion. second bites at the apple and the total runs in the hundreds of billions. the flood insurance that existed didn't solve the problem, but it helped. but flood insurance is an example of what can happen and probably is likely to happen to the private health insurance market in the united states when the federal government engaged, they write regulations that favor the federal government and disfavor the private sector and set their premiums so this purple shrinks that is the private plan and this purple circle grows. federal flood insurance is $19.2

billion in the red with no way to pay for it except to ask for this congress to borrow from the chinese. couldn't we be better off. and maybe if the premiums paid on flood insurance would have reflected the real risk, we would have built more buildings up above the flood plain so she didn't have to buy the flood insurance premium. i know these things because i spent my life working in drainage projects. that's what can happen to the health insurance today and i it ought to scare us. and if it begins to scare us at all like it did during hillarycare, the american people will come to the town hall meetings, fill them up, have your say, write letters, go so your congressmen, let them know that you are intense about

maintaining your freedom. that's the argument. we have to fix health care before we can fix the economy, the economy that has had 30% of its profits nationalized by the federal government in the last year. the proponents of the nationalization that took place in between tarp when they were buying up large banks, $700 billion in tarp, three large investment banks nationalized. a.i.g., the large insurance company nationalized. fannie mae, freddie mac, general motors, chrysler, all nationalized. you add that will all up, we are looking at 30% of the profit of the private sector in the united states now under the control of the federal government. and that's nationalized. on top of it, there's an attempt

right here h.r. 3200, the senate version that speaks to nationalizing eventually another 17.5% of our economy. when you round that out, it becomes 48% of the private sector nationalized by the federal government. and when the private sector is nationalized, the freedom of the american people is diminished. that is what is going on, mr. speaker and the president has said health care costs too much and we have to fix an economy that is in economic crisis and can't fix the economy unless we first fix health care, because health care costs too much money at 14.5% of our gross domestic product. the average of the industrialized world is $9.5% of their g.d.p. we don't know if they are comparing apples to apples because there are many nationalization that has taken place in those countries.

we are different people, mr. speaker. we're a nation that lives and breathes freedom. we want our freedom and want to take risk we want the reward people to succeed but if we spend too much money on health care, let's have a debate on how to fix that and perhaps i'll come back to that in a moment. i want to come back to the president's next point, which is the other big problem, first one is we spend too much money on health care. the other big problem is we have way too many that are uninsured, 47 million americans that are uninsured. well, i happen to have a little poster that helps illustrate that, mr. speaker. this poster illustrates the universe of the 47 million uninsured. it says the uninsured are not

all the same and we have to break it down. we don't have the 47 million number on here. the other poster that i had last week does and so does the data that this data is produced by the republican conference in the united states senate. down that hallway, not out of this shop. but that's the source of it. this is 47 million. now do we want to cover all the people, this 47 million. we would believe that the 47 million are all middle and lower middle class working families that are working for some -- they want us to believe it, i don't believe it, working for some employer that are pocketting profits that won't provide health insurance for employees. many employers do and do so to become competitive because they want a high quality of people to come work for them. we want to pay as much money we can and the best benefits that we can. the 47 million that are uninsured at any given time,

that's a snapshot are not come prizing the lower and middle income working poor. to some degree they are. we start with 47 million and start to subtract, first those that are in the united states illegally. this chart says undocumented noncitizens. those are illegal aliens in the united states, illegal immigrants. this chart says six million. the other data that i was looking at that comes from the senate conference is 5.2 million. in any case, the next level of immigrant here are noncitizens who may not be eligible for government-sponsored health care. they probably are not eligible because the united states is, if you come to the united states, you are barred from receiving welfare benefits for five years. we don't want to be a magnet that people say the united

states is a giant a.t.m. in any case, the old chart was five million. we are at 10 million people we don't want to cover with this. we don't want to reward illegals to come to the united states and cash in on obamacare. go back to your own country or get in line behind the people who are waiting to come in legally right now. 10 million immigrants that don't qualify that are part of the 47 million. . we have nine million of those, they could write a check and take care of their own premiums. then we have those eligible for government programs but are not enrolled. generally that's those eligible for medicaid that didn't bother to sign up. that says 10 million, it's 9.7 million. got to split a couple hairs here because we're going to get down to a decimal point here, mr. speaker. also those we don't want to

ensure -- insure, or those i don't, who are eligible for employer-sponsored insurance but aren't enrolled. they turn down their employer's policy. that's six million. of 47 million, and i say i don't want to insure them, i think they should take their own responsibility to do that, they have affordable options or they're disqualified because they're illegally in the united states or barred by law. those left, the americans without affordable options aren't 47 million, they're 12.1 million people. now that's still a lot. but it's less than 4% of the population. a little larger than the population of iowa. but here they are right here in orange. now, there's one more point to make. out of these 12.1 million people, the americans without affordable options, the people who are proposing obamacare would like to have you believe is 47 million and a crisis now become a little sliver of the american society. i'll show you how.

this is the population of the united states, mr. speaker. this bluish circle represents about 306 million perhaps as many as 307 million americans. these people that are in -- this whole circle does, the purple -- this big chunk of the pie, the blue chunk of the pie, represents 84% of the population. those are the americans covered by a plan, whether it's a private plan, employer-provided plan, medicaid, medicare, americans that are covered by a plan. 84% of the population. 16% are not. number's actually around 15.5%, when you start splitting the hairs. but here's the categories they come in. yellow are the illegal immigrants. we already know that the president has said even that

he's not going to support funding illegals in the health insurance exchange. it's pretty interesting, it really did infuriate a lot of open borders people in the country. but the president said so and we're going to hold him to his word. we're not going to fund illegals. another 2% of those are under the five-year bar. that's in black. those are legal immigrants that are barred by law. now we're at 4%. here's a 3% which are individuals earning more than $75,000 that didn't take the trouble to get insured and here's another 3% in green. those are those that are eligible for government programs, these are the medicaid eligibles for the most part that didn't bother to sign up. and in blue are those eligible for employer-sponsored, those six million, but they didn't bother to sign up or they opted out. so when we look at this chart, we're trying to, i think this is where the bipartisan -- we're trying to fix a problem of the americans without affordable

options who are not insured. they don't really have an option, no affordable option. that's the orange. that's the less than 4% that i mentioned when you start to subtract the others. so think of this chart as everything but the orange is covered in one way or another or else they can take care of themselves and are by law, with the case of legal immigrants, required to do. so we're only down to this orange sliver, less than 4% of the population. i'll submit, mr. speaker, that this bill, this jelly bean chart, h.r. 3200, scare the living daylights out of someone in techny color chart right here, is designed to completely transform 100% of the health insurance that exists today in the united states and 100% of the health care delivery system

in the united states -- the best system in the world being transformed completely by h.r. 3200. 31 new agencies and a new health choices insurance czar who would write regulations and wipe out a lot of the health insurance in america, all of that, 100% transformation by this flow chart bill to address this little less than 4% of americans without affordable choices. mr. speaker, i'll submit that that is a radical approach to a problem that isn't nearly as bad as the people who want to have a socialized medicine plan and i'm going to list the things that republicans want to do about it and i want to yield to the gentlelady from minnesota. we want tort reform on this side of the aisle, we're not on the side of the trial lawyers. we want people to buy health insurance across state lines everywhere in america. we want portability so you can

take your policy with you. we want to expand health savings accounts so they can become retirement accounts if you have a healthy life and manage your health. we want to have full deductibility for everybody's health insurance premium. we want electronic medical records with protection for people's integrity of their records so it doesn't leak out. we want to have expansion of associated health care -- health insurance policies so that groups of professionals can join together to buy insurance. and we want transparency in billing so we can see who's charging who what and the consumer can make those decisions and we need to also take look at long-term care so people can manage their lives in a more efficient way. that's what republicans want to do. that's what i want to do. and now i want to do something else and that is i'd love to yield to the gentlelady from minnesota, michele bachmann, who is always in here fighting for truth, justice and the american way. mrs. bachmann: i must have my cape on, to the stunning gentleman from iowa, the great steve king, i want to thank you for allowing me to be a part of

this discussion that you're broaching and you've done a wonderful job all week on different occasions, talking about the true depth of this problem and the positive alternatives. i appreciate the fact that you've tried to lay context today about truly how many people are in need of insurance and how many people are without coverage. that's a very important part. we can't make true decisions unless we actually have the facts on the table. and i'm also extremely grateful that you're trying to give a positive alternative. we're looking at a couple of different options here to deal with health care. one would be president obama's option and the option that's been offered here in the house with essentially about $1 trillion of spending on health care and in the senate with something like $850 billion worth of health care from senator bachus that was just released. senator bachus' plan has not engendered much bipartisan support. i think there's a reason for that and it's because of the tremendous tax burden on the

middle class of the senate plan and i'm sure we'll be talking about that as we go forward. here's a part of our positive solution. we can have one plan that will burden future american taxpayers with trillions of dollars in unfunded mandates, trillions of dollars of spending, borrowing, taxing. and that is a burden as we go forward, when our country can least afford it. or we can take an alternative that would free up our economy and give free choices to the american people and not add to the burden of our treasury. and it's very simply this, as my colleague steve king of iowa has said, we want freedom to -- for the american people. we want the american people individually to own their own health care, just like they own car insurance, just like they own their house insurance. we don't want the government to own their insurance policy, we don't want the government to call the shots, or have control over people's health care decisions. or their employer. we want people to own it

individually. then next we want people to have the freedom to band together with whoever they prefer, whether it's realtors or teachers or farmers or maybe a community like a credit union, you come together in a geographical area, you join together with whoever you want to buy a policy. so you have purchasing power. next we want people to have freedom to buy any policy they want, anywhere they want in the country, from anyone they want to purchase the policy from. true choice in purchasing insurance. then as my colleague said, we want people to be able to set aside in an account, whether it's $5,000 a year or $10,000 a year or $15,000 a year, tax-free. in other words, you take that money out of your earnings or out of your savings and you put it tax-free in an account, up to a certain amount, if you spend more than that account then you

can deduct those health care savings off of your income tax return. that would include eyeglasses, dental work, hearing aids, whatever your health care would be, you get to fully deduct that. then finally we want lawsuit reform so that we don't have unnecessary spending so that doctors can try to protect themselves from frivolous lawsuits. these are very simple commonsense solutions and you notice not one of these solutions requires a vast infusion of federal tax money. that's because it's called freedom. that's the american way. and that will solve about 95% of our health care problems. will we need a government-supported safety net? always. we will always have one. because there will always be people who through no fault of their own have physical conditions that won't allow them to work. that won't allow them to be able

to pay their premium or pay for their health care. we can afford and we must pay for those people. but for the vast overwhelming majority of people, we can make health care affordable and that's why the proposal, which was just offered by senator bachus, is so concerning. on the senate side. congressman steve king has made an excellent case against the house measure, 3200, and he made an excellent case why this option is so expensive and so burdensome on the individual. the reason why the senate plan is equally negative in our eyes is for this reason, i take this out of the "wall street journal," it said the centerpiece of the obama-bachus plan, remember, it was just a week ago here in this chamber when president obama essentially backed the senator bachus version of the health care plan, but this is what "the wall street journal" has to say today, the centerpiece of the obama bachus -- of the

obama-bachus plan is a decree that everyone purchase heavily regulated insurance policy -- policies or pay a penalty. now manl that. i don't even think this survives a test of constitutionality. the federal government would make the american people purchase a product or service that people don't want to buy and the government would find them -- fine them and tax them with the penalty of going to jail if they don't buy the product or service that the government tells them they have to buy. think of how incredible this is. the enforcement of this mandated brute force health care policy would be enforced by the internal revenue service. so we would be forced to buy services and products we don't want to buy at a cost we can't afford and the internal revenue service would be the inforcement mechanism. this is not what the --

enforcement mechanism. this is not what the american people want to have which is why the republicans' positive alternative makes so much sense. you own it, you band together with anyone you want to purchase any amount of policy you want from anyone you want, anywhere you want with tax-free money or money that you deduct on your income tax policy and then we have lawsuit reform. i think it's a great alternative and i yield back to the gentleman from iowa. mr. king: i thank the gentlelady from minnesota and i couldn't ask for a better composite rendition of what we're looking at here from the health care industry and what's being driven on one side of the aisle versus that of the other. and the choices that we have and the options that are there, i think, mr. speaker, the things that are not considered are that good ideas don't get debated when the wrong people hold the gavels and i'm not speaking of you, i know my time has run out. i appreciate your indulgence. the gentlelady from minnesota. i yield back the balance of my time. the speaker pro tempore: the chair recognizes the gentleman from iowa for a motion.

mr. king: mr. speaker, i move the house do now adjourn. the speaker pro tempore: the question is on the motion to adjourn. adjourn. those in favor say aye.

18 years later he won the pulitzer prize for a bright shining lie. this weekend, he will discuss his latest, a fiery peace in the cold war on the nuclear arms race. that is sunday night on c-span. >> next month, take a rare visit inside the supreme court as we talk to the justices about their role, traditions, and history of the court. >> he said he would not come in here. he said that this building was celebre ended due to their heads. maybe he was right. it has become, over time, a symbol for government and the need for stability and the rule of law which is what america stands for. >> as a complement to this production, c-span offers teachers free teaching resources on our judicial system.

>> president obama announced changes to the u.s. missile defense program, scrapping a plan to build defense systems in the czech republic and poland. defense secretary robert gates reported on the details. from the pentagon, this is 40 minutes. >> good morning. before starting on today's announcement, i would like to a acknowledged the loss of six italian soldiers and a number of civilians in a bombing attack in kabul. our condolences go up to the families of those killed.

this week, the president, on their recommendation and advice of his national security team and leadership, decided to change the architecture of our ballistic missile defense in europe. it is a change that i believe will enhance our ability to respond to the most immediate threats to the continent as well as future threats. first, he at -- first, we have some background. in 2006, i recommended that president bush initiate a europe-based missile defense system that would put in an advanced radar in the czech republic and put interceptors in poland. there has been a change in our communities sense of the iranian

threat. the threat from the short and medium-range ballistic missiles are is developing more rapidly than previously projected. this poses an increased and more committed three to our forces on the european content as well as to our allies. on the other hand, our intelligence assessment now assesses that the threat of potential iranian enter- continental ballistic missile capabilities has been slower to develop than was estimated in 2006. the second development relates to our technology. over the last few years, we have made great strides with missile defense, particularly in our ability with short and medium- range missiles. we now have proven capability is to intercept is ballistic missiles, supported by much improved sensors. these capabilities offer a variety of options to detect, track, and shoot down enemy missiles.

this allows us to deploy a distributed center network, rather than a single-fifths of sight. -- single fixed site. we have improved the sm-3, which has had six successful flight tests. these tests have demonstrated the capability and has given a greater confidence in its system and its future. based on these two factors, we have now the opportunity to deploy new sensors and interceptors in northern and southern europe that, near term, can provide missile defense coverage from more needed defense from iran and others. in the initial stage, we will deployed ships with interceptors that provide the flexibility to move interceptors from one region to another if needed. the second phase, about 2015, will involve fielding upgraded land-based sm-3's.

consultations have begun with allies about hosting a land- based version of the sm-3 and other components of the system. based on some interceptors on land, they will provide additional cover. over time, this architecture is designed to continually in corporate new technologies, as well as new interceptors, improving their ability to knock down multiple targets and increasing the survivability of the overall system. this approach also provides us with greater flexibility to adapt to developing threats and involving technology. for example, although the iranian long-range missile threat is not as immediate as we previously thought, this system will allow us to incorporate future defensive capabilities against such threats as they develop.

perhaps most important, though, we can now feel the initial elements of the system to protect our forces in europe and our allies, roughly six years to seven years earlier than the previous plan. the fact has been made more relevant by continued delayed by the czech and polish r ratification process is. the plan is to cover most of europe and to continue on about the same schedule as before. as the president has said very clearly, as long as the iranian threat persists, we will pursue a permanent cost effective missile defense systems. today, the department of defense is briefing [unintelligible] we will continue to rely on our allies and work with them to develop a system that most effectively defend against a very real and growing threats.

those who say we are scrapping missile defense in europe are either misinformed or misrepresenting the reality of what we are doing. the security of europe has been a vital national interest to the united states for my entire career. the circumstances, the borders, and the threats may have changed but the commitment continues. i believe this new approach provides a better missile defense capability for our forces in europe for our european allies, and eventually for our homeland. it is more adapted to the threat we see developing and it takes advantage of new technical capabilities available to us today. with that, let me turn to general cartwright who has been deeply involved in the development of this proposal for more detailed presentation. >> thank you. i would like to step down to some of the elements of this

capability and its architecture as it develops and give you a sense of how we are thinking about it. most of this work has emanated from a congressionally directed ballistic missile defense review that is a part of our qvr analysis. one thing that has not changed is the set of priorities that we started with -- the defense of the homeland first, the defense of their deployed serve -- the defense of our deployed forces, and our friends and allies. [unintelligible] some of these decisions started back in the bush administration has resorted to shift to the priority and the weight of our efforts towards the deployed forces after we feel that the initial ground-based interceptors in alaska and in california. the review it and the account -- and the accompanying analysis has moved us based on the threat. but also on the opportunities

that technology has unveiled to us to shift to the architecture and enhance it. this is not moving away from the defense of the homeland and the capabilities to the ground-based interceptor. it is an acknowledgement that there are capabilities out there that are able to address the threat that has really emerged versus the threat that we initially postulated, what we would call the most dangerous, the threat to the united states. if the fact that the iranians are starting to feel capabilities associated with intermediate and medium-range and short-range ballistic missiles in numbers that are substantially larger that could be addressed by 40 or 10 ground- based interceptors. we're talking about hundreds. this had to be addressed, both for are to deploy forces and those nations affected by those missiles. we put together an architecture

that is globally deployable and is the same architecture that you would find if you went to japan, south korea, facing the north korean threat and the ground-based interceptors that depend upon that. this is an architecture that is globally exportable. we are going to focus today on the european aspect of that architecture. it is adaptable. in other words, one of the realities of life is that the enemy gets a vote. if they do not emerge the same way that you planned five years and 10 years ahead of time, if you can adapt, cured left disadvantage. -- if you cannot adapt, you are left disadvantage. elements of the system -- we

normally break them down. the ability to network systems together in a way that makes the whole substantially greater than any one of the elements is at the heart of this command and control system. i will talk a little bit more about that as i get into this. the sensors. one of the key activities is the rapid dances of our sensor technology. we started with a ground-based interceptor. we were focused on large terrestrial raiders that were basically left over from the cold war -- terrestrial radars that were basically left over from the cold war. if you look at the world from on top, the way the missiles look at it, things fly across the polls. this was to defend us against incoming icbm's. we have added mobile and

relocatable radars. that system has proved to be very effective and very capable. second is the mobile radars, both on the aegis, the organic radar, to the patriot system and the sea-based >> pan which is deployed in the pacific. these are capable of being moved to of wherever it is we feel we need to defend ourselves. that is an important aspect. when ps we have not had until now is the airborne layer. -- one piece we have not had until now is the airborne layer. it will add to the redundancy, survivability, and efficiency of the overall system. that work is ongoing now. it was part of their 2009-2010 budget submissions.

-- it was part of our 2009-2010 budget submissions. it is very promising technology. then we have our space-based centers. this gives us the adaptability we believe we will need to have. the last piece in this triad of capabilities is the weapons. everybody pretty much knows the capabilities of the patriot system. it is out there and globally deployed. many countries have deployed it. you would put this at a critical infrastructure, a facility like an airport or report, to defend that area. it has proven itself in the testing and we are now fielding in larger numbers. it is a multiple defense area mechanism. [unintelligible]

the thad has just started to finish its testing. its first operational deployments will be this year. we will do that to make sure that we ring the system out. by all measures, this is successful itin its testing. then there's a ground-based interceptor. reported in the ground in alaska and in denver, california. -- we put it in the ground in alaska and in annenberg, california. [unintelligible] one thing i am relatively sure

of is the threat will change. we have a thinking adversary and we have to acknowledge that. the first phase starts in 2011. actually has already started. but this is the deployment of the patriot systems that are out there today. this is the deployment of the essen-three system -- of the sm- 3 system. we have had eight good test. it is what we used to shoot down the satellite. it is an efficient system with a long heritage of r&d and knowledge about it. we have deployed to the eastern mediterranean already and we will begin to deploy that in number -- in larger numbers. when we marry that with the senses, that will give us the ability to defend the critical infrastructure, deploy forces in europe and the minute -- and the mediterranean as we move forward. we expected in 2011 to be fully in place.

we expect to have an upgrade to the sm-3 block1a, which will be called the sm-3 block1b. that one will have better sensors and the beginning deployment of sensors should they apply themselves in the way we think they will. it will allow us to move from a relatively small area -- this would be at least three times larger based on the ability of the missile and the sensor packages to with -- to address the threats that are out there. we will have a much larger deployment capability and we will bring in the first phase of land-based sm-3. that is something that we have today. we have the systems at air test facilities. we do most of our testing on the land anyway. -- we have the systems at our

test facilities. we do most of their testing on the land anyway. -- we do most of our testing on the land anyway. what we're looking for in 2018 is the emergence of the sm-3 block2. it would be a stamp -- is substantially larger missile that would deploy both on ships and a short period that missile will allow us -- both on ships and on shore. that missile will allow us to defend against intermediate and short-range missiles. that is a substantial improvement from where we are. that is an r&d effort. at the same time, we're continuing the effort that we have ongoing debate on the ground-based interceptor. that is to build a two-stage give ability. those tests are funded and will continue. -- that is to build a two-stage

capability. those tests are funded and will continue. until we know, we are not abandoning the work we do with the ground-based interceptor. the last piece of this, in 2020, is a land based sm-3 block2a and sm-3 block2b. this gets at additional coverage beyond the ground-based interceptor the united states and europe against intermediate ballistic missiles or intercontinental ballistic missiles. that technology is still out there and is still to be proven. we cannot abandon or scrap the capabilities that we have today on a ground-based interceptor,

nor do we intend to. if these new technologies prove out, what they do have that the current system cannot have is the ability to get at what we call rate size. when we predict we built the original system on -- we built the original system on size. we are dealing with hundreds of missiles on the ir p.m.bm. what you can do with gun sm-3 and affordability and dispersal is greater for the number of missiles than we currently have for the ground-based interceptor. this is a substantial [unintelligible] if it does not emerge, we do not have to build the mall.

but if it does, we are ready to go after it. we have put in place and architecture that allows us to be adaptable. it is a global architecture. but recovered just a couple more things. first, cost, that is one of the questions that gets asked. it patriot cause to $1.3 million. there are other -- one paid trip costs you want when $3 million. the sm-3 we are talking about is about $9.5 million. we estimate that the newer missiles we would develop in the future would be up to $15 million a round. the interceptor that is in the ground today is $70 million. he did not want to go after large numbers with a very expensive missile unless it is absolutely essential. we need an approach that allows us to build layers that allows us to defend both what we think we thinwe will have to defend

against a day and what we see in the future. the patriot system is deployed all over the world. they're not owned by the united states. they are purchased by those countries. the aegis system is the same way. we can monitor the systems and upgrade them and keep them up with the technology then buying them ourselves. we have the capability for burden-sharing. in the r&d part of the equation, we estimate that that r&d effort is pentecostals about $3.5 billion. the japanese government has already kicked in over $1 billion toward that investment. that investment will lead us the capability that is far beyond just worrying about the pacific and the japanese. this is a significant opportunity to work in a call --

in a global construct to field and find and maintain this capability in a way that we have not been able to do in the past. the other piece is the integration. we don't necessarily need to have all american systems. we are integrating the israeli arab system into this capability. we're looking at other -- is really aero system into this capability. we're looking at others. that gives us the opportunity to leverage your investments in a way that we did not have with the soley dgi system. this is consistent with the budget we submitted for 2009- 2010. the timing now is to make sure that the debate is allowed to occur, that we can inform the congress and the american people and our allies, and give them choices about the way we move forward.

with that, i will take your questions. >> i noticed that none of you said the word russia in your remarks. can you say to what extent the hope for a better relationship with russia and russia's cooperation in any future sanctions regime or other attempts to cover the iranian missile threat, to what extent was that a factor in making this exchange? >> general card rate is set in with all -- general cartwright satin with all the meetings. the decisions on this were driven almost exclusively private changed intelligence assessment. it was a deer -- it was a zeroth-base look. that said, first of all, the russians are probably not going to be pleased that we are

continuing with missile defense efforts in europe. at the same time, there are two exchanges in this architecture that should allay some of their unfounded concerns. one is there concern that the radar that was going into the czech republic looked deep into russia and could actually monitor the launches of their icbm's as well. the second is that the russians believe, despite our best efforts to dissuade them, that the ground-based interceptors in poland could be fitted with nuclear weapons and become an offensive weapon, a weapon for which there would have virtually no warning time. the move to the sm-3's, while enhancing our capabilities, that is a weapon that they cannot rationally argue that there is any kind of threat to russia.

and we are very interested, as i have talked to the russians for the last two years, in having them partner with us. their radar in the southern part of russia could be integrated into this network and could be very effective in giving greater coverage to potential iranian missile launches. >> what do you say to the people in government of poland and the czech republic who invested in a political capital and tried to sell the old systems to their people? >> as the president mentioned in his remarks, he has talked with both prime ministers. i must say, based on the very brief accounts that i have

gotten, they have been reasonably positive about this. we are very interested in continuing to work with the czech republic in terms of a piece of this architecture and we are eager to go forward with the framework agreement with the czechs on this. clearly, what this represents is that, if the polls are interested in going forward, it meets their concerns about having this capability in poland. i think this is an enhanced opportunity particularly for the polish government. it also offers opportunities for the czech republic as well. >> you did mention that there could be the deployment of a radar in europe. could still be in the czech republic? >> it is likely to be more in the caucasus.

that would be to get the early tracks. that would likely be more down in the caucuses. >> and lot of people are wondering why we should trust the intelligence assessments today when they got it so wrong in the war in iraq. [unintelligible] >> first of all, i think the important thing is to go back to what general cartwright was saying and what i said in my opening statement. this gives us some capability very soon. the other alternative gave us no capability until the next decade. we would have no head until 2018 with the original program that i approved in december 2006.

this gives us at least some capability early on, i'm increasingly enhanced credibility p during this enhancederiod -- during this entire period. >> i am relatively sure that the systems will be wrong if we have a good bet for syria. the intent is to develop a system that has since this is a sufficient agility to accommodate that. -- the intent is to develop a system that has sufficient ability to accommodate that. >the question is how many do we need in what areas, what is going on in europe, what is the political situation, is there a threat against a particular

country? on a day and in death cases, we're looking for a -- on a day- to-day basis, we are looking for areas of interest. we would surge additional ships and part of what is in the budget is to get us a sufficient number of ships to allow us to have a global deployment of this capability on a constant basis with a surge capacity in anyone theater at a time could >> i would remind you that the fiscal year 2009 budget would have [unintelligible] >> on afghanistan -- >> let's do more on missile defense. >> israel was mentioned a couple of times earlier. there is concern that israel

may attacked iran preemptively with this system -- preemptively. would the system be able to tell it is real, you will be protected. please do not attack iran. >> one of the things that this does is to enhance their defense capabilities against iran. we hope that it will reassure them that there is a little more time here. we are all concerned about iran running out the clock on us on the nuclear program. but our view is that there is still time for diplomacy and sanctions to persuade the iranians that their security will be diminished by going down the track of nuclear weapons rather than enhanced talks.

>> i think the issue here is much broader than just israel. if this is the emergence the way we think it will, what you're doing here is providing another form of deterrence that is an alternative -- that is an alternative. that has to register -- it has registered in the pacific as you have seen with the investments by the south koreans and the japanese. this is broader than just israel for the same reasons that the secretary talked about. >> and explain why the caucuses might be less of a threat to russia than the czech radar. by 2011, how many medium-range missiles from iran could they conceivably launched toward europe? >> on the capabilities of the x ban radar, [unintelligible]

[laughter] >> the first question really has to do with russia and their perception of a threat from the raider that it would've been in the czech republic. -- from the radar that would have been in the czech republic. it has a very deep. capability into russia. the worry would be that then we would able to see very early the lodge's if russia were launching their icbm's. that could be seen as destabilizing. the other one points in a single direction. it will be very clear that is pointing south toward iran. you want to get that radar as close as you can to be able to get the initial watches and understand where the missiles are going, whether they are just tests or whether they are threatening the >> ban radar gives you that capability very quickly. -- whether they are threatening.

the x ban radar gives you the capability very quickly. [unintelligible] ] -- >> [unintelligible] >> we are working on a bilateral and a multilateral basis in the gulf to establish the same kind of regional missile defense that would protect our facilities out there as well as our friends and allies. i have addressed this issue two years running. we already have patriots out there. we have aegis ships out there. we have very strong bilateral relationships and developing missile defense with several companies -- several countries in the gulf. now we want to layer on top of that multilateral cooperation as well.

>> can you talk about when and how russia will [unintelligible] >> i do not know the answer to that. >> let's talk a little bit more about the opt to be -- the architecture appear. how many sites where you need for the 1a and 1b? >> initially, we would stir with a land-based system. -- we would start with a land- based system. it would be agnostic to be wheare. the czech republic and poland are both candidates. there are other candidates in that region.

deeper into europe, there would be good sites for the sm-3. it is not as particular about where it is located. you have a wide range of choices. any of those countries have the opportunity to participate in it. even if we had three countries that wanted them and we only need one, the general concept is that each box will have about eight missiles. we can move this around and disperse it even more for survivability and for better assurance of our allies that they're protected. >> we have time for one more on missile defense and then we will take a couple on other subjects. >> the plan you just announced may be good from the u.s. perspective. but for people in poland and the polish government, the most important part of missile defense is the presence of u.s.

military in poland. now you are offering: another five years -- offering poland another five years or seven years of stocks. it was the u.s. government that got poland to agree to host the missile defense. what would you say to those who invested and lost? have you consulted this new approach with the government of poland and the czech republic before? >> yes. the answer that i would give to poles asking that question is that we still want to partner with poland. we would prefer to put the sm-

3's in poland in place of the ground-based interceptors. that will still involve a presence of the u.s.. they may be there earlier than they would have been with the ground-based interceptors because their would not become operational until 2017-2018. we're talking about 2015 now. there are all of the same opportunities for a partnership between the united states and poland that existed under the previous program. >> some are calling for general the mcchrystal's assessment to be publicly released.

can you explain why they can get their own assessment from the general? >> there has been a lot of -- talk this week and in the last two weeks or three weeks about afghanistan. frankly, from my standpoint, everybody ought to take a deep breath. the president announced at the end of march, when he announces other decisions on afghanistan, he made very clear after the elections in afghanistan we would reassess where we are and whether the strategy his decisions that he made at that time continue to fit the situation that we face. the generals assessment is a part of that. frankly, i believe that the president reserves the right to observe the assessment himself and have his questions and my

questions and others questioned relating to the assessment answered before its delivery. it is a pre-decision aal document. it was briefed on the hill. i'm standing is that it will be made available on the hill if not passed out so that the representatives will have access to it. we need to understand that the decisions the president faces on afghanistan is some of the most important he may face in his present -- in his presidency about how we go for their. this is a situation where i think that the decision process should not be rushed. if there are urgent need, i just authorized, in the last 10 days or so within the troop levels that the president has approved, sending another 2300 to 3000 critical enablers that

the general has asked for. this is before the president makes a decision on whether we send a significant amount of combat troops. it is important to make sure we have the strategy right before we start talking the resource issue. some of the questions we are arresting a park outside of the general's area of -- some of the questions we are asking are outside of the general's area of authority. there is -- i felt a sense of a building momentum that was demanding a decision in days, if not a week or two weeks. given the importance of the decisions, we need to take your time and get this right. -- we need to take our time and get this right. >> the general has completed his

report on troop requests and is waiting on washington. >> we are working through the process by which we want that submitted. >> of the president is about to award yet another medal of honor to the family of a soldier that died in an act of courage in the work. people are getting very curious why there is no living medal of honor recipient. what is your view? has no one performed an act of courage worthy of the medal of honor and lived through it? >> this has been a source of concern to me. i think it was one of president bush's real regrets that he did not have the opportunity to honor a living medal of honor winner or recipient, i should say.

we are looking at this. without getting into any details, there are some in the process. as everybody knows, it is a very time-intensive and thorough process. i have been told that there are some living potential recipients that have been put forward. >> the decision about troop levels will be made after [unintelligible] is he right in saying that no decisions on troop levels will be made even after the civilian surges finish, which might be the beginning of the year? >> i do not want to get into the timing. the president will make his decision when the questions that he has asked and the assessments that are going on have been completed.

i do not think anybody should put any conditions on that. the troops he has already approved are almost all their at this point. the civilian surge is beginning to flow. it remains to be seen how long it will take to see the outcome of the election. but i would tell you that there's no question that the nature of the election in afghanistan has complicated the picture for us. thank you. >> in 1971, as a new york times reporter, neil sheehan obtained the top-secret pentagon papers. 18 years later, still writing about the vietnam war, he won

the pulitzer prize for "a bright shining lie." this weekend, he will discuss his book. q&a is sunday night on c-span. >> next month, take a rare visit inside the supreme court as we talk to the justices about the role, traditions, and history of the court. >> brandeis said he would not come in here. the reason justice brandeis said he would not come in here is that the building is so elaborate that it would go to their heads. maybe he is right. has become a symbol of the court system, the third branch of government, and the need of stability, the rule of law, which is what america stands for. >> as a complement to this original production, c-span offers teachers free teaching resources on our judicial system. >> now there's a discussion on health care with vermont gov. jim douglas.

he is also president of the national governors association. from the national press club earlier today, this is about one hour. >> our guest today, gov. jim douglas has announced that he will not seek reelection in 2010. .

improve the quality and performance of the health care system and contain costs. as a result of his efforts, and gov. douglas was honored in 2006 by aarp as one of 10 extraordinary people who have made the world they better placed to their innovative thinking, passion, and perseverance. vermont has been ranked the healthiest state by the united health foundation for the past two years while the uninsured population has shrunk from nine poor -- 9.8% in 2005 to a lower percentage. he has a critical role of states in national health care reform. he will talk to us about his yearlong initiative. prescription for health reform, affordable, accessible, accountable. it lets states contribute to the success of national health care

reform and the importance of state efforts to help all citizens have access to more coordinated and efficient health care. please join me in welcoming to the national press club, gov. jim douglas. [applause] >> thank you. thank you for those kind words in your introduction. it is nice to be here today. especially with some expatriate's from vermont in the audience. it is great to see them along with the team from the national governors' association. i do not get to our nation's capital to much. when you live in heaven, why would you want to come to washington? i am honored to come here today and talked a little bit about a timely topic.

in response to some of the questions i got before coming in, we had a great maple crop. our summer tourists are up. next summer will be wonderful as the leaves begin to turn. we hope you all have a chance to come to the state. i want to thank donna and matt for their invitation to be here. and this was scheduled some time ago. timing is everything. a little bit too much on my initiative. i would be remiss if i did not talk about what is going on on capitol hill in terms of health care reform. nobody in washington is talking about it. i thought i would offer a few perspectives from the standpoint of the governors. these are important issues for all of us. every governor wants to improve

the quality of health care in our country. every governor was to reduce the cost of that care. it is particularly imperative because health care is such a huge portion of the national economy in terms of percentage of gross domestic product. increasingly, it is a large part of every state's operating budget. medicaid is 22% of state budgets around the country. and places like vermont, it is an expanded program where it is greater. we expect it will be much higher over the decade. we have to take this seriously from an economic and fiscal standpoint as well as to improve the health outcomes of our great country. if health reform gets through congress, states will play a significant role in its implementation. some health programs are generally run by the state governments whether it is

medicaid or some other program. it is obvious that states will play a key role in what capacity congress. it is critical from our standpoint that governors be given the time and flexibility to implement those reforms if we are going to be successful in carrying them out. i will talk a little bit about several aspects of reform and how they affect the governors across the country. i think it is fair to say that although these are my own thoughts, i am reflecting on the preponderant of views of my counterparts on both sides of the political aisle. we appreciate the efforts that the congress is making. we recognize their progress. we want to make sure that federal policy makers are aware of the huge risks that the states are making. as i talk to people around the green mountain state and discussed the issue with my

colleagues, there is a consensus that we have to do something. keeping the american people healthy is not a republican or democratic objective. there is a conference that they are sponsoring across town on the early education of young people. one focus of that is ensuring that kids are healthy when they are in their youngest years and come to school ready to learn. their educational outcomes will be more successful as time goes on. at the other end of the chronological spectrum, vermont is the second coldest day in the nation in terms of age. as we get older, we have to -- oldest state in the nation in terms of age. we have common interests across the political spectrum. we have to make sure that congress is it right. i mentioned the economy. over the past year, the state has been faced with some real

economic stress. even before the current recession, i talked about the affordability agenda. one key element of that agenda is the cost of health care. it is squeezing the budgets of families, small businesses, and governments as well. and she noted a few minutes ago, i work with republicans and democrats in our legislature to pass comprehensive health reforms and really make a difference for people in our state. the successes that we realized in vermont have not come easily. they're required timor, compromise, and willingness to address the tough issues are around health care. i think they can be a model for reform across the country. as we come out of this global recession, the longest and deepest since the great depression, we need to make sure that we are ready to grow as a nation in terms of economic

health and the health and well- being of the people who live here. we are going to have to find some common ground. i have decided to make health care reform the focus of my yearlong initiatives as chairman of the national governors' association. after 6.5 years of working, i welcome the current discussion in washington. if an order for the state reforms to be successful, the state government should be a full partner. reforming one sixth of our national economy is no small task. it is a tough job for the congress. i certainly respect that. whenever they're talking about health care, and they are not discussing a single system, but a complex web of political, economic, and social issues that have a profound impact on the american people. it is understandable that americans have the right to worry about how they will affect

the quality and affordability of the care that they receive. they have the right to worry about the inaction of how a quantity, not quality driven system will help. and there is nothing wrong with the lively and spirited debate on an issue like this one. citizens of march have an obligation to speak openly and honestly about the costs and consequences of all of the reform proposals being advanced. the debate seems to have a way of veering off track, away from our common goals. my greatest concern about the current political discussion in washington is that it is to focus on the wrong end of the health-care debate, mainly the payment structure we have in place now. with so much time and energy focus on where the money comes from, no matter who pays, health care costs are on track to bankrupt our families if we do

not act boldly in order to reform our system. the nation spends almost $7,500 per person for health services every year. that is more than double the national average for the other industrialized countries are brown world. the outcomes for america are no better. it promotes duplication and waste. it too often does not encourage disease prevention, instead opting for expensive care after people are already sick. rather than oversimplifying the debate about how we pay, we need to put our heads together and talk about how we make health care more affordable and accountable across america. states like vermont that have demonstrated how innovative reforms can increase access to care can be a guiding light for the nation as we continue this debate in our capital.

if there is one thing that i have learned about reform, it is that coverage is not enough coverage without significant improvements will eventually cause further strain on an unsustainable system. true reform needs to have cost drivers. we need to have changes in how we deliver care, how we realize health and wellness to realize the population. these are things that will truly reform health care and contain spending that is out of control. we have to drive value in the system. it will take a lot of effort. in vermont we have displayed a reputation for having comprehensive reforms and incorporate aspects of high quality care along with expanded coverage. it is a simple reality that when americans are healthier, they spend fewer dollars on cluster services.

-- health-care services. by combining health care and information technology and how we pay for its, we can eliminate duplicative services. the blueprint in vermont and what we have in place six years ago, we utilize that helps teams to provide coordinated services for primary care practices. medicaid and private insurance companies along with employers are participating in this effort. >> yesterday's announcement will now be able to participate in this kind of exciting and state led reform. these are not just theories about what will happen sometime in the far future. these reforms are having a real impact on the lives of people today. vermont is not the only place where reforms have been overtaken -- undertaken. there are programs in minnesota

and washington and in other states that are removing care and removing excess spending in the system. they can all serve as models for the state government and other states. coverage efforts really need to go hand in hand. many governors have expanded coverage through private and public programs to make sure that folks have access to republic insurance. and needs to be more than insurance in name only. they need coverage that helps them stay healthy and prevent disease. we focus on improving the delivery spending -- a system it will improve health outcomes. and is not just important for the health of families, it is critical for state government. that has to be done right. my colleagues are watching the debate in washington closely. the impact on their state budgets could be enormous. health care reform that doesn't respect the fiscal realities of state for government will not

only failed to improve the system, it will sap resources from other efforts such as improving education, protecting the apartment, and helping our economies. states cannot print money. we have to balance our books at the end of every fiscal year. doing so is not getting easier. states are facing a projected budget shortfalls of over $200 billion in the coming years. democratic and republican governors are forced to make painful decisions. 28 governors proposed spending cuts to higher education. 20% recommended cuts in k-12 education. some governors recommended tax and fee increases, totaling nearly $24 billion. vermont is no different. we learned last month that our state revenue projections are down 2.5% right after our budget

was passed last year over my objections. to give you a sense of the gravity of the situation, even under its most optimistic projections, state revenues will not have recovered to pre- recession even by 2014. states are going to have to make even more tough decisions to balance our budgets and avoid increasing taxes to a level that will stifle growth and innovation. federal mandates that are not fully funded, at health reforms will bust budgets and ultimately failed to achieve their objectives. health care reform of the federal loveland its respect the fact that implication the state level is not the up-one-size- fits-all. governors have it critical role. it will take a lot of potential restructuring of state governments to move this forward. states will be where the rubber meets the road. leadership and experience will

be crucial to succeed with transitioning to a reform system. they will insure that they have the flexibility to implement those reforms. my colleagues are working hard to ensure that policymakers in washington hear that message. flexibility is the key to the innovation critical to the success of their reforms. we realize that there will be adapting in the state capitals to whatever passes here. a key component is to help governors understand what national reform means for them and their programs. we will need to get up to speed so governors can make decisions on the timing and process of implementation. they need to approach its strategically. if health-care reform becomes law, many will be left to federal agencies. we will need to work with the agencies to ensure the concerns are noted.

i want to offer some personal views on the current congressional discussions. a lot of work has gone into developing the house reform proposals. they have been listening to state concerns and made some changes in their proposals to address them. of all governors believe that improvements are needed in the system. their initial reactions differ. some are opposed to any unfunded mandates to states all others signaled their strong support for the proposals. all governors need more details. they are all concerned about the impacts to our states. i wanted to mention three areas very briefly. on insurance reform, the finance committee lays out new federal standards. it appears to give states flexibility to make changes and others that states believe will supermarkets. the amount of state insurance pre-emption is limited and the day-to-day insurance is deaf to

the states. these are not changes we can make with the flick of a switch. that is what it does occur -- is critical to face in any new rules. we need to make sure they about the experts in the state's to put them with existing structures and regulations that we already have. the finance committee seems to recognize the value of the help the exchange concept. a complex array of court commission issues cannot be dictated from the federal level. but it is critical that states run the six changes brit several pioneering states have already demonstrated that they can make it successful for consumers. we know that states need to thoughtfully develop the relationship between the exchange and state medicaid programs so that low-income individuals can get the

appropriate care. they also need to provide food stamps and welfare systems. finance committees, entrance reforms still need work. i think they're heading down a path that seems workable for the states. governors remain most concerned about the medicaid expansion and tremendous liability for states. the original house committee bill are recognized our precarious fiscal condition by permanently funding in medicaid expansion. governors have discussed the expansion at great length. the chairman's proposal has moved far going from 0 to an average of almost 90% federal funding over the long term. there is still enormous risks of four states. many states are concerned that medicaid expansion will create up for pressure that is unsustainable. -- upward pressure that is unsustainable.

this is a reasonable trend to expect. it has many governors concerned about the fiscal pressure is by the millions that are currently eligible, but enroll. there could be 6 million of these individuals coming into medicaid from the woodwork effect. they should be treated as part of the expansion population. i believe it should receive an increased federal match. as congress moves forward, we hope they work with governors to craft a successful reforms. they need to recognize that the forms cannot be built on the backs of states, but only can be done in partnership with them. governors can shake a prescription for health care reform to make sure that it is affordable and successful and accountable to our citizens and have an opportunity to fill our role as leaders and improve the quality of the system and provide more insurance coverage.

it is an important issue on the minds of all of the governors of our great country. i am pleased that we have been able to work across the aisle to articulate their concerns. i hope that before all this is said and done that the folks in the congress will find a way to reach across the aisle and find some bipartisan solutions. it will improve the health outcomes to the people and our country. thank you all very much indeed. [applause] >> we have a lot of questions here. what lesson should washington take away from your experience in passing health reform in vermont? >> the key to what we have accomplished is a comprehensive approach.

it is not just adding more people to medicaid or other publicly supported programs. it is changing how we actually deliver care. let me give you a specific example. we have community health teams. we have three communities across the state that comprise 10% of our population where we have a primary care delivery model that is exciting and successful. we have a medical home for vermonters so that their affiliated with the practice brit a dietitian, whatever is necessary to fulfil the needs of the individual patient. at the white house health form that i was privileged to host in march, a young woman from the northeastern part of our stay parked about her experience. this is a young woman that suffered from the chronic

disease that was not making much progress that was out of work and expensive to our system. when she got into a practice that constitutes a medical home with her community health team, her life began to turnaround. she has a team of professionals they're really care about her and provide the ongoing care that is necessary to get her on the road to recovery. she is managing her illness. it really can make a difference. the message is that there needs to be a comprehensive approach. it is well thus, prevention, management of chronic illness, providing an incentive to providers to provide a good quality of care. we pay an incremental bonus to our primary care providers in this program based on their adherence to standards of the

national council on quality and terrance -- quality insurance. they get paid more for delivering better care. in medicaid alone we have seen an 11% decline in the number of admissions to our hospitals and a 6% decline in the emergency room usage. i think that we have a model that works. we have saved nearly a quarter billion dollars in medicaid over the last few years. for vermont, that is a lot of money. >> what is the one aspect of vermont reform that you have not seen represented in the national health care bills? >> to be honest, we have not seen the bill from the senate finance committee. i am not sure i could answer that specifically.

i do appreciate the chairman of reaching out to governors. we have had a number of meetings and teleconferences. he has reflected some of the concerns we have raised. he has moved in the right direction. most governors want to see what it means to their individual states. until we have the language of the legislation, i am not sure i know what the impact is in vermont. there were some numbers floating around. i want my medicaid director to a put in the number from my state. we have been so focused on medicaid expansion that we have not had detailed conversations about reform. to the extent that it does not incorporate what i described to you as a model for a delivery system reform, that needs to be added. >> is there a health care reform that vermont tried it that was a mistake and that you

think that federal lawmakers should avoid? >> probably the ones that the legislature passed that i vetoed a few years ago. namely tax increases. the reason i say that is that you have to get costs under control. i have often said to the people of vermont that whether you are for publicly funded health care options or private options, it does not matter what pocket we pay for it out of, all of their pockets are going to be empty unless we get the cost of health care under control. raising taxes is not the right response. we need to focus on cost of payment. we have been successful in doing that. the problem is that there always is a need for instant results. that is not likely to happen.

we have launched the blueprint for health in 2003. after six years, we have been able to achieve some of the results i have described. it takes time and dedication and commitment on the part of insurers and providers and everybody in vermont to turn the proverbial barrel ship and put things in a different direction. -- battleship and put things in a different direction. we have demonstrated that it can work. adding more money to the system i do not believe economically or fiscally is the way to go. >> what was your political strategy in vermont that help you avoid some of the political pain that is going on now like the tea party movements? >> there was a little pain. after we passed a bill and they passed a bill in 2005 that i

reject it, we came back in next year and work together and accommodate the different points of view and got a bill passed that was not everything i wanted, it was not everything the legislature wanted, but it was something we could agree to. i was pleased when a senator from the other party said, echoing through the first round with the veto willie -- really resulted in a better bill. has -- it was not at a better bill entirely, but there is a level of mutual respect. vermonters are ruggedly independent. we care about the people we represent. despite our differences, we are able to come together. >> what is the status of the health and information exchange in vermont? >> we began a program a few

years ago, the vermont information technology leader said that has public and private participation in establishing an exchange for our state. i believe strongly that the information technology is one key to cost containment and improvement of care. we are seeing real evidence of that as well. publication. did you write that question? this highlighted this in a couple of places, notably in the city where we have the regional medical center. there was a medication history pilot project. if we go into the emergency room and you are part of that community of care, your history is on mine for the emergency room doctors to see the soon as you come in the door.

there was a case reported where a woman came in and had stomach pains of some kind. without this capacity to get the information immediately on line -- online, who knows what would have happened? in fact, the doctor pulled the history up on the screen, talked to the patient, found that she had not taken her medication for for a problem. the care was delivered quickly, expansively, and correctly. i believe that technology is key to get providers the information that they need to make real time decisions. it is vital to this program we have launched with our providers. we have a program where we are getting laptops to providers.

we have a website that we have been working with to facilitate this. we are going to make sure that the entire state has the capacity. >> speaking of the emergency rooms, this question asks, a physician just call me that the emergency rooms are becoming dumping grounds of the nation's health-care system. how do you fix that in any health care reform? >> we are making progress on that front. we have seen a 6% decline in the emergency room usage by our medicare population because of our blueprint strategy of focusing on preventive care and early care and screening and making sure the people get their russet-regular physical exams and putting community health- care teams in place. it really does work. i think most americans would

rather spend their time somewhere other than the emergency room. if we could give them the tools, the care team, the self- confidence to do what is necessary to take better care of themselves, then we can achieve those results. we have seen some progress in vermont. it is a model that can work elsewhere. >> how does your program to increase access for uninsured or underinsured people? what evidence do you have that they are getting access? >> as you noted in your introduction, we have reduced the uninsured rate from 9.8% to 7.6% in the couple of years since we launched our efforts. the majority of those uninsured are eligible for medicaid, they just do not sign up for it. we have extensive average programs. i guess we will have to make

them better. we have provided affordable coverage as a result of our reforms. what i have done i think is a good model. it is a seamless system of access based on family affordability. we have the basic medicaid program that reform -- requires no outlay on the part of the participants. the vermont access program is a program that requires a premium based on income to participate. we have a partnership with some private providers where participants pay a premium based on their ability to pay. eventually, people are able to afford insurance on their own. that is what we need to do. the problem we have in america is the benefit cliff where you

are either on a public program for you are not. there is no incentive to better the yourself or improve the economic condition of your family. that is not right. we have to find a way to make a grudge with its system of access. that has been the philosophy we have used in their state. we have thousands of people covered. we will keep at it. >> i want to know who the person is with bad handwriting and good questions. given the costs in vermont have gone up more than the national average according to the health care administration, what evidence do you have that the medical home pilots will save money overall? >> in medicaid, we are saving money. according to our medicaid office, in the four chairs of the global commitment waiver we have in place since 2005, our

expenditures are $245 million less than they would have been under the traditional program. i mentioned the drop in utilization in hospitals. i am very proud of that. we have work to do. we have an infrastructure in vermont that is probably not as efficient as it might be in some other places because of our small population. the rural nature of vermont, the small population makes it difficult in many fields to achieve the economies of scale the other places do. it is true in public education where our expenditures per capita are the highest in the nation. it is true in corrections where our cost per inmate is quite high because we have smaller facilities spread around the state. it is true in health care where we have relatively small hospitals. i am not sure that the economy of scale is something you can never completely overcome.

we have seen some real progress in our medicaid costs. i am confident that our strategy will be successful for the entire population. >> i kept two questions about canadian commuting habits. they are asked in opposite ways. in vermont, and do you see many canadians coming to your state for procedures that are superior in the vermont health care system or care that they would have had to wait for in canada? >> we see canadians coming to vermont for a variety of reasons. to ski, to shop. i think nearly 40% of the passenger traffic is from north of the border. it is a lot smaller and more convenient than the bigger airports in montreal. a lot of folks come self for that purpose. .

come south for that purpose. we regard our quebec neighbors as not foreigners, but friends prayed that this has gotten us off topic. we have villages by the international border. we have a manufacturing plant that the split. we have an opera house and a library that is split by the border. these are our friends and neighbors. there is a lot of interaction. there is commuting for work across the border. i can tell you about one conversation i have had with the canadian woman in the not too distant past. despite the challenges, most canadians like their health care system and want to preserve it. if the supreme court of canada earlier in this decade said in a famous quote, access to a waiting list is not access to health care.

there is some movement to a public, private land in canada. -- blend in canada. this woman told me about her son prince i am almost that the two-year anniversary when i asked for an appointment for somebody to see him. the lesson i take from general conversations with canadians is that their quality of care is good. there are emergency care is good. if it is not the merchant, they are made to wait. -- the emergency, they are made to wait. i do not want a mother to know the two-year anniversary of a request for an appointment to see a practitioner. >> this is the converse. do not lots of vermonters go to canada for cared?

does this not mean that we could learn something from their insurance company-free system? >> i anecdotally do not know of vermonters to do. we have seen some access to prescription drugs from north of the border. they are often less expensive. in terms of actual care and the convenience of somebody that is closer to a community on the border, i have not seen that. >> moving on to the federal situation, how much consultation is going on between congress and the governors? do you feel like the governors have been a part of the process? >> i discussed that in my remarks. i do appreciate that, especially the reaching out we have seen from the gang of six. even beyond that, i have met with and talk on the phone with speaker pelosi a number of times.

we talked about this and other topics. there has been some interaction. the bulk of it has been very recently when the chairman and his colleagues spent a lot of time with the governors. we have a variety of different formats and which we do that. we have a health care reform task force that i appointed that has 14 governors, seven in each party. it is tough on short notice to get everybody on the phone. we get the vast majority of them when there is an opportunity to talk with the senators present there are four leaders of the association that will be available to meet with them. we do it almost always on a bipartisan basis as i suggested earlier, that is the way we are going to succeed in these health care reform efforts. i thought the senator made a good point in the comment that heights are reported a couple of

weeks ago. he said that the senate could pass a bill that is not a bipartisan. they marshalled and the necessary votes to push them through. in the long run, i hope congress will want the reform effort that the american people can feel good about, that the american people will buy into. if that is something that the force of the people and our country or force on the states and it is unworkable or unsustainable, then it is not sustainable. >> how important do you think the recent discussion on medical malpractice reform is to the health care reform debate? >> it is an element that is worth pursuing. the president mentioned it in his speech. the chairman has included it in the bill he is presenting this

week. some states have made some real progress on medical malpractice reform. california has some innovations that are often cited as quite strong. mississippi has put in place some reforms as well. we have tried in vermont with less than complete success. i think it makes sense the way the senate finance committee is approaching it. there would be grants for states to put in place some kind of reform efforts. whether it be some kind of mediation process as or malpractice courts. whenever states would like to do with a little bit of federal support to facilitate that, i think it is a good idea. i know there is a lot of debate about the significant cost of care. some judgments and settlements are no more than 1% of the total

cost. there is a defense of medicine. you will hear that from physicians and hospital ceos. i had a chat with one ceo that is no wonder in his position. we were chatting about this a few years back. he said that i will be honest with you. if you, jim douglas, come off the ski slope with a fracture and come into this hospital, we will give you the best care that we can and you will be just fine and you will be good to go as soon as possible, but if it is somebody from washington that is not in the local area but has a license plate from far away, we are probably going to run some more tests. that is the way we do business. it is a factor that we need to consider.

i was pleased that the chairman was included in this. >> do you see any alternative to expanding medicaid or is the answer to have full funding of any expansion? >> frankly, there should be full federal's -- awful federal's book funding if there is an expansion. mandates are not? -- acceptable. i suggested a few weeks ago that the new committee draft has moved in the direction of more federal support and we are grateful for that. some of my colleagues pointed out that even at 5% of state funding, 5% is still a lot of money. to put this in context, i mentioned the fact that we're now going to be to our pre recession revenues of 47 or eight years.

look at what states have done during that time. we have cut education, which is the big public expenditure that most states have. states have underfunded pension systems that have borrowed more in some cases. they have laid off more workers. we can expect states, just one the revenue recovers, to put every incremental dollar into an expanded health care system. there are other competing demands. the feds have to own up to whenever they require the states to do. some say the medicaid expansion is not the way to go. it is a program that is big, unsustainable, inflexible, and we ought to think of something new and different and a more creative way to expand coverage. our approach in vermont has been a public, private partnership. i think it has been pretty

successful. i am sorry that we have to beg the federal government for permission for the waiver process to implement some of the reforms that we have. i have to tell you a little story about that. when i came down here several times to request the waiver to put in place the reforms that i described. i came in with the secretary in number of times. somebody said, now you have to go over to omv. i did not know that. they sign off on all of these financial own arrangements. i made an appointment to go meet with the folks over there. i went into the old executive office building. the then governor of texas was coming out of a similar meeting asking for a medicaid waiver from the folks there.

i said, jeb, how did it go? he said that i do not think it got too well. he said that if you cannot get a waiver from this administration, i do not know about me. >> do you think the reform proposals do enough to address long-term care and the strains on medicaid? >> i am glad that you brought that up. here is another area where vermont has innovated. i really feel good about the progress we have made. we have something called choices for care. medicaid participants, that makes old or disabled vermonters' or americans. there is a bias towards nursing- home sprint what we have done is get equal access to care at home and institutional settings. we are the second oldest state.

despite that, we have been licensed several nursing home beds over the last few years -- delicensed several noosing home beds over the last few years. we are caring for people to home. my in-laws are in their middle nineties. they are not well. they are still at home with a lot of care. they are not on medicaid. i cannot imagine if we have a choice, not keeping them there in the home where they have lived for 65 years. i think most americans feel that way. we got a waiver to use our medicaid dollars to keep more people at home. we have saved millions of dollars over the last couple of years through that effort. i think that long-term care has to be a part of it. it is not a big -- the biggest piece of the program,

especially as the population ages. >> considering that vermont is the second coldest day, what was the public response to the so- called death panels. >> i mentioned earlier that vermonters are independent. it is fair to say that we are quite simple in our public discourse. one of our senators it serves on the health committee. he had several well attended forums as other members of congress did around the country during the august recess. there were no disruptions similar to what we saw in other places. people had opinions. and they express them. sometimes strongly, but in a very respectful and civilized way. the range of public opinion in vermont is across the spectrum in terms of their views of these

reform efforts. the level of debate i think has been a higher level than we have seen in some other places. >> what do you make of the tea party movement and what it says about sentiments about obama's plan for health care nationwide? >> as i suggested early in my remarks, it is perfectly appropriate for people to have strong views, to ask some serious questions to try to understand what it means when proposals seek to reduce medicare expenditures. does that mean a cut in benefits? does that mean reimbursement to providers is going to be reduced. a less access to the care that people need. i think that these are fair questions. they need to be debated on their merits and not with the kind of

inflammatory performance as we have seen in some areas. for anyone who believes that these were organized by the republican party, i do not think we are the organized. i think americans are concerned about this and showed up at these events to express the concern. i hope if we can refocus the debates on the real merits of the issues that need to be discussed, we can do something positive. >> you have been asked to solve a mystery. it looks like the public auction is dead. who or what killed it? >> i think it was the professor in the library. with the candlestick.

i am not a fan of the public option to be honest. let me give you a reason from our own experience. about 20 years ago, vt. started a program called doctor dinosaur. that is a medicaid-supported program for children. we have virtually full universal coverage for our kids. the percentages are quite low. it is the transition to the population. it is virtually universal. it has been affordable because insuring children is a lot less expensive than it is for people in their older years. here is what happened. the program went into effect and a lot of employers said to their employees, take your kids off of the company planned and put them on that new state program.

that has happened to a lot of folks. what we're trying to do in our reform effort is to provide subsidies to people to get coverage through their employers as well as the catamounts plans. that is amassed debt -- mascot for a university. it is a panther that is now extinct. the last one was shot in the 1830's sex. -- 1836. through their employer, if it is at least as comprehensive of a plan as we have offered, since we saw this migration away from plans to employers, my fear is that the public auction will see the same kind of migration and not provide the robustness of

the market that we need. >> we arguably have the best health care technology in the world. new technologies are always expensive. how can we ration the use of these technologies across the population. >> that is a good question. i am not sure if we can figure that out in vermont. we have a certificate process. we can determine when a capital expenditure is necessary for a health-care institution. it is difficult to say no when a community comes to a state regulator and says that we have got to have that dialysis program and our community. with gas prices as high as they are and no public

transportation, you cannot expect us to drive 25 miles to some other community to get dialysis, and do you? that replicates itself throughout our state many times. i'm sure it is true in other places as well. we are seeing a significant expense for an infrastructure. that relates to a question that she asked earlier about the relatively high costs in vermont. we do not have the economy of scale that other places do. that is an area that continues to challenge us. i am sure that is true in other parts of the country as well. >> we have a wild card question for you. how do you feel about your video of the same-sex marriage built? what impact do you think same- sex marriage will have in vermont? >> that is a matter of great debate. earlier this year, it is a

matter of intense personal opinion. i see it quite differently from other issues that we confront. it is not something that deals with the economic well-being of our state, the fiscal integrity of vermont, job creation, or affordability. it is a personal opinion that people have. everybody will cast his or her vote as he or she deems appropriate. i cast my vote in the legislature decided to go another way. i certainly accept that. >> we are just about out of time. before i ask the last question, i have a couple of important matters to take care of. let me remind our members of the future speakers we have the president and ceo of the mayo clinic. we will have another health-care chat tomorrow. on september 28, ken burns, the

documentary filmmaker will be joining us to discuss his new program on national park sprint on october 8, the postmaster general of the united states postal service will give us the state of the postal service. i would like to present our guest with the traditional and much coveted national press club mug. >> thank you. [applause] >> for our last question, what is the first thing you will do after a new governor is inaugurated in vermont? >> jump for joy. it will be a transition for me and for the state. it feels like the right time for me to move on. i have been in public office most of my so-called adult life. i ran for the legislature of the year i graduated from college.

i have been at it ever since. we do not have term limits in vermont, but we run every two years. i have done it four times. i want to make sure i emma's energize of the last day in office as i was on the first -- i am as energized the last day in the office as i was in the first. i would like people to ask why are you going to soon rather than why did you stay so long? i want to do everything we can to improve the health outcomes for the american people to control those costs and make some real progress on something that is so important to the future of our country. another answer to your question is that i have to remember how to drive a car. thank you all very much. [applause]

>> i would like to thank you all for coming today. i would also like to thank staff members for organizing today's lunch. also thanks to matt. the video archive from the luncheon is provided by the broadcast operations center. our broadcasts are offered as free downloads on itunes as well as our free web site. non-members may purchase videotapes -- [inaudible] [applause] [captioning performed by national captioning institute] [captions copyright national cable satellite .